Dr Bernadette Ssebadduka and Ssengendo John

1. Perceptions of quality HIV services among female sex workers and truckers:A participatory assessment conducted at hotspots along the Kampala – Juba transport corridor in Uganda Dr Bernadette Ssebadduka and Ssengendo John

2. BACKGROUND • Truckers and FSWs acknowledged among the key populations at higher risk of HIV exposure (Uganda National Strategic Plan, National Prevention Strategy) • Only 10% of FSWs reached by existing HIV programmes (UNAIDS 2006) • Weak HIV programmes targeting truckers and FSWs (IOM 2008) • Dearth of information on unmet health needs & desirable quality of services for study populations HEALTHY MIGRANTS IN HEALTHY COMMUNITIES

3. HIV HOTSPOTS ALONG TRANSPORT CORRIDORS Areas where mobile populations interact with local communities in environments conducive to multiple concurrent sexual partnerships. Such places include truck stops, border posts, and construction sites. For study purposes, all active hotspots along the Kampala – Juba corridor included HEALTHY MIGRANTS IN HEALTHY COMMUNITIES

4. STUDY OBJECTIVE • To map out the health service needs and desirable quality of health services among FSWs and truckers at hotspots along the Kampala-Juba transport corridor in Uganda. • Key actions : • to consult intended beneficiaries ( to establish what is friendly); • map HIV service providers (locations, capacity, existing quality); and • to inform referral systems and replication of best practices); and. HEALTHY MIGRANTS IN HEALTHY COMMUNITIES

5. STUDY OBJECTIVE The study findings have provided information for the design and implementation of quality HIV services for key populations (using FSWs as the core population) at hotspots along transport corridors in Uganda. HEALTHY MIGRANTS IN HEALTHY COMMUNITIES

6. METHODOLOGY • Study conducted in 5 hotspots* along Kampala–Juba route; • A combinationof methods was used: structured questionnaires, KII, and FGDs; • 240 truckers and 254 FSWs were interviewed; • 87 respondents in 10 FGDs (5 with FSWs, 5 with truckers at each of the hotspots); • Interviewees identified through known contacts. HEALTHY MIGRANTS IN HEALTHY COMMUNITIES

7. Socio demographics Majority of FSWs have primary or no education. Reverse is true for truckers. HEALTHY MIGRANTS IN HEALTHY COMMUNITIES

8. Majority of truckers are married HEALTHY MIGRANTS IN HEALTHY COMMUNITIES

9. Majority of FSWs are young people HEALTHY MIGRANTS IN HEALTHY COMMUNITIES

10. HIV related behaviour and practices Multiple sexual partnerships Transactional sex common: 64% of FSWs and 27% of Truckers reported up to 49 partners in the six months preceding the study; 34% of truckers had not used a condom with any of the partners; Inconsistent condom use across partners – trust, need to feel ‘skin on skin’, failure to negotiate, more money offered; No HCT in preceding 12 months: 55% truckers and 35% FSWs. HEALTHY MIGRANTS IN HEALTHY COMMUNITIES

11. Healthcare seeking HIV not a priority health concern; Private providers are preferred to government; Provider choice was dependent on proximity to truck stop, service availability, affordability & (47%of truckers) waiting time Hindrances to healthcare access: high cost of services (36%); unfavourable service hours (35%); do not know service location (24.9%); long distance (25%); long waiting time (23%); and unfriendly providers (14%). HEALTHY MIGRANTS IN HEALTHY COMMUNITIES

12. What services do you need most? HEALTHY MIGRANTS IN HEALTHY COMMUNITIES

13. What services did you need but could not get? • HCT (22%), STI treatment (21%), Post abortion care (11%), HIV care and treatment (8%), Health Information (7%). • Only 3/13 facilities surveyed stock PMTCT medicines. • “We need HIV testing services so that we can test ourselves whenever we want to. The clinics and drug shops around here don’t offer HIV services.” • (FSW in Migyera Hotspot) • “Many of our friends have passed away because they have abortions and die because they fear going to hospitals.” • (FSW in Bweyale Hotspot) HEALTHY MIGRANTS IN HEALTHY COMMUNITIES

14. How can we reach you better? HEALTHY MIGRANTS IN HEALTHY COMMUNITIES

15. What is a quality service? HEALTHY MIGRANTS IN HEALTHY COMMUNITIES

16. RECOMMENDATIONS Support existing and preferred service providers; Improve coordination – for referral, replication, standardization of services delivery Strengthen partnerships among stakeholders; Build migrant-friendly healthcare systems; Compliment services with BCC; In build M&E at all programming levels. HEALTHY MIGRANTS IN HEALTHY COMMUNITIES

17. OUR RESPONSE Branded clinic along Kampala-Juba transport corridor HEALTHY MIGRANTS IN HEALTHY COMMUNITIES

18. OUR RESPONSE HEALTHY MIGRANTS IN HEALTHY COMMUNITIES

19. OUR RESPONSE • Placed IEC and TV in waiting room • Improved client flow arrangements • Deployed community mobilizers • Trained private practitioners in ‘friendly’ healthcare • Encouraged staff to wear uniform • Extended work hours • Marked service areas • Repaired clinic floor • Linked with government hospital and local NGO (TASO) so they can offer ongoing support supervision and on job training Branded Clinics and Placed clearer signposts HEALTHY MIGRANTS IN HEALTHY COMMUNITIES

20. CONCLUSION Programs targeting FSWs and their clientele within HIV hotspots should endeavor to offer services that meet a defined qualitythat incorporates the perceptions of beneficiaries; Quality service standards should be implemented in cooperation with the Ministry of Health and other key partners; Use the priority health needsas an entry to HIV services, place emphasis on those services where there is a high unmet need; Work within a combination HIV prevention framework. HEALTHY MIGRANTS IN HEALTHY COMMUNITIES

21. THANK YOU AND PLEASE GET IN TOUCH Dr. Bernadette Ssebadduka Mobile: +256 (0) 772709635 Email: bssebadduka@iom.int Republic of Uganda Ministry of Works & Transport Ugandan AIDS Commission Makerere University College of Humanities and Social Sciences