TCI Foundation, the social arm of Group TCI (India’s largest surface transport organisation) is implementing an HIV / AIDS prevention program for long distance truckers through a national network of interventions in major transshipment centers across the national highway network.

Project Kavach, funded by Avahan (the India AIDs Initiative of the Bill & Melinda Gates Foundation) has a unique and innovative approach to HIV prevention amongst the mobile trucking population. The salient elements of this approach are:

•	Branded National Network of interventions focusing on Long Distance Truckers  operating on national routes in India

Truckers are not a homogeneous population; they encompass at least nine major ethnicities / regions. There are also substantial differences in the duration of time truckers spend away from home. By virtue of the routes they travel, long distance truckers spend a longer contiguous period of time away from home than do short distance / regional truckers. Therefore, even though some short distance truckers may spend as many cumulative days away from home in a month, long distance truckers are potentially at greater risk because of the contiguous number of days spent away from home. They also have the potential to take the epidemic from the southern to the northern states over a longer period of time.  It is implicitly assumed that regional/ethnic differences, together with differences in duration of time spent away from home contribute to degree of risk of HIV of a trucker.

Major elements of the program include Behaviour Change Communication, STI Management and Condom Promotion.

•       Behaviour Change Communication: Behaviour Change Communication was delivered via inter-personal communication (IPC) conducted at each of the intervention locations through 5-6 outreach workers (ORW) of the implementing NGOs. However field experience has shown that peer led communication, supplemented by innovative mid-media is more effective and acceptable among truckers; and also contributes to expanding programme reach and coverage. The program is thus revamping its behaviour change communication model by replacing the existing didactic, flip book style messaging through outreach workers by peer-led dialogue based interpersonal communication (IPC). A cadre of peers is being recruited, trained and deployed at the intervention locations for this purpose. These peer led IPC sessions will be supplemented by thematic mid-media activities at each location, implemented in a synchronised manner across the network of intervention locations. In addition, the enhanced BCC strategy will use outdoor signage at each intervention location and at strategic locations along the highway (fuelling stations, border check-posts etc).

The program has technical support from PATH, an Avahan capacity-building partner for the communications package.

•       Treatment of Sexually transmitted infection:The package of services includes setting up programme owned clinics at each intervention location. Each of these clinics houses a qualified medical practioner, a trained nurse and a counsellor. In addition to STI treatment, these clinics also provide general health services.

Apart from the static clinics the project has established multiple satellite clinics at large intervention locations thereby significantly upscaling service utilization and maximizing program reach within each intervention location. This has been made possible by providing a second full time medical team. The package of services is being customized at each site based on available volume of truckers and potential for high quality interaction by focussing service delivery in natural traffic areas i.e. in proximity / within premises of long distance brokers.

The program has technical support from FHI, an Avahan partner for the clinical component of the program.

•        Condom Marketing: “Kavach” is marketing condoms to the truckers through its outreach teams, clinics and through the availability of condoms at several traditional and non-traditional outlets in the intervention locations. Outlet owners are trained to conduct condom demonstrations, they are also provided IEC materials to help promote clinic services.

The Project has technical support from PSI in the social marketing of condoms component of the program.

itself. The NPMU has specialists in STI Management, M&E, Communications, Branding and Program Management.

Three Regional Project Management Units coordinate the project implementation at their respective intervention sites. Finally there is the Project Implementation Unit located at each of the 17 intervention locations run by a sub-grantee NGO.

Out of the total truckers treated 30% are for STI complications, the remaining 70% for general ailments.

      • Integrating Communication:

     By supplementing the peer led dialogue based IPC tools with synchronised and thematic mid-media and appropriate cost effective mass media to widen exposure and facilitate program recall

Mid-media such as street plays, health games, video shows and magnet theatre is proposed to be synchronised across sites on the basis of themes emerging out of IPC sessions led by trucker peers. Typically, themes may highlight the importance of partner reduction, usage of condoms even with trusted and known partners, and explore the sexual exploitation of helpers by truck drivers.

Large scale outdoor signage at high traffic checkposts, distribution of audio cassettes with content specifically designed for truckers and airing a radio program for truckers are examples of mass media initiatives proposed by the Program.

A research agency has been commissioned to do a qualitative study on trucker behaviour and aspirations to appropriately position program services to the community. This study expects to present its findings by first week September 2006.

A creative agency is being selected for awarding a creative contract to thematize mid-media, mass media, signages and printed material for the program post the qualitative research study.

• Branding and Signage:

Apart from standardizing static clinic signage and interiors, the visual identity of the program needs to be reinforced at the service extensions cost effectively, and uniform directional signage within the intervention locations are needed to supplement the brand association with the trucker. 

• Corporate Partnerships:

The program seeks to enhance the involvement of corporates and industry associations connected with the transport sector. Tyre companies, petroleum companies, transport associations and the National Highways Authority of India would be some of the targeted stakeholders, which the program seeks to address.

The engagement with corporates would be through:

To supplement the output captured by the existing Monitoring & Evaluation system (which includes routine monitoring data collection and a trucker IBBA), the following additional elements need to be added:

Output and Outcome Tracking System:  An annual survey capturing data organized by route clusters to measure exposure and coverage at program level

Qualitative Reporting: Enabling the program to harness themes / issues emerging from peer led dialogue based IPC and generating an appropriate program-wide response to address these issues.

This aggregation of themes would seek commonalities across sites for a program-wide response through mid-media and information dissemination both through IEC materials and IPC sessions.

Khushi Clinics in India