AIDS Program in corporate sector by karishmahealth

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									Health Vision and Research

Heallth Viisiion and Research Hea th V s on and Research
Corporate Chapter in West Bengal

Falling Back on Corporate Faces For HIV Prevention In West Bengal
Process Document Prepared for

West Bengal State AIDS Prevention & Control Society
By Health Vision and Research

Process document: HIV intervention in corporate sector through TOT strategy

Health Vision and Research

Contents
Sl no 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Item

Foreword

Page no 3 4-7 10 11 13 14 22 23 24 24 28

Executive Summary

Background and Justification

This is an Action Research Study Project At a Glance Project in details

8-10

Process Towards Implementation

11-12

Findings of the study: Baseline and End line Training of TOT, as a special activity

The Module at a glance

Facilitating training by TOTs to other staffs Point Person or Master Trainer? Preparation of IEC material in Hindi and Bengali The HIV Prevention Policy, an overview Process towards development of HIV Prevention policy Policy and Labour Leaders

Proposed Implementation Procedure of HIV AIDS workplace 30 Effectiveness of the TOT strategy and its replicability Learning from this action research Annexure Photo Gallery 31 32 33

Certificates awarded to Health Vision and Research Flex chart prepared by us

Process document: HIV intervention in corporate sector through TOT strategy

Health Vision and Research

Foreword

The West Bengal State AIDS Prevention and Control, Society has entrusted Health Vision

and Research to conduct an action research among employees of corporates in West Bengal to mainstream HIV/AIDS. The team of Health Vision and Research has taken the noble responsibility to prepare this Process Document for the benefit of policy makers of

WBSAP&CS, managerial staffs of the corporates. It may not be relevant for other sector. involvement within the training will affect the productivity. On the other hand, due to the social responsibility a corporate cannot avoid the duty to make their people aware of

Time will be constraints for training participants in the corporates as because their

HIV/AIDS so that they can prevent HIV spread among themselves. So this document will are providing resources to corporates, or corporates implementing the HIV prevention programme in their areas, The objective of Health Vision’s project was to test their hypothesis that “ TOT approach is

help the stakeholders at various levels so that our experiences will benefit others while they

cost effective model for raising awareness among employees in a corporate sector” with in six months period. So it is limitation of the effort to address behaviour change communication issues adequately. We hope that this process document will be an asset for the donors, corporate sectors.
Director

Health Vision and Research

Process document: HIV intervention in corporate sector through TOT strategy

Health Vision and Research

1. Executive Summary


Background and rationale

West Bengal State AIDS Prevention & Control Society has identified the workplace as a vital component of national responses to HIV/AIDS/STI. Each year it has its reflection in their annual actions. It is a key point of contact with the most affected age group of those who are mostly15-49 year olds and many of them are vulnerable populations e.g. young adults and mobile workers. In this back ground Health Vision and Research thus responds through this action research to fight against HIV/AIDS by developing effective strategies for mainstreaming corporate sector. The project title is “TOT strategies for involving corporates in intersectoral collaboration initiative in HIV/AIDS programme of WBSAP&CS” Hypothesis of the study: TOT approach for corporate involvement in ISP is a cost effective strategy. The project goal: The overall Goal of the project is to develop strategies for mainstreaming corporate sector with in the intersectoral collaboration initiative combating threats of HIV AIDS.

Objective of this process document:  Inform the developed effective strategy for mainstreaming HIV/AIDS in corporates  Provide practical information on how to do it for those who want to start mainstreaming HIV/AIDS in their work places  Share Health Vision and Research’s experiences in strategy development for mainstreaming HIV/AIDS with interested partners The action research Our intervention is basically an action research. Action research is a period of inquiry, which describes, interprets and explains social situations while executing a change intervention aimed at improvement and involvement. It is problem focused, context-specific and future-oriented.

Baseline and endline survey with critical findings Purpose of the Study To use critical baseline indicators as denominator for testing the hypothesis that TOT approach is one of the best approaches for corporate sector involvement in HIV prevention initiative in NACP III road map. After the selection of the employees a baseline study was conducted in the various categories of the employees of organizations among 111 respondents using closed ended questionnaire to assess their knowledge about HIV/AIDS and relevant issues. The survey and intervention were conducted in six corporates. After intervention, end line study was conducted among 89 respondents using same questionnaire.
 

Training of trainers and facilitators’ training

87 Master Trainers or Point Persons have been selected and they have been trained. These Master Trainers formally or informally have oriented their fellows. Training of other employees was conducted through cascade method. A training module has been prepared on HIV/AIDS awareness programme for the employees of the corporates. The training module will be shared with stakeholders and then feedback will be incorporated and then submitted to WBSAP&CS. IEC material has been prepared by HVR on HIV/AIDS awareness programme for the employees of the corporate organizations. HVR has prepared the flex charts in Bengali and Hindi keeping in mind exactly the session objectives.

Process document: HIV intervention in corporate sector through TOT strategy

Health Vision and Research


HIV Prevention Policy development

Through a semi-structured interview schedule stakeholders were interviewed for their opinions on HIV prevention Policy. Using their opinion data and the ILO policy, a corporate specific policy has been developed. The key points are as followings: -

Key Points of HIV Prevention Policy
           Protection against discrimination, victimization and harassment Employment Opportunities And Termination Of Employment Voluntary Testing Confidentiality Awareness – rising and education Care and support for workers and their families Work performance Benefits Health care Implementation and monitoring Quality of services



Effectiveness and replicability

There has been significant improvement in the knowledge level with in six months of intervention through TOT strategy. So this can be a low cost model intervention strategy among corporates. The effectiveness clearly states that it is a replicable model. The state can adopt the model as a low cost model for corporate place intervention to combat HIV/AIDS spread. The following couple of tables will perhaps make the issue clear and we will have better understanding about proportion of changes towards effectiveness. The cost calculation as shown in the table 4. It shows that unit cost is very low. So Health Vision and Research recommends this as a replicable model for mainstreaming HIV/AIDS in corporates. Table 1: Change in level of knowledge Item Baseline: % 70.3 87.4 91.8 94.8 34.4 63.9 85.6 7.2 11.7 86.5 46.4 16.2 11.7 Endline: % 84(94.3) 97.8 86.5 97.8 95.5 86.5 97.8 46.0 56.2 91.8 14.6 28.1 43.8

Heard of STD Heard of HIV/AIDS HIV transmits through sexual route HIV transmits through blood transfusion HIV transmits through needle sharing HIV comes from infected mother to her child through breast feeding HIV comes from infected mother to her child in her womb Genital discharge is a symptom of STD Genital ulcer is a symptom of STD Without condom doing intercourse spreads HIV infection Mosquito bite spreads the disease Tuberculosis happens to AIDS victims Pneumonia happens to AIDS victims

Process document: HIV intervention in corporate sector through TOT strategy

Health Vision and Research Similarly the following table also states that though not adequate, (which is normal as because stigma cannot be removed all on a sudden) there have been certain percentages of stigma reduction through the intervention.
Question The person infected of HIV AID is characterless HIV AIDS infected people should be isolated

Table 2: Change in stigma and discrimination
Baseline: n (%) 29(26.1) 23(20.7)

Endline: n (%) 19 (21.3) 7 (7.9)

From the data it is obvious that exposure to intervention has been increased and better awareness to availability of services have been observed.
Item Ever heard about VCTC Know the location of the nearest VCTC to your home Knew about information on HIV/ AIDS

Table 3: Change in exposure to intervention
Baseline N (%) 19(17.1) 3(2.7)

Endline N (%) 74 (83.1) 51 (57.3)

NGO program 15(13.5) NGO peer 7(6.3) Govt health functionaries 9(8.1) Private health functionaries 3 (2.7)

NGO program 22 (24.70) NGO peer 53 (59.6) Govt health functionaries 35 (39.3) Private health functionaries 13 (14.6)

Unit Cost calculation
Indicator No of corporate No of target group No of master trainer prepared

Table 4: Unit cost for Beneficiaries Total cost 6 3,20,000 7000 3,20,000 87 3,20,000

intervention Unit cost Cost * 53333.3 270000 45.7 270000 3678 270000

Unit cost 45000 38.5 310.3

* Cost excluding research 

Major Project outputs
o o o o o o o o o Baseline and end line survey reports TOT Training Module HIV Prevention Policy for the Corporates Process Document prepared 87 Master Trainers created in 6 corporates 25 Facilitators’ training sessions conducted Flex charts prepared for trainings Wall paintings done by the corporates Labour leaders created for refresher sessions

Process document: HIV intervention in corporate sector through TOT strategy

Health Vision and Research


Couple of learnings

Some issues should be considered essential when mainstreaming HIV/AIDS in corporates. Obviously, not all these criteria have to be met before starting to get engaged in mainstreaming. They may be achieved as a result of the mainstreaming process.  HIV/AIDS has to be understood as a development issue

 Commitment and active support of decision-makers really tough
 Clearly defined objectives for mainstreaming of HIV/AIDS

 Knowledgeable, compassionate and skilled staff  Sufficient allocation of resources  Sufficient documentation

 Expertise and support is available and made of us

 Evidence based work needed and then only issue of replicability can be raised  Overcoming resistances is a challenge  Welcoming innovations

 Time bound achievement and other risks may hasten the achievements  Developing policy is much easier than integrating policy

 Arranging facilitation training is breaking the real barrier

Process document: HIV intervention in corporate sector through TOT strategy

Health Vision and Research

2. Background and Justification

Globally, over 50 million people are living with HIV/AIDS. Nine out of every ten are adults, the majority in their productive and reproductive prime and therefore, the mainstays of families and communities. The epidemic strikes hard at the most vulnerable groups in society, exacerbating existing problems of poverty and

inadequate social protection, gender inequalities, and child labor. Women, especially young women, are not only being infected in larger numbers than men in many countries, but they also carry the greatest share of the burden of care. In the worst affected countries, the ILO has calculated a likely labour force loss of between 10 and 30 percent by the year 2020. HIV/AIDS is causing a loss of skills and experience, and

it is changing the age and sex distribution of the labor force. Of all the factors that affect enterprise survival and national development, the skill base is one of the most important. Enterprises in many countries report increases in absenteeism, staff turnover, and the costs of labor, recruitment and training of workers as a result of HIV/AIDS. Equally important, yet more difficult to measure, are the impacts of an increasing burden of work on remaining workers, the loss of colleagues and the fear of infection; all of tax base, discourages foreign investment and adversely affects consumer and which can lower morale and productivity. Overall, the decline in profits reduces the business confidence. The World Bank estimates that negative growth in gross domestic product can be expected when national adult HIV prevalence rates reach 5 percent. West Bengal State AIDS Prevention & Control Society has identified the workplace as a
vital component of national responses to HIV/AIDS/STI/TB. It is a key point of contact with the most affected age group, 15-49 year olds, and with some particularly vulnerable populations—young adults and mobile workers; it is a recognized source of authoritative messages; it has a tradition of training and education; and it has mechanisms in place for employee benefits, health and safety, and non-discrimination. As a result the workplace is conducive to awareness raising and the promotion of behaviour change, as well as offering opportunities to generate employer and worker leadership. In this back ground Health Vision and Research thus responds through this action research based initiative to fight HIV AIDS through developing effective strategies for mainstreaming corporate sector with in the state initiative. In this initiative Health Vision and Research has also expressed particular interest in the development and incorporation of workplace policies and initiatives based on the ILO Code of Practice in national strategic plans and revalidating it for the state to combat HIV AIDS.

Process document: HIV intervention in corporate sector through TOT strategy

Health Vision and Research

Health Vision and Research started its venture of corporate sector intervention for HIV/AIDS through action research using the following framework as a tool.

Process document: HIV intervention in corporate sector through TOT strategy

Health Vision and Research Project title:

“TOT strategies for involving corporates in intersectoral collaboration initiative in HIV/AIDS programme of WBSAP&CS”
Objective of this Process document:  

Inform the developed effective strategies for mainstreaming HIV/AIDS in corporates. AIDS in heir work place

Provide practical information on how to do it for those who want to start mainstreaming HIV

 Share Health Vision and Research’s experiences in strategy development for mainstreaming
HIV/AIDS with interested partners

3. This is an Action Research
Hypothesis of the Study: TOT approach for corporate involvement in ISP is most cost effective strategy

Our intervention is basically an action research. Action research is a period of inquiry,

which describes, interprets and explains social situations while executing a change intervention aimed at improvement and involvement. It is problem focused, contextspecific and future-oriented. Action research is a group activity with an explicit critical value basis and is founded on a partnership between action researchers and participants, all of who are involved involving a dynamic approach in which problem identification, planning, action and evaluation are interlinked. Knowledge may be advanced through reflection and in the change process. The participatory process is educative and empowering,

research, and qualitative and quantitative research methods may be employed to collect data. Different types of knowledge may be produced by action research, general application explored through the cycles of the action research process. including practical and prepositional. Theory may be generated and refined, and its

Process document: HIV intervention in corporate sector through TOT strategy

Health Vision and Research

4. Process Towards Implementation
project has been described. The right-sided ladder describes key broad steps of our intervention of the action research. Each broad step has its own detailed processes through which we had to undergo. Selection of corporates itself was major constraints. Further conducting TOT sessions and MT sessions were not also easy. Challenge was to develop policy by interviewing stakeholders.

In the following chart, the key steps which were involved in implementing the

End line Evaluation Draft Workplace policy development Training of Trainers (TOT) Development of Training Methodologies Development of Training Module Stakeholder interview Even though policy was developed, its integration would be further difficult. Couple of corporates undertook it as part of their mandatory CSR (Corporate Social Responsibility) that they just got done by us. Motivation was not adequate.

Assessment of KABP Baseline study

Selection of corporates

5. Project at a Glance
Project Goal
The overall Goal of the project is to develop strategies for mainstreaming corporate sector with in the intersectoral collaboration initiative combating threats of HIV AIDS.

Immediate Objectives

Process document: HIV intervention in corporate sector through TOT strategy

Health Vision and Research    To improve knowledge of employees about HIV AIDS and relevant issues. towards the greater community.

To integrate HIV prevention policy with in Corporates that protects employees and contribute To involve employees as change agent for a better conductive environment.

Project Activities beyond what were proposed as part of action research
                Orientations with stakeholders for corporate selection Developing workplace specific programme implementation plan for intervention Advocacy with departments, organizations, trade unions, and industry organizations for work place policies Advocacy with unions, advocacy/sensitization with the leaders of local associations, transport workers associations, etc. Mobilize private sectors to cover informal workers in their work place programmes Facilitating union involvement in the WPI response Identification of and tie-up with training institutions to provide technical support to employers and unions Linking WPI areas with hospitals, private facilities, VCTC and other care and support institutions for referral services Providing information on condom promotion with in the work place BCC activities in the workplace for behaviour change Trade union will execute prevention programme among the workers of the unorganized sectors such as ICDS Anganwadi workers, construction, Facilitation of annual meeting for information sharing IEC distribution among employees Flex chart preparation for the corporate employees in A few corporates have been so motivated that they arranged wall paintings of their own Also new proposals came from the interventions like need of hoardings, quiz books and developing audio visual CDs by which the activities could have been sustained. So we have provided CDs from Thoughtshop Foundation.

Process document: HIV intervention in corporate sector through TOT strategy

Health Vision and Research

6. Project in details

6.a Selection of Corporates: In the first phase of the programme corporate organizations were
identified and selected to carryout the project intervention. The identified corporate organizations are as follows


The Apeejay Surrender House- it is a conglomerate of three corporate organization such as (equivalent to 3 Corporates) a) Apeejay Shipping b) Apeejay Oxford Bookstores Pvt Ltd c) Apeejay Surrender Corporate Service Pvt. Ltd  The Anglo Indian Mill in Jagatdal  The Reliance Mill in Kakinara  Aukland Jute Mill in Athpur in Shyamnagar

6.b Baseline study and endline study

After the selection of the employees a baseline study was conducted to the various categories of the employees of organizations to assess their knowledge about HIV/AIDS and relevant issues.

6.c Purpose of the Study

To use critical baseline indicators as denominator for testing the hypothesis that TOT approach is one map.

of the best approaches for corporate sector involvement in HIV prevention initiative in NACP III road

6.d Sampling Methodology

Five Corporates were conveniently selected covering an approximate target population of 7,000. baseline data can be compared with the end line population.

Findings cannot be extrapolated in the state. However, the population is not mobile and that is why

6.e Coverage of the Study

Target groups were covered under the survey from different sample centers. The center-wise coverage under the study has been depicted in the following table. Name of the corporate Table 1: Sample distribution

Baseline

No endline

Apeejay Surendra House, Shipping, Kolkata,

Apeejay Surendra House, Oxford Book Stores, Kolkata Apeejay House, Corporate Service Pvt. Ltd.; Kolkata Anglo Indian Mill, Jagatdal Reliance Mill, Kakinara TOTAL

28 27 30 26 111

20 22 25 22 89

Auckland House, Meghna More, Shyamnagar

Process document: HIV intervention in corporate sector through TOT strategy

Health Vision and Research 6.f. Instrument Development

In order to carryout the baseline study a small questionnaire has been developed to conduct survey knowledge about HIV/AIDS and relevant issues. The instrument will be required to understand people’s health seeking behaviour and their knowledge, attitude, opinion and practice regarding STD/HIV/AIDS. Same questionnaire was used for endline survey.

with the selected employees of the Jute mills and corporate organization in order to assess their

6.g Pre-testing of questionnaire

The questionnaire or the instrument developed to carryout the survey was pretested in the field in order to incorporate any modification required before carrying out the survey in the actual field.

6.h Survey

A baseline and endline study was conducted in those organizations as mentioned above to assess knowledge, attitude and certain practices of employees about HIV/AIDS and relevant issues

6.i Fieldwork

The fieldwork was conducted from 1st June to 30th June 2006. During the fieldwork, representatives

from HVR conducted the survey in the sample centers to acquire the appropriate information on target groups and other related details. The time taken in administering each questionnaire was about 50-60 minutes. The supervisors monitored the data collection procedure during the fieldwork. The endline was conducted during 30th September to 30th October 2006. completed questionnaires were checked and scrutinized at the field before leaving the fieldwork area. All the

7. Findings of the study
a. Knowledge about STD

The following table describes the values of baseline and endline survey data depicting the level of knowledge of employees about STD/HIV/AIDS. Question Table 2: Knowledge about STD and Symptoms of STD Baseline n (%) 78 (70.3) 13(11.7) 19(17.1) 11(9.9) 2(1.8) 9(8.1) 8(7.2)

Heard of STD diseases Genital Discharge Genital Sores

Endline n (%) 84(94.3) 41 (46)

Burning sensation while passing urine Swelling in groin area Itching/reddening Skin rashes

50 (56.2) 34 (38.2) 36 (40.5) 8 (9) 30(33.7)

Process document: HIV intervention in corporate sector through TOT strategy

Health Vision and Research

During the baseline survey it was found that there is very scant knowledge about symptoms of STD.

But in endline survey it is found that people have good knowledge on the symptoms of the STD. The baseline and endline data comparatively have high scale of difference. Ref Fig 2. From the figure it is clear that during endline survey 46% people know that genital discharge is one of the symptom of STD whereas during baseline survey only 7.2% are aware of the symptom. Similarly is the case of other symptoms of STD. Please Ref Figure no 3

Comparative Data of Baseline and Endline Survey P e r c e n t a g e 56.2 46 38.2 11.7 17.1 Baseline (%) Endline (%)

60 50 40 30 20 10 0

7.2

Genital Genital Sores Burning Discharge Sensation while Passing urine Symptoms of STD
Figure no 2

Comparative data of baseline and endline survey P e r c e n t a g e 45 40 35 30 25 20 15 10 5 0 40.5 33.7 Baseline (%) Endline (%) 9 1.8 Swelling in groin Itching/reddening Skin rashes Area Symptoms of STD
Figure 3

8.1

9.9

Process document: HIV intervention in corporate sector through TOT strategy

Health Vision and Research b. Knowledge about diseases with AIDS Table 3: Symptoms/diseases with AIDS What are the common diseases Baseline data symptoms that may occur when N (%) affected with AIDS Tuberculosis Pneumonia Diarrhoea Weight loss Fungal infection 18(16.2) 13(11.7) 38(34.2) 8(7.2) 11(9.9) Endline data N (%) 25(28.1) 39 (43.8) 71 (79.8) 78 (87.6) 14 (15.7)

It s obvious from baseline survey that employees have no adequate knowledge about symptoms or diseases associated with AIDS. Endline survey shows that after people have got training their knowledge about the symptoms or diseases associated with AIDS have increased considerably. Almost 79.8 % and 87.6% people are ware that Diarrhoea and weight loss are the major symptoms of AIDS
Please refer Figure no 4.

Comparative data of endline and baseline survey
P e 100 87.6 79.8 r 90 80 c 70 Baseline 43.8 e 60 50 34.2 28.1 Endline n 40 30 16.2 15.7 11.7 9.9 t 20 7.2 10 a 0 Tuberculosis Fungal infection Diarrhoea g Weight loss Pneumonia e Symptoms of AIDS

Figure No: 4 c. Awareness about HIV/AIDS

In the following table we see the comparable values of baseline and endline data on awareness level of the respondents on specific issues.

Process document: HIV intervention in corporate sector through TOT strategy

Health Vision and Research

Table 4: Awareness about HIV/AIDS Question Baseline data (%) Have you ever heard of HIV/AIDS 87.4 A person gets HIV or AIDS by getting injections with a need le that has already been used by some one else who is infected People Gets HIV or AIDS from an infected blood transfusion A pregnant women infected with HIV or AIDS transmit the virus to her unborn child A women infected with HIV or AIDS transmit the virus to her newborn child through breast feeding People Get HIV or AIDS through unprotected sexual contact Medicine can cure a HIV or AIDS patient A healthy looking person can be infected with HIV or AIDS HIV/AIDS be prevented A person gets HIV or AIDS by sharing a meal with someone who is infected A person gets HIV or AIDS from a mosquito bite. 34.0 94.8 85.6 63.9 86.5 28.9 75.3 71.1 34.0 46.4

Endline data (%) 97.8 95.5 97.8 97.8 86.5 91.8 12.4 83.1 80.9 6.7 14.6

Indicator-wise level of awareness that person gets HIV or AIDS by getting injections with a need le that

has already been used by some one else, A pregnant women infected with HIV or AIDS transmit the

virus to her unborn child and women infected with HIV or AIDS transmit the virus to her newborn child figure no 5 &6

through breast feeding in endline survey and baseline survey are quite comparable. Please refer

Comparative data on Awareness about HIV/AIDS P e r c e n t a g e 120 100 80 60 40 20 0 87.497.8 34 Have you ever A person gets People Gets Heard of HIV or AIDS by HIV or AIDS HIV/AIDS From an infected Getting Blood Injections with a Transfusion Infected need le Routes of transmission 95.5 94.897.8 Baseline (%) Endline (%)

Process document: HIV intervention in corporate sector through TOT strategy

Health Vision and Research

Figure no 5

P e r 120 c100 e 80 60 n 40 t 20 0 a g e

Comparison of endline and baseline data

Baseline data (%) Endline data (%) A PW infected Women People Get HIV With HIV or Infected with Or AIDS through AIDS transmit HIV/AIDS Unprotected The virus to her Transmit the Sexual contact Unborn child Virus to her Newborn child through breast feeding Routes of Transmission
Figure no 6

In the endline survey it is found that myths and misconception like a person gets HIV or AIDS by sharing a meal with someone who is infected and a person gets HIV or AIDS from a mosquito bite is quite low. In this case both the endline and baseline values of these can be compared considerably. Please refer figure no 7

Comparative study between endline and baseline P er c e nt a g e 90 80 70 60 50 40 30 20 10 0 83.1 75.3 80.9 71.1 34 6.7 46.4 14.6 Baseline(%) Endline (%)

A healthy HIV/AIDS A person A person Looking Be Gets HIV/ Gets HIV or Person can Prevented AIDS by AIDS from a Be infected Sharing a Mosquito With HIV or Meal with Bite. AIDS Someone Myths and Misconception
Figure No7

Process document: HIV intervention in corporate sector through TOT strategy

Health Vision and Research d. Awareness about condom and related issues In the following table we get an idea about awareness of the respondents about condom and related issues during baseline and endline survey. Question Table 5: Awareness about condom and related issues Baseline data Yes: n (%) Yes: n (%)

Endline data

For what purpose could a condom be used?

Sexual Pleasure 36(32.4) Avoiding pregnancy 94(84.7)

Sexual Pleasure 35 (39.3) Avoiding pregnancy 66 (74.2)

STI prevention 29(26.1) HIV/AIDS control 31(27.9)

HIV/AIDS control 51(57.3) Don’t Know 0 (0.0)

STI prevention 63 (70.8)

Don’t Know 4(3.6)

After the TOT when endline survey was conducted it was found that majority of people are aware that condoms are not only used for avoiding pregnancy but also for STI prevention and HIV/AIDS control. See Figure no 8.

Comparison between Baseline and
P e 100 r c 80 e 60 n 40 t a 20 g 0 e

Endline Data on condom use
84.7 74.2 39.3 32.4 70.8 57.3 26.1 27.9 Baseline (%) Endline (%)

Sexual Avoiding STI HIV/AIDS Pleasure Pregnancy Prevention Control Purposes of condom use

e. Stigma and Discrimination Certain issues as mentioned below and their percentages will perhaps explain that all employees are not much positive in attitude and thus stigma and discrimination prevails with in the community. However, there have been significant achievements through intervention.

Process document: HIV intervention in corporate sector through TOT strategy

Health Vision and Research

Table 6: Stigma and discrimination

Question Do you personally know anyone who is infected with HIV AIDS? The person infected of HIV AID is characterless In hospital s HIV AIDS patients should be given same type of medical care just like other in the society without any discrimination HIV AIDS infected people should be isolated HIV AIDS infected people should be provided good medical treatment and emotional support
f. Exposure to Intervention

Baseline data Yes: n (%) 9(8.1) 29(26.1) 73(65.8) 23(20.7) 96(86.5)

Endline data Yes: n (%) 25 (28.1) 19 (21.3) 62 (69.7) 7 (7.9) 76 (85.4)

The following table show the baseline and endline data on the exposure to intervention
Table 7: Exposure to intervention Baseline data N (%) 19(17.1) 3(2.7) 4(3.6) NGO program 15(13.5) NGO peer 7(6.3) Govt health functionaries 9(8.1) Private health functionaries 3 (2.7)

Item

Have you ever heard about VCTC? Do you know the location of the nearest VCTC to your home? I do not want to know the result but have you ever had an HIV test Can you tell us about the source of this information of message about HIV AIDS

Endline data N (%) 74 (83.1) 51 (57.3) 4 (4.5) NGO program 22 (24.70) NGO peer 53 (59.6) Govt health functionaries 35 (39.3) Private health functionaries 13 (14.6)

In baseline survey we find that only 17.1% have heard about the word VCTC and only 2.7% know that the employees have gained exposure and nearly 83.1 % people have heard about VCTC and 57.3 % people know where VCTC is located. Please refer figure no 9.

where VCTC is located. Only 4 employees have undergone HIV testings. But after the training we find

Process document: HIV intervention in corporate sector through TOT strategy

Health Vision and Research

P e r c e n ta g e

Comparative study between baseline and endline Data 100 80 60 40 20 0 83.1 57.3 17.1 2.7 3.6 4.5 Baseline (%) Endline (%)

Have you ever Heard about Know the Had an HIV VCTC? Location of the Nearest VCTC Test? To your home Exposure to Intervention about VCTC
Figure no 9

Process document: HIV intervention in corporate sector through TOT strategy

Health Vision and Research

8. Training of TOT
C, D staffs

8.a Development of Training Module for TOT (Point Person) for group

A draft training module has been prepared on HIV/AIDS awareness programme for the employees of the jute Mill. The training module will be shared with stakeholders and then submitted for feedback from WBSAP&CS, WBPSU.

8.b Development of Training Module for TOT (Point Person) for group A, B staffs

One of the major concerns of an effective workplace HIV AIDS training program is the presence of an effective and participatory HIV AIDS training module. To make this intervention a complete one Health vision and Research has developed HIV AIDS workplace training manual for two levels staff. training module has been prepared based on the need assessment evolved from those experiences. academic level has been considered in the module. The

Training module has been designed in a participatory way. Employee categories, age, occupation and The academic profile of the staffs are quite high and their knowledge level is also higher in regards to HIV/AIDS. So for such a higher profile staffs, we have added couple of other components in the training module.

Some point persons have been selected from Reliance mill who has been trained on relevant issues of HIV/AIDS. The main objective is to develop a few employees for a better conducive environment so that other employees can avail HIV/AIDS related information from them through informal and or formal ways.

8.c Point Person Selection

8.d Coverage through TOTs
Activity Done Capacity No. of person building of the trained in TOT employees through TOT Done 15

Work area

Table 8: Coverage of TOTs
Date Representative from HVR s

Reliance Jute Mill

11/06/06

Aukland Jute Mill

Done

17

10/07/06

Aukland Jute Mill Apeejay House

Done Done

17 15

17/07/06 22/07/06

Aparna Majumdar (resource Person) Devlina Mukherjee, Anjan Saha Devlina Mukherjee Mr. Joseph Das Mr. Sanjay Chakraborty Devlina Mukherjee Mr. Apurva Sarkar Devlina Mukherjee

Process document: HIV intervention in corporate sector through TOT strategy

Health Vision and Research
Dr. Apurva Sarkar Devlina Mukherjee Dr. Sanchayan Malakar Devlina Mukherjee Dr. Apurva Sarkar

Apeejay House Angloindia Total

Done Done

8 15 87

22/08/06 20/07/06

A training kit was given to each of the point person in Bengali and Hindi. The following materials has been given in the training kit
   

Handouts of training sessions in Bengali and Hindi Writing Pad Pen

List of VCTC with addresses

9. Facilitating training by TOTs to other staffs
Table 9: Facilitation of training by TOTs to other staffs Work area Facilitating training by staffs Activity Done No. of person Date Representatives from HVR

TOTs to other Reliance Mill Mill Mill Mill Reliance Aukland Aukland Jute Jute Jute Jute Done Done Done Done Done Done Done

trained in TOT

19 20 10 5 12 15 20

17/08/06 27/08/06 18/09/06 24/07/06 14/10/06 12/10/06 16/10/06

Devlina Mukherjee, Devlina Mukherjee, Devlina Mukherjee Devlina Mukherjee Devlina Mukherjee Dr. Apurva Sarkar Devlina Mukherjee Devlina Mukherjee

Apeejay House Angloindia Angloindia

Process document: HIV intervention in corporate sector through TOT strategy

Health Vision and Research

10. Preparation of IEC material in Hindi and Bengali

IEC material has been prepared by HVR on HIV/AIDS awareness programme for the employees of the corporate organizations. HVR has prepared the IEC materials in Bengali and Hindi keeping in mind exactly the session objectives.

The IEC materials have been collected from WBSAP&CS and distributed among the employees.

Distribution of IEC material

11. Development of HIV Prevention policy
The purpose of this policy is to ensure a consistent and equitable approach to the prevention of HIV/AIDS among employees and their families, and to the management of the consequences of developed and will be implemented in consultation with employees at all level. A set of guidelines will areas of action. It evolved out of reviewing ILO policy and findings of our interviews with stakeholders. Right to know get No gender HIV/AIDS, including the care and support of employees living with HIV/AIDS. The policy has been be provided in the policy to address the HIV/AIDS epidemic. The guideline covers the following key

11.a Objective

No discrimination against HIV spread that Right to protect

No HIV test without consent No sexual harassment

support for PLWHA discrimination for

and environment for

access to services

No dismissal even though status is positive and if employee’s Confidentiality

productivity is alright Never say no to Comprehensive information

physically fit PLWHA in selection process

refreshing sessions in workplace is mandatory

facilities for new comers and

Healthy workplace

Process document: HIV intervention in corporate sector through TOT strategy

Health Vision and Research

11.b Steps undertaken to develop HIV prevention policy
A small questionnaire has been developed to conduct survey on HIV prevention policy for corporate relevant methodologies for incorporating HIV/AIDS prevention policy. Interviews Development of Interview Schedule II

organization. The survey was done to know the strategies of initiating HIV/AIDS prevention policy and

The survey has been conducted in all the four Corporates to take the opinion of the managerial staffs, administrative staff and other technical staffs level so that HIV prevention policy is developed An overview of the policy

Specific Provisions of the Policy:
Protection against discrimination, victimization and harassment Employment Opportunities And Termination Of Employment Voluntary Testing CONFIDENTIALITY AWARENESS – RISING AND EDUCATION IMPLEMENTATION AND MONITORING HEALTH CARE BENEFITS WORK PERFORMANCE CARE AND SUPPORT FOR WORKERS AND THEIR FAMILIES

Quality of HIV/AIDS services
1. Protection against discrimination, victimization and harassment or perceived HIV status.

All employees will be protected against discrimination; victimization or harassment based on their real 2. Employment Opportunities And Termination Of Employment opportunities, merely on the basis of HIV infection. 3. Voluntary Testing

No employee will suffer adverse consequences, whether dismissal or denial of employment

There may be situations where workers wish at their own initiative to be tested including as part of voluntary testing programmes. Voluntary testing should normally be carried out by the community health services or VCTC and not at the workplace. Where adequate medical services exist, voluntary

Process document: HIV intervention in corporate sector through TOT strategy

Health Vision and Research testing may be undertaken at the request and with the written informed consent of a worker, with advice from the workers’ representative if so requested. Suitably qualified personnel should perform it with adherence to strict confidentiality and disclosure requirements. Gender-sensitive pre- and posttest

counselling, which facilitates an understanding of the nature and purpose of the HIV tests, the an essential part of any testing procedure. 4. Confidentiality

advantages and disadvantages of the tests and the effect of the result upon the worker, should form

Job applicants and workers will not have to disclose their HIV status. The company recognizes the sensitive issues that surround HIV/AIDS, where an employee chooses to reveal his or her HIV status to management; the Company will keep the identity of such person strictly confidential. Mechanisms will

be created to encourage openness, acceptance and support for those employees who voluntarily disclose their HIV status within the workplace, including encouraging persons openly living with

HIV or AIDS to conduct or participate in education, prevention and awareness

programmes; encouraging the development of support groups for employees living with discriminated against or stigmatized.
5. Awareness – rising and education

HIV/AIDS; and ensuring that persons who are open about their HIV status are not unfairly

Appropriate awareness and education programmes will be conducted to inform employees about HIV and AIDS which will enable them to protect themselves and others against infection by HIV. All programmes will take into consideration, the needs of both sexes. Some of these will include the families of employees and the local community when possible. The Company recognizes the importance of involving employees and their representatives in the planning and implementation of awareness, education and counselling programmes, especially as peer educators and counselors.

Practical measures to support behaviour change and risk management will include referral to sexually where possible.

transmitted infection and tuberculosis treatment services in the community and distribution of condom Several programmes like information and awareness raising programmes, educational

programmes, linkage to health promotion programme, Practical measures to support behavioral change, Community outreach programmes, and distribution of BCC.
Training will be arranged for key staff, including Managers, Supervisors and Personnel Officers, trainers

of trainers (both male and female), peer educators and occupational safety and Health Officers within the Company. Reasonable time off will be given for participation in education and training about HIV/AIDS and related health matters. 6. Care and support for workers and their families

The Company will treat employees who are infected or affected by HIV/AIDS with empathy and care.

The Company will provide some reasonable assistance, which may include counselling, time off, sick

Process document: HIV intervention in corporate sector through TOT strategy

Health Vision and Research leave, and information regarding the virus and its effect, Social security coverage, Employee and family assistance programmes, benefits 7. Work performance

It is the policy of the Company to respond to the changing health status of employees by providing suitable work sites for those infected with HIV. Employees may continue to work as long as they are able to perform duties safely. If any employee with AIDS is unable to perform his or her tasks adequately, the Manager or Supervisor must resolve the problem according to the Company’s normal procedures on poor performance/ill health. 8. Benefits

Employees living with HIV/AIDS will be treated no less favorable than staff with any other serious appropriate, and other available sources. 9. Health care

illness/condition in terms of statutory and company benefits, work place compensation, where

The Company will help employees living with HIV/AIDS to find appropriate medical services in the community, as well as counselling services, professional support and self-help groups if required. Reasonable time off will be given for counselling and treatment. 10. Implementation and monitoring and programme.

The Company will establish an HIV/AIDS committee to coordinate and implement its HIV/AIDS policy The implementation of this policy will confirm the Company’s normal disciplinary and grievance procedures. Confidentiality will be assured during any and all procedures. In order to plan and evaluate baseline data and regular risk and impact assessment studies. The studies will include knowledge, its HIV/AIDS policy and programme effectively, the Company will undertake a survey to establish attitudes and behaviour/practices (KABP). Studies will be carried out in consultation and with the consent of employees and their representatives, and in conditions of complete confidentiality. The policy and related information on HIV/AIDS will be communicated to all employees using the full range of communication methods available to the Company. the findings of surveys/studies conducted. This policy will be reviewed annually and revised as necessary in the light of changing conditions and

11. Quality of services:

Inability to pay and delay to pay should not be the constraint against access to services in time. The corporate should have the provision to arrange the services in time to ensure quality of an individual’s convenience. life. Necessary provision should be there so that the employee can pay the amount in his her

Process document: HIV intervention in corporate sector through TOT strategy

Health Vision and Research

12. Proposed Implementation Procedure of HIV workplace Policy
Once approved, an organization’s HIV/AIDS policy needs to be implemented throughout the of the entire HIV/AIDS program. Management, labor, and supervisors should be trained in the policies so that they can help other employees understand them. The way in which the policy is introduced will

organization. The employer should plan implementation of the policy so that it becomes the foundation

set the tone for future communications about HIV/AIDS in the workplace and will introduce the other programs and activities to follow. Implementation of the HIV/AIDS policy calls for a thoughtfully planned communication strategy so that the policy will be implemented as carefully as it was developed. As with other communication systems within the organization, the employer’s structure, introducing a HIV/AIDS policy follows

size, and style will determine the best ways to communicate about HIV/AIDS. One approach to A. Provide appropriate initial messenger(s) and messages

A joint management and labor leader announcement of the new HIV/AIDS workplace policy is likely to

provide maximum impact and credibility. Plan your message and your messengers carefully. Then introduce the policy from the highest levels of management— preferably by the most senior person in the organization or work site, such as the general manager, managing director, or other principal officer—in partnership with the top labor leader. Management can communicate commitment from the top down, while union shop stewards simultaneously begin to communicate the importance of the policy to each worker. When both labor and management introduce and support the policy, the policy is most likely to be “heard” throughout the workplace and viewed as important. The initial message should be presented so that all employees can learn about the employer’s general factors, among them:      

position on HIV/AIDS at the same time. What constitutes an appropriate message depends on many National and organizational cultures;

Employee language, literacy, education and training levels; Existing levels of knowledge about HIV/AIDS; Other workforce characteristics; The employment sector; and Enterprise size and resources.

Another important factor is whether your employer has already been addressing HIV/AIDS directly, or messages, and who is chosen to deliver them, are appropriate.

whether this will be the first workplace communication on this topic. Be sure your communication

Process document: HIV intervention in corporate sector through TOT strategy

Health Vision and Research

In addition to the initial communication about the policies to all employees, most organizations will needs and responsibilities of specific groups of employees. Some suggested approaches follow.

B. Carry out sequenced additional communication

need to provide a series of carefully-planned communications that provide more depth and address the

Supervisors and managers: Supervisors and managers need to understand not only the
overall policy, but also their responsibilities regarding policy implementation and enforcement. Plan the sequence of communication so that it begins with people whose job functions require more information (i.e., human resource managers and supervisors likely to be addressing situations such as a person living with HIV/AIDS in a work group, or health care professionals or other senior managers who might be expected to advise other supervisors and managers about how to address HIV/AIDS). Provide clear

information about how to administer the policy and about the specific roles and responsibilities of each group, with the expectation that they will serve as resources within the organization. If individuals have little knowledge about HIV/AIDS, also plan to provide basic education about HIV/AIDS.

Labour leaders can carry the message about HIV/AIDS policies and their implications for workers at every level. They can emphasize the provisions that protect worker rights and the guarantees of access HIV/AIDS prevention education. Labor leaders are likely to be especially interested in the practical to testing and care, and can also play an important role in identifying or serving as peer educators for implications of the policy for worker rights and services and the possible inclusion of similar language in future collective bargaining agreements. They will need detailed understanding of policy provisions that directly affect workers with HIV/AIDS and those that affect all workers. Plan your communications to provide this information and prepare them to pass on their knowledge to workers at all levels. Where a

Labour leaders

workplace is not unionized, the active involvement of respected leaders among the workers are new policies. Workers. Determine how and when to communicate the policy to workers, and the level

similarly important. They should participate in communications about the content and implications of of detail such communication should contain. The initial organization-wide communication introduces

the policy and will prepare workers for future HIV/AIDS education and prevention, care, and support programs. Although workers do not usually need to know a lot about administration of a policy, they will need to know its main provisions and how the policy affects them. Workers will need to understand the benefits of a HIV/AIDS policy and be aware of expectations regarding worker protections and treatment of HIV-infected workers. Often, such information best comes from labor leaders and management working together. The content of the communication will be different for non-supervisory staff than for supervisors and managers. Use a variety of methods and channels to communicate to all

workers, such as notice boards, mailings, pay slip inserts, special meetings, training sessions, and

Process document: HIV intervention in corporate sector through TOT strategy

Health Vision and Research informal question-and-answer sessions. If there is special concern about particular aspects of the flyers or other materials explaining them. C. Implement the policy

policy—such as confidentiality guarantees or non-discrimination provisions—plan specific sessions and

Once the policy has been widely and clearly explained, move quickly to implement it fully. Provide responsibility. Establish a process for answering questions and addressing concerns that may arise. Be sure there are individuals and workplace unit(s) take charge of ensuring efficient and consistent

needed training for shop stewards, supervisors, and managers with specific implementation

implementation. The committee should remain available to address concerns; clarify policy intent, and monitor implementation. You may want to ask union leaders to help with feedback sessions to be sure the message has gotten out and the policy is being appropriately implemented. D. Periodically review, monitor, and revise the policy

Once the policy has been implemented, the planning committee will transfer its primary attention to

other activities such as program development. However, the committee should also encourage the

development of a plan and schedule for reviewing and if necessary revising the policy after it has been in place for several years. You may need to refine your policy based on experience, new treatments, or a plan to change your program. You will want to ensure that your workforce policy remains consistent collective bargaining agreements where applicable.

with the refined program (as described in what is usually the fourth section of the policy) and with

13. Effectiveness of the TOT strategy and its replicability
13.a Change in the knowledge The following table clearly depicts that there have been significant change in knowledge indicating enhancement of knowledge in a period of six months’ intervention. Table 10: Change in level of knowledge Item

Heard of STD Heard of HIV/AIDS HIV transmits through sexual route HIV transmits through blood transfusion HIV transmits through needle sharing HIV comes from infected mother to her child through breast feeding HIV comes from infected mother to her child in her womb Genital discharge is a symptom of STD Genital ulcer is a symptom of STD Without condom doing intercourse spreads HIV infection Mosquito bite spreads the disease Tuberculosis happens to AIDS victims Pneumonia happens to AIDS victims

Baseline: % 70.3 87.4 91.8 94.8 34.4 63.9 85.6 7.2 11.7 86.5 46.4 16.2 11.7

Endline: % 84(94.3) 97.8 86.5 97.8 95.5 86.5 97.8 6.0 56.2 91.8 14.6 28.1 43.8

Process document: HIV intervention in corporate sector through TOT strategy

Health Vision and Research 13.b Change in stigma and discrimination Similarly the following bale also states that though not adequate, which is normal as because stigma the intervention.

cannot be removed all on a sudden, there has been certain percentages of stigma reduction through Table 11: Change in stigma and discrimination
Question

Do you personally know anyone who is infected with HIV AIDS? The person infected of HIV AID is characterless In hospital s HIV AIDS patients should be given same type of medical care just like other in the society without any discrimination HIV AIDS infected people should be isolated HIV AIDS infected people should be provided good medical treatment and emotional support

Baseline data Yes: n (%) 9(8.1) 29(26.1) 73(65.8) 23(20.7) 96(86.5)

Endline data Yes: n (%) 25 (28.1) 19 (21.3) 62 (69.7) 7 (7.9) 76 (85.4)

13.c Exposure to intervention From the data it is obvious that exposure to intervention has been increased and better awareness to availability of services have been observed.
Item

Table 12: Change in exposure to intervention
Baseline data N (%) 19(17.1) 3(2.7) 4(3.6) NGO program 15(13.5) NGO peer 7(6.3) Govt health functionaries 9(8.1) Private health functionaries 3 (2.7)

Have you ever heard about VCTC? Do you know the location of the nearest VCTC to your home? I do not want to know the result but have you ever had an HIV test Can you tell us about the source of this information of message about HIV AIDS

Endline data N (%) 74 (83.1) 51 (57.3) 4 (4.5)

NGO program 22 (24.70) NGO peer 53 (59.6) Govt health functionaries 35 (39.3) Private health functionaries 13 (14.6)

13.d Unit Cost Indicator No of corporate No of target group No of master trainer prepared Beneficiaries 6 7000 87 Total cost 3,20,000 3,20,000 3,20,000 Unit cost 53333.3 45.7 3678 Cost excluding research 270000 270000 270000 Unit cost 45000 38.5 310.3

Process document: HIV intervention in corporate sector through TOT strategy

Health Vision and Research 13.e Replicability

The effectiveness clearly states that it is a replicable model. The state can adopt the model as a low cost model for corporate place intervention to combat HIV/AIDS spread.

14. Learning from this study

Some factors should be considered essential when mainstreaming HIV/AIDS in corporates. Obviously, achieved as a result of the mainstreaming process. 

not all these criteria have to be met before starting to get engaged in mainstreaming. They may be HIV/AIDS has to be understood as a development issue: All stakeholders involved should be aware of the different dimensions of the global and local HIV/AIDS epidemic and understand it as an important development issue that concerns many sectors. Commitment and active support of decision-makers: Mainstreaming needs to be of everybody's concern. Commitment and action of the decision makers within the Corporates would facilitate the mainstreaming of HIV AIDS in workplace. Clearly defined objectives for mainstreaming of HIV/AIDS: Objectives should be





clear and adapted to the context. Defining clear objectives for mainstreaming should ideally be part of a new project/programme, but can also be done if programmes are already evaluate its effect. running. Having clear objectives for mainstreaming will also help to monitor the approach and



Knowledgeable, compassionate and skilled staff: Everyone with in the organisation must know how he/she can contribute to fighting HIV AIDS with in the frame of the organization’s policy and field of action and understand how the organisation itself is affected by HIV AIDS. Teambuilding events and creating an emotional momentum (such as for example by watching and discussion a film together or paying a visit to a treatment and care center for people living with HIV AIDS. Are crucial to win support and enhance commitment. issues and on how to mainstream it into development work is essential. Expertise and support is available and made of us : Capacity building on basic knowledge about HIV AIDS on how to communicate about these



is nowadays available, which can provide locally and culturally adapted support and advice, while it is often easy to identify support for questions related to HIV AIDS prevention, challenging.

In many countries local expertise

treatment and care, identifying competent support for mainstreaming strategies is often more

Process document: HIV intervention in corporate sector through TOT strategy

Health Vision and Research  Sufficient allocation of resources: Sufficient allocation of resources (financial, human and technical): Mainstreaming HIV/AIDS is not cost free and budgets and human resources need needs relatively few financial and material resources. Cooperation Offices can provide funds to to be allocated accordingly. However, experience has shown that a mainstreaming approach

projects and programmes in order to stimulate the initial phase of mainstreaming HIV/AIDS. budget allocation within the overall planning.

Nevertheless, projects and programmes should increasingly co-finance initiatives and consider  Sufficient documentation: Willingness to learn, reflect and share experiences: There is a need for consistent documentation, monitoring and evaluation at various stages of policy partner organizations. formulation, project design and implementation and for sharing knowledge and expertise with    Evidence based: If baseline and endline data are not available, we cannot claim of effectiveness and address the issue of replicability. Overcoming resistances: Resistances from union, from managers, their stigma attached to HIV/AIDS and lack of initiatives are really problematic. Welcoming innovations: During this action researches need and innovations were upcoming which we tried to adopt with in our budget constants like we had to print flex IEC materials even though it was not mentioned with in the budget.

  

Time bound achievement and other risks: Time bound achievement was not possible due to the facts that corporates which agreed to participate did not at end. corporate is really hell and heaven difference. Developing policy versus integrating policy: Policy development and integrating it into he Arranging facilitation training is breaking the barrier: Arrangement of facilitating sessions through MTs was really tough. We prepared 87 MTs out of which in the beginning hardly people were interested to facilitate the session. We had to adopt Labour Leader Concept to promote this.

Process document: HIV intervention in corporate sector through TOT strategy


								
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