Ed Scholl, AIDSTAR-One Project Director, John Snow, Inc. AIDSTAR-One is funded by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through USAID’s Office of HIV/AIDS, and provides rapid technical assistance to USAID and U.S. Government (USG) country teams to build effective, well-managed, and sustainable HIV and AIDS programs, and promotes new leadership in the global campaign against HIV.
Sanjay takes his lunch break on his construction job near the city of Nagpur in the state of Maharashtra, India. He migrated here in search of work from his home in the northern state of Madhya Pradesh. He’s 23 and single and hopes to earn enough to get married, start a family, and help his parents back home.
During his break, Sanjay (not his real name) decides to visit the big van parked near the construction site, where an outreach worker told him he can get free HIV and sexually transmitted infection (STI) testing. He’s curious and a bit concerned about his HIV status, since he knows that visiting sex workers back in town, as he and his fellow workers occasionally do, puts him at risk for HIV. He enters the van and is greeted by the counselor, who explains how HIV and STIs are transmitted and what he can do to avoid them. Sanjay then gives his consent for an HIV test. The counselor shares some pamphlets that give him additional information about HIV and STI prevention. Before she leaves, she demonstrates how to use a condom and offers him some.
Next, he visits the doctor, who goes through a checklist of STI symptoms and provides a physical exam. Finally, he goes to the lab, where blood is drawn. He is told to come back for the results in four hours. At the end of his shift, he returns to the van and the counselor tells him, much to his relief, that he is HIV-negative and does not have an STI. She reminds him how he can stay healthy and avoid HIV and STIs and answers all of his additional questions.
Scenes such as this play out every day at the Nagpur mobile clinic and the four other clinics that are part of an innovative program supported by USAID/India and the National AIDS Control Organization (NACO), in coordination with the Maharashtra State AIDS Control Society. One of USAID/India’s key partners, the Mumbai-based Avert Society, implements the program with other non-governmental organizations (NGOs) in five districts of Maharashtra, which were chosen for their high rates of HIV.
Given the nature of the HIV epidemic in India, with most infections concentrated in specific groups within the population and in certain areas of the country, USAID/India supports interventions focused on most-at-risk populations, such as female sex workers, men who have sex with men, and people who inject drugs. Also targeted are “bridge populations” who have contact with the most-at-risk populations, such as the clients of sex workers, many of whom, like Sanjay, are migrants. Given the difficulties of reaching these populations with traditional HIV testing and counseling centers at government or NGO locations, USAID/India and NACO agreed to support mobile clinics that would take services directly to the groups that need them most.
Six large vans were remodeled to house the clinics. Each van has three rooms: one for counseling, one for medical exams, and one for collecting and processing blood samples for HIV rapid tests and syphilis tests. In addition to these tests, the clinic staff also evaluates patients’ symptoms to identify other STIs. If a symptom, such as discharge or a sore on the genitalia, is present, the mobile clinic provides STI treatment kits. Each mobile clinic is staffed by a doctor, a counselor, a lab technician, and a driver. Collaborating NGOs in each district spread the word about the arrival of the mobile clinic through their outreach workers and peer educators, who encourage the targeted populations to attend.
Although the mobile clinic program is less than a year old, it has shown promising results to date. A typical day will result in 35 to 40 clients seen, more than are seen daily in government testing and counseling centers. The NGOs and their outreach workers and peer educators confirm that they are reaching greater numbers of high-risk groups than they did before the program began. The mobile clinics also offer the added advantage of STI screening and syphilis testing, which are not available at government or NGO testing and counseling centers.
And the clients themselves? They say that they really like the mobile clinic because it is convenient and free. They also appreciate the respectful and friendly way the staff treat them. For many, the visit to the mobile clinic is the first time they had been tested for HIV or heard about STIs. As the program continues and operations scale up, many more most-at-risk and vulnerable populations in Maharashtra will be served.