Objective="Promoting regular health check-ups of sex workers."
Details for Reform Option "Smart Card Initiative for Sex Workers, Karnataka"
In the year 2005, it was estimated that 0.1% the female sex workers were HIV positive. The year before 0.07% sex workers were found infected. During the year 2005, the contribution of HIV infection from the sexually transmitted infection afflicted population group has been found to be 1.7 million in comparison to 1.3 million in 2004.
An increasing number of persons acquire HIV through high risk sexual behaviour. In order to tackle the problem at its root, Government of Karnataka introduced smart cards to promote regular health check-ups among female sex workers. Karnataka is one of the six high prevalence states in India.
The Smart Card initiative has been developed by the Karnataka Health Promotion Trust (KHPT) in association with Ashodaya Mahila Samanwaya Samiti (AMSS), an association of sex workers of Mysore and Mandaya districts. A pilot project was launched in July 2006 in these two districts; the initiative was supported by Bill and Melinda Gates Foundation and University of Manitoba, Canada.
AMSS members were initially given identification numbers for health check-ups which they did not remember. They were then issued health cards, but these also did not promote regular health check-ups. Pennant Consulting Services, a software company was then approached; it merged the health cards with smart cards, which were then issued to AMSS members.
With the smart card a sex worker gets discounts when she shops at the designated stores, but to keep her card valid she will have to go for health check-ups at least once every three months. The smart card also contains confidential medical record of the card holder.
The women have to report at the clinic set up by KHPT, Mysore, for sex workers. Here they undergo a thorough health check-up, for any symptoms of sexually transmitted infections, particularly, HIV.
Five business establishments—two restaurants, two garment shops and a provision store—are taking part in the pilot programme. While the vendors can record and read their transactions on these cards, they will have no access to the health data stored on them. The health data can only be entered and accessed at the clinic, using the main computer. The system is designed in such a way that the Simputers (handheld computing devices developed by Indian Institute of Science, Bangalore) will not read cards that have not been updated at the clinic in the preceding three months.
Findings can be requested from the resource person on the completion of the pilot project. The pilot project has initially involved 500 sex workers from Mysore district and is rolling onto Mandya district.
Information not available.
Mysore and Mandya districts, Karnataka.
Six to 9 months.
Building up self-esteem: The sophistication and confidentiality attached with the card raises the self-assertion and self-recognition among the sax workers.
Promoting positive sexual health: It has raised concern among the sex workers regarding their sexual health and shall be accelerating the reduction in STIs and HIV/AIDS.
Promoting reproductive health: The regular check-up will further help in interrupting the transmission of HIV virus and STIs from mother to child.
Socio-cultural barriers of non-acceptance of sex-workers: the prevalence prejudices and stigma against sex workers itself may resist the initiative.
Illiteracy: Smart Card may be difficult to use and taken care by illiterate sex workers
Baseline data need assessment, supportive environment, advocacy, clinical facility, diagnostic lab.
Who needs to be consulted
Sex workers, health professionals, software companies and business establishments.
This initiative is still under trial and needs to be observed further. However, advocacy is crucial to creating a practice of regular health check ups among sex workers.
Chances of Replication
The experience in Mysore district was encouraging enough to extend the initiative to Mandya as well. The detailed nuts and bolts of the implementation process will emerge once the pilot project is complete.
Monetary incentive can prove an effective strategy to motivate hard to reach high risk population to undergo health check-up on regular basis. The cost involved in attracting them may be far less than the cost spent on treatment and control of STI such as HIV/AIDS.
Dr. Anil Bhola, Research Consultant, National Institute of Medical Statistics, New Delhi November, 2006.