Reducing Filipino migrant domestic workers' HIV and SRH vulnerability: the ACHIEVE experience.

The private nature of the work done by Filipino migrant domestic workers renders them vulnerable to physical, sexual and psychological abuses. With minimal access to sexual and reproductive health and rights (SRHR) information and services as well as gender-based differences in power, female domestic workers encounter difficulties in halting sexual advances and negotiating for use of condoms to protect themselves from STIs and HIV.

The impact of these circumstances on their health is tremendous. The National HIV/AIDS Registry of the Philippine Department of Health currently states that among the overseas Filipino workers infected with HIV, migrant domestic workers comprise 18%. (1) This is significant, given that only 8.6% of those working overseas were employed in the domestic sector. Regrettably, it is difficult to implement and monitor standards of protection and education for migrant domestic workers, as their work is not legally recognised as work in many destination countries.

In response to this growing concern, Action for Health Initiatives (ACHIEVE), Inc., a Philippines-based NGO implementing programmes on migration and health, with a specific focus on the SRHR and HIV vulnerability of Filipino migrant workers, is currently implementing a project that brings together various stakeholders in health and migration: domestic worker communities, migrant support organisations, health institutions, and local and national government institutions. Because the vulnerability of domestic workers is both behavioural and structural, ACHIEVE believes it is imperative to implement a holistic programme that responds to the issues comprehensively at different levels. ACHIEVE also focuses on continuous advocacy directed at the Philippine government.

At the start of the project, ACHIEVE conducted a survey to assess the SRHR health status and needs of migrant domestic workers, specifically looking at the knowledge, attitudes and practices of migrant domestic workers in relation to SRHR; SRHR-related problems encountered; and the level of access to SRHR information and services in the three phases of migration. (2) The study ran for 18 months and covered four major cities in the Philippines. Interviews were conducted with 302 potential migrant domestic workers.

Findings showed that 24% of the participants were not aware of reproductive tract infections (RTIs) and although 75% had some familiarity with AIDS, only 33% knew that safer sex practices could prevent HIV transmission. It was alarming to find that 77% perceived that they had no chance of becoming infected with HIV. To address these knowledge gaps, community-based trainings were conducted to raise the awareness of migrant domestic workers on SRHR issues, including HIV/AIDS. To sustain these educational discussions at the community level, a core group of migrant domestic workers were trained to become peer educators. The peer educators have also developed their own training modules for their specific community. A typical module includes a day-long session that covers HIV/AIDS, STIs, family planning, maternal health, child care, and abortion. These discussions are contextualised within the participants' lives as women and as migrant workers.

This work also encompasses building the capacity of government and NGOs to enable them to provide better services to Filipino migrant workers, particularly with regard to HIV/AIDS. A training session generally takes two days and covers a number of issues: basic HIV/AIDS information, gender and sexuality in the context of HIV/ AIDS, the relationship between migration and HIV vulnerability, and counselling and managing the HIV-related concerns of migrant workers. With the support of local officials, ACHIEVE was also able to work with the local government units in two provinces. A memorandum of agreement was signed between ACHIEVE and two Provincial Health Offices and one Municipal Health Office to set up a reproductive health desk to cater to the specific needs of migrant domestic workers before they go abroad and upon their return. ACHIEVE's commitment is to train health personnel in handling SRHR and HIV/AIDS issues, including counselling.

In carrying out these related activities, ACHIEVE ensures the involvement of domestic workers living with HIV. They educate others through sharing their knowledge and experiences and they themselves are empowered through this process. Their critique and analysis informs the direction of ACHIEVE's research; and they also set up advocacy networking meetings that plan for or evaluate and monitor responses to migration, SRHR and HIV/AIDS.

Endnotes

(1) The Philippine Department of Health's HIV and AIDS surveillance is posted on their website (www.doh.gov.ph/NEC/HIV.htm) monthly.

(2) The three phases of migration cover pre-departure, on-site and reintegration.

By Mara Quesada, Programme Officer, ACHIEVE, Inc. 162-A Sct. Fuentebella Ext., Brgy. Sacred Heart, Quezon City 1103 Philippines. E-mail: [e-mail] Tel: [phone] Tel/Fax: [phone]