Rapid urbanization and economic development are experienced in various countries in the wake of globalization. The worst affected are the poor  who lack adequate and secure livelihoods. In the countryside as well as in  cities, they experience unemployment and underemployment. Unreliable nature of casual labour, low wages, unhygienic and unsafe working conditions add to their misery. Their livelihoods are made precarious by multiple factors such as: inadequate access to land and irrigation,  deficiencies of transport and the over exploitation of common resources.  Confronted with this daily vulnerability, poor people often struggle to diversify their sources of income and food. They work on the land, in quarries and mines, take temporary and part-time menial jobs as truckers, sell goods in the streets and do piecework in factories and at home leading to unprecedented migration and vulnerability.

Truck driving is a profession full of pain and anguish. Long distance travels keep trucker away from home for long time. They live a life full of risk and uncertainty. The feeling of anonymity often provokes them to feel free from social norms. This loneliness pushes them to vulnerability. They often fall prey to unsafe sex on the highways that takes its toll on their health.
The other problems are harassment at the hand of officials on road. They are also the targets of local people who vent their anger of local issues on truckers. They face unsecured livelihood with deplorable road conditions that makes them prone to fatal accidents. They do not have adequate social security measures like stability in jobs and risk coverage during the journey on road. Barring a few no health care facilities are available along the highways. That makes them prone to occupational hazards.
They hardly have any unions or forum to redress their problems.

Cross border intervention by AID is taking place in bordering districts of West Bengal, Orissa and Jharkhand.
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Several Dhabas and petty shops have also come up along these highways to cater to the needs of Truckers. Mobile Women in Prostitution (WIPs) also frequent these places.  Good connectivity with the major industrial towns has led to opening many tourist points along the highways.
The truckers in their way to their destination stop over at these halting points to relax and take much needed rest. It is here that they come into contact with dhaba owners and workers, petrol pump workers, vulcanizing shops, petty shops as well as mobile WIP.

A.I.D aims empower the inter-state migrant truckers, CSW's by raising their level of awareness in AIDS prevention and control. It is expected to cover a number of issues such as the transmission of the virus, prevention, risk factors, and the impact of STD/HIVAIDS. It also looks for a long-term perspective of change in behaviour and policy change to achieve sexual health rights and equitable partnership. For this very purpose A.I.D. has identified 22 intervention sites or halting points in the entire network. Six have been selected as Major Halting Points along the highways.

A.I.D.’s MOBILE HEALTH UNIT AT WORK:

The main objective of starting the mobile unit by A.I.D. was to make the truckers feel less stigmatized for seeking health services. More than 11000 truckers had received services during the first year of activities in 2004-2005, including counseling and referral, as well as treatment for other STIs.  Efforts were made to bring in behavior change through extensive message campaign using brochures, showing video spots and condom distribution.

SPECIAL INTERVENTION BOOTHS:
To address their vulnerability and ready access to counseling and health services, four intervention booths have been installed in major halting points at Jamsola, Chichra, Dimna and Kokpara. Encouragement for partner treatment is done by our dedicated health staff.
Case Study: Unfaithful partners

However our A.I.D. staff also faces some communication problem with truckers who belongs to other states like Tami Nadu or Karnataka.
Case Study: Problem no one to listen to

A.I.D. health workers are also in process of identifying mobile sex workers and build rapport among them. Once contacted they are taught about the safe sex practice by using condom. They are explained about the danger of HIV and STDs. A.I.D. is trying to form a group among them for educating and enhancing their knowledge regarding healthy and safer life.
Case Study: Discriminated lot

TRAINING:
Training has been imparted among truckers related contact sources like Dhaba owners and workers, vulcanizing shops, petrol pumps workers, petty shop owners, motor repairing shops, clearing agents etc. Some of them are even working as peer educators referring STD patients to information booths and distributing condoms within the working area.

Video Show, cultural programs like street theatres, puppet shows, etc are arranged at periodic intervals in these intervention areas along the High ways among the truckers and way side villages. 

NETWORKING:
AID is working in close cooperation with PLHA-People Living with HIV and AIDS. It is an association of HIV patients in the state of West Bengal. The association is interested in extending their support and open branches in the states of Orissa and Jharkhand with help of A.I.D. “If you have any patient who is not getting proper treatment, then inform us. We will take care of him”, says the Secretary of the Association who, himself, is a full-blown AIDS patient.
Well coordinated networking with Hindustan Latex Limited (HLL) has helped in securing 65 automatic condom vending machines for A.I.D. This scheme has been launched for the first time in East Singbhum district under the Government of India and JSAC (Jharkhand state AID Control society) programme. The machines will be distributed at the sensitive points like petrol pump stations, road side dhabhas etc.
Interestingly, the HIV/AIDS awareness that is further campaigned aggressively by A.I.D. have had an effect on truck- drivers in that they stay away from 'high-risk' brothels. Instead they look for sexual services in the remote villages that they pass through, using contacts and networks.

With the absence of any formal health monitoring mechanism on the highways, the truckers have put their head in the block. Not much attention has been paid to this underserved and extremely poor group of society. An integrated approach is required to address the problems of the Truckers.

Government Red Tapism fails to integrate HIV/AIDS with other health program:

• When asked about condoms to be distributed in Jamsola area among the truckers, the CDMO, Mayurbhanj, Orissa remarked about non-availability of condoms in the head of HIV/AIDS program and expressed her inability to provide supply of condoms that are for the family welfare program. She advised to contact the Orissa State AIDS Control Society so that condoms of family welfare program can be chanalized for the truckers HIV/AIDS intervention. Doesn’t HIV/AIDS fall under the purview of Family Welfare? Is it a disease isolated from society that only happens to persons living outside the family? Do welfare of the truckers fall outside family welfare? The red tapism has also taken its toll on health programmes.
• PHC incharge in Chichra block of West Midnapur in West Bengal, when interviewed by AID worker remarked, “very less truckers comes here for treatment as they are in hurry. They prefer to discuss their problem to the private doctors on the way. Moreover the PHC do not have any powerful antibiotics at the center. We are having shortage of antibiotic medicines for STD treatment”.

The Minister of Health said that the government would provide for free Antiretroviral Therapy (ARTs) that helps in delaying in immune deterioration and improves quality of life.
Here is what  the official at West Bengal health department remarked at Midnapur, “it is not possible to provide ARTs to every possible patient. ART is the last resort for treating the full-blown cases of HIV person. As per the circular from the government we have to consider the economic status of the patient and those with lowest income are to be given preference for the treatment. However we do not have enough funds for treating the AIDS patients. It cost more than Rs.1800 per month per patient to treat an AIDS patient. So we only give them advice of taking a balanced diet that is generally advised at the time of providing ART treatment”.

The Minister further said, “We are going to scale up VCTCs (Voluntary Testing and Counseling Centres) and make sure every district hospital has a VCTC”. However it was found by our AID staff that the district of Mayurbhanj does not have any VC/TCs at its district headquarters at Baripada. As per the government's instruction, every district must have one such facility for testing of HIV cases. As a result people have to travel a distance of more than 70-80 Kms to another district at Balasore in the state Orissa.

Problem at the local level:
Most of the doctors posted at PHCs are not the local residents. They arrive late and leave early as they often come from far off places. At some PHCs, it was informed that PHC incharge are also under tremendous political pressure not to maintain time schedule of the visiting doctors.