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In this notebook, we learn about how the development agency CARE-Bangladesh involved key stakeholders, particularly a transport workers’ union, in the task of HIV/AIDS prevention in Bangladesh. Although Bangladesh has one of the lowest HIV/AIDS infection rates in the world, it is surrounded by countries in which the disease is widespread, and many worry that it is only a matter of time before it spreads to Bangladesh. Transportation workers, such as truck drivers, are particularly at risk of contracting and spreading the disease. CARE-Bangladesh worked to gain the trust and respect of the Bangladesh Truck Driver’s Federation and then together implemented a program of advocacy including health education and services through integrated partnership. Particularly important was the cultivation of a sense of ownership of the project on the part of the union, including the employment of paid peer educators and the use of union premises for outreach work and health services. The story of CARE-Bangladesh’s work provides important insights into engaging key stakeholders in advocacy work that is socially acceptable and relevant to the lives and experience of target communities.

Since the first identification of HIV and AIDS, their prevalence has been particularly high in communities situated on transport routes, such as border posts and port towns and cities. The HIV virus spreads as people travel, so transport workers are particularly vulnerable. Although Bangladesh is currently rated 161st of 166 countries and territories in rates of HIV/AIDS, it is in close proximity to Asian countries with relatively high rates. Rather than wait for the epidemic to arrive, CARE-Bangladesh sought a strategy that would prevent the spread of HIV/AIDS.

CARE-Bangladesh recognized that it was crucial to engage transport workers, unions, and companies as key stakeholders in combating the spread of HIV/AIDS. As a result, in partnership with the workers’ union and associations, and with owners of the transport companies, we initiated a behavioural change program to prevent an HIV/AIDS epidemic and to provide quality health care services to transport workers, especially truckers. Because we planned to give the project over to its participants–namely the transport union–after the initial design phase, the primary stakeholders, especially the union, have been actively involved in program development and activities. By holding the union accountable and responsible, CARE-Bangladesh has facilitated a process whereby the workers’ union has become an implementer of health care services, including prevention services, related to sexually transmitted infections (STIs) and HIV.

The active involvement of the union has brought many positive results. Its participation and sense of ownership have been essential in sustaining the program and making it socially acceptable. Union involvement was also instrumental in the scaling up of project activities and the ability to quickly create a nationwide service network.

To address the mobility and needs of some 300,000 transport workers, the program now has 45 Drop-In Centres (DICs) nationwide, each called "Traveller," about 300 paid peer outreach workers, and 25,000 volunteer peer educators (recruited from the transport workers themselves). Approximately 4,000 transport workers receive health services from the DICs each month. The project has also established a system for the social marketing of condoms through Peer Outreach Workers and more than 200 local depot holders. On average, 200,000 condoms are sold through this system every month. The establishment of these DICs not only addresses the mobility of transport workers, but greatly improves their access to effective health care services.

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