1. ICSW - S.H.I.P. Seafarers’ Health Information Programme
Topic 7 : STIs, including HIV / AIDS

4. Maritime Sector >90% of World Trade is transported by Ship
± 1.2 million people work at sea:
450,000 officers = 2-5% shortage
750,000 ratings = 10-15% surplus
60 % from Asia
>20% from The Philippines

5. Maritime Industry

6. Maritime Sector Global sector: fierce competition >> low wages
harsh working conditions
manning countries = cheap labor countries
manning agencies for recruitment and contract

7. Threats and Challenges

8. Maritime Regulators IMO: ILO:
Standards on Training, Certification & Watchkeeping STCW ’95 treaty 1995
International Shipping & Port facilities Security ISPS Code 2001
SOLAS: Safety of Life at Sea
MARPOL
ILO:
Maritime Labor Convention 2006

9. Seafarers’ Health
Plenty occupational, physical, chemical and other health hazards:
Construction, cargo, isolation, climate changes
Noise, vibration, radiation
Loading, discharging, cleaning, painting
Travelling, accidents, infections, unsafe sex
This slide introduces the audience to seafarers’ health and the many factors and hazards that influence health onboard.
This is the “classic” approach to maritime health and maritime medicine, these hazards and problems are dealt with in today's medical services to seafarers, through occupational and company health services.
SHIP is NOT a programme on these aspects of seafarers health, the next two slides explain why.

10. Why S.H.I.P.?
To stimulate seafarers to take responsibility for their health in the living and working environment onboard
Healthier, fitter, safer…

11. Ten Topics Food Safety Fit on Board Safe travel Healthy food Malaria
Overweight
STI, HIV / AIDS
Mental Care
Dental Care
Skin Care

12. This slide ends the presentation and gives the speaker the opportunity to demonstrate and distribute to the audience some of the sample material that SHIP forwards to you on request before the presentation.

13. How? Contact points Pre-employment examination: clinics
Health Policies: Shipping Companies
Transit points: seafarers’ centers
Ship visitors in ports
Courses
Website
Sportsevents: ISS …

14. Seafarers and STIs, HIV / AIDS
An intervention has to involve:
Shipping Companies
Unions
Welfare Organizations
IMHA
ILO / IMO / WHO

15. Seafarers and STIs, HIV / AIDS
Shipping Companies:
C.S.R. = Corporate Social Responsibility
Unions
Welfare Organizations
IMHA
ILO / IMO / WHO

16. C.S.R.
“The essence of corporate social responsibility (CSR) is that companies should not seek profits alone; they must conduct their business activities with consideration of society, the environment, and human rights, and strive for sustainable growth as part of the global and local community”
“Corporations are one of the building blocks of modern society. And we have seen time and time again that when a company loses the trust of society, it is quite difficult to recover”

17. C.S.R. & Health
Health of employees is an integrated part of the organisation
People are the most important asset in the organisation
Every employee, on any level, has a unique contribution to create and maintain a healthy work environment and promote a healthy lifestyle
Care for health of employees is an essential part of the success of an organisation
Healthy employees improve the performance of the organisation

18. Seafarers and STIs, HIV / AIDS
Shipping Companies
Unions
ITF = International Transport Workers Federation
“Highway of Hope”
AIDS coordinator
ITF Seafarers’ Trust: startup funding for S.H.I.P.
Welfare Organizations
IMHA
ILO / IMO / WHO

19. Seafarers and STIs, HIV / AIDS
Shipping Companies
Unions
Welfare Organisations
International Committee on Seafarers’ Welfare
Faith-based Organisations:
AOS, MTS, BISS, DSM …
Seafarers’ Centres
IMHA
ILO / IMO / WHO

20. Not many of the participants will know the ICSW therefore it is good to start with a short intro on what the committee does and who the members are

21. A Charity registered in the UK
What Are We ?
A Charity registered in the UK
An international umbrella organisation dedicated to the implementation of the ILO Instruments on Seafarers’ Welfare.
Convention 163
Recommendation 173
On the ILO instruments it may be worht mentioning the creation of seafarer welfare boards on national, regional and local level stimulated by the conventions and elaborate a bit on the recent consolidation of the maritime conventions although others may have done this before you.

22. Seafarers and STIs, HIV / AIDS
Shipping Companies
Unions
Welfare Organisations
IMHA
Maritime Medical Professionals
Expertise & Research
2007 IMHA & ITF join to condemn HIV discrimination at sea
ILO / IMO / WHO

23. Seafarers and STIs, HIV / AIDS
ILO / IMO / WHO
1988 IMO resolution A.639 (16): undesirability of HIV screening of crews and passengers on ships
1989 IMO/IMO/ WHO joint consultation: seafarers are not at particular risk of HIV infection in their occupational environment

24. Seafarers and STIs, HIV / AIDS
HIV / AIDS is a maritime issue. Not only because it affects the workforce, but also because ships have a role to play in the wider struggle to limit the spread and effects of the epidemic

25. Seafarers and STIs,HIV / AIDS
Risks and vulnerabilities:
Working and living away from spouses and partners
Working in isolation with limited social interaction and limited health facilities
Single-sex working and living arrangements dominated by men, where women are in a small minority
Limited control by the individual on protection against infection

26. Seafarers and STIs,HIV / AIDS
The number of HIV positive seafarers is thought to be quite low, because of:
Shorter turnaround time in ports
Stringent duty and watch systems
High workload ~ crew reduction
Port facilities far away from town centers
ISPS code: more stringent security systems
Increased dangers and hostilities faced by seafarers in some regions
…/…

27. Seafarers and STIs,HIV / AIDS
Mandatory pre-employment testing in major manning countries
Higher education and training level:
…Making choices…
Drug and Alcohol policies:
“dry” ships
“Healthy worker effect”
True for all Seafarers?

28. Seafarers and STIs,HIV / AIDS
Prevalence:
Not enough facts and figures
HIV prevalence among seafarers is not higher in most studies
Prevalence of other STI is higher in most studies
“Absence of evidence ≠ evidence of absence”

29. Seafarers and STIs,HIV / AIDS
Prevalence:
The Philippines:
HIV + n=1611 n=2484
OFW 28% %
Seafarers 38% (n=171)
UNAIDS estimate: n=12,000

30. Seafarers and STIs,HIV / AIDS
Prevalence:
Higher in certain sailing areas?
Patchy pattern of high prevalence?
Like “Corridors” in road transport
Higher in certain types of trade: e.g. cabotage?

31. Seafarers and STIs,HIV / AIDS
Knowledge, Attitude, Behavior and Practice:
Small group: sexually very active
Large group: occasionally unsafe sex
Small group: no risk at all

32. Seafarers and STIs,HIV / AIDS
Knowledge, Attitude, Behavior and Practice:
Knowledge: misconceptions
Peers are more important than knowledge for behavioral change
Use of condoms varies from 20% to 60% depending on the study

33. Seafarers and STI, HIV / AIDS
Challenges of a Maritime STI, HIV / AIDS Awareness Campaign:
Neutrality of the message:
Tone, level, technicality
Culturally indifferent
No stigmatization
Faith-based welfare organizations
Participation of sector and community

34. Seafarers and STIs,HIV / AIDS
Guidelines on the Prevention of Sexually Transmitted Infections including HIV and AIDS Onboard Merchant Ships
STI, you are part of it!...
Trailer
Three posters
Questionnaires
Health Promotion in a Shipping Company + PP

35. Seafarers and STIs,HIV / AIDS

36. Seafarers and STIs,HIV / AIDS
A Campaign in Seven Steps
Why a Campaign on STI HIV AIDS for seafarers?
How to handle this?
What is important?
What needs to be done?
Start the campaign!
Have the goals been achieved?
Keep the momentum going!

37. Seafarers and STIs,HIV / AIDS
A Campaign in Seven Steps
Create support for a STI HIV AIDS campaign
How to handle this?
What is important?
What needs to be done?
Start the campaign!
Have the goals been achieved?
Keep the momentum going!

38. Seafarers and STIs,HIV / AIDS
A Campaign in Seven Steps
Create support for a STI HIV AIDS campaign
Set up a structure for a STI HIV AIDS campaign
What is important?
What needs to be done?
Start the campaign!
Have the goals been achieved?
Keep the momentum going!

39. Seafarers and STIs,HIV / AIDS
A Campaign in Seven Steps
Create support for a STI HIV AIDS campaign
Set up a structure for a STI HIV AIDS campaign
Investigate what the target group needs and wants
What needs to be done?
Start the campaign!
Have the goals been achieved?
Keep the momentum going!

40. Seafarers and STIs,HIV / AIDS
A Campaign in Seven Steps
Create support for a STI HIV AIDS campaign
Set up a structure for a STI HIV AIDS campaign
Investigate what the target group needs and wants
Make a plan for a STI HIV AIDS campaign
Start the campaign!
Have the goals been achieved?
Keep the momentum going!

41. Seafarers and STIs,HIV / AIDS
A Campaign in Seven Steps
Create support for a STI HIV AIDS campaign
Set up a structure for a STI HIV AIDS campaign
Investigate what the target group needs and wants
Make a plan for a STI HIV AIDS campaign
Implement the campaign
Have the goals been achieved?
Keep the momentum going!

42. Seafarers and STIs,HIV / AIDS
A Campaign in Seven Steps
Create support for a STI HIV AIDS campaign
Set up a structure for a STI HIV AIDS campaign
Investigate what the target group needs and wants
Make a plan for a STI HIV AIDS campaign
Implement the campaign
Evaluate
Keep the momentum going!

43. Seafarers and STIs,HIV / AIDS
A Campaign in Seven Steps
Create support for a STI HIV AIDS campaign
Set up a structure for a STI HIV AIDS campaign
Investigate what the target group needs and wants
Make a plan for a STI HIV AIDS campaign
Implement the campaign
Evaluate
Adapt and continue

44. Key elements Website E-mail Campaign material www.seafarershealth.org
(ICSW)
Campaign material

45. VII. THOU SHALT TAKE AND WEAR THY PROPHYLACTICS