Especially for undocumented migrants and refugees, being hidden due to their legal status is seriously increases stigma against them and hinders access to prevention, care and treatment.
Lacks of information on HIV/AIDS, as well as STIs are often the factors that migrants have. They were not informed about prevention of HIV and STIs.
There are factors in the whole migrations that become the background of risks for migrants. People need to understand the history of why migrants were not using condoms, for example, that made them vulnerable to HIV. There are a lot of factors, including economical factors. Among other factors, culture and tradition within the migrants’ community are also push factors for their risky behaviour. Peer pressure plays an important role in encouraging the conduct of risky behaviour.
Other push factors that often mentioned are loneliness and homesickness. The needs of companionship and biological urgency also plays important role for them to get involve in casual sex relationship, and this often has great impact to their relationship with their spouses, partners and family back home. Nevertheless, the impact on family who is left behind requires extra attention as well. The spouses and partners are as vulnerable as the migrants themselves. Carrying the same reasons of loneliness and needs of companionship, spouses and partners often get involved into casual sex relationship that made them vulnerable to HIV. The existence of HIV among the family is upsetting the family and personal relationship.
Another push factor that considered made migrants and their spouses vulnerable to HIV is the “single entry” migration policy in many destination countries had made migrants unable to take their family along to migrate causing the depression, psychological as well as biological problems both for migrants and their spouses.
What are the barriers to Universal Access caused by HIV-related restrictions?
Misconception and prejudice on HIV due to lack of information still caused stigmatisation on PLHIV. There is a trend for PLHIV who travels to countries with restrictions to stop their treatment [ART] to avoid entry ban. This step caused resistance to the treatment.
Universal Access had been misinterpreted in many ways. Every country has their own definition of Universal Access. Many of countries define it as access to health for their nationals only, and seeing the non-nationals need in healthcare as economic burden or budget to the country.
The restriction is also considered raising false sense of security to the nationals because it interprets HIV as a foreign problem brought in by migrants or foreigners to the country, despite the fact that the epidemic is already in the country. Many of foreigners who migrate to countries with restrictions as workers or students failed to follow the consistency of treatment because they kept changing clinics, doctors and treatment using different names and identity to protect their true identity. PLHIV are forced to go around the system and become the criminal for disclosing their status for health reasons. And the lack of referral system in the home-country of migrants had also caused inconsistency of treatment.
The government of Brazil thought that health services should never have any relations with private information such as nationality and HIV status. Thus, Brazil has a long term treatment program aimed not only for nationals but also for non-nationals, documented and undocumented, residing or visiting Brazil. According to Brazil, it is impossible for one country to fall into bankruptcy just because of the inclusion of treatment for migrants in their national budget.
All countries have to remember that all UN member states were signed on to the International Health Regulations which does not single out any diseases, including HIV. This regulation must be the baseline of advocacy for treatment provision in the country. Influential countries such as USA and China should take on the leadership on this regard and be a good role model for other countries when they actually eliminate the restrictions.
PLHIV have to be able to work in order to enable them accessing treatment. Denial of work permit and visa will only limit their access to work and source of income which affecting their health conditions.
What are the concrete actions that government, CSOs and International Organisations can do in the next year to further the elimination of HIV-related restrictions?
Government should revisit the restriction policy with better understanding that by implementing the restrictions, they do not remotely protect their nationals because HIV is not a foreign problem. The review also has to be based on empirical and better data collection, sharing experience and separating health services from the immigration control. Especially for EU countries, there is a need to focus on the Czech Republic since this country is going to the opposite direction. The government and regional authorities have to take the lead in removing the restrictions within the region. Since EU countries endorsed the UNAIDS recommendations regarding travel restrictions, a significant step towards Czech Republic need to be taken.
Additional steps to engage broader range of stakeholders than just HIV-focused organisations is necessary. Particularly engagement with Human Rights-based organisations who can work together to hold the government accountable is highly suggested because HIV now had overlapped with a lot of other issues outside health.
Multi-pronged strategy that looks at building internal and external pressure on eliminating the restrictions is recommended. Political will and leadership from the government is essential.
The policies on access to treatment for immigrants need to be strengthened both by governments and NGOs. CSOs and NGOs should advocate on integrating HIV prevention and treatment into the agenda of strong migrants’ organisations in the countries of destination as well as advocating for inclusion of migrants and mobile populations into the agenda of National HIV/AIDS Prevention in the sending countries. Apart from that, government should conduct training on HIV/AIDS and the impact of travel restrictions to Immigration Officials in order to raise awareness.
What can we do to make sure that we achieve some of the points mentioned?
The government of Brazil thought that health services should never have any relations with private information such as nationality and HIV status. Thus, Brazil has a long term treatment program aimed not only for nationals but also for non-nationals, documented and undocumented, residing or visiting Brazil. According to Brazil, it is impossible for one country to fall into bankruptcy just because of the inclusion of treatment for migrants in their national budget.
All countries have to remember that all UN member states were signed on to the International Health Regulations which does not single out any diseases, including HIV. This regulation must be the baseline of advocacy for treatment provision in the country. Influential countries such as USA and China should take on the leadership on this regard and be a good role model for other countries when they actually eliminate the restrictions.
PLHIV have to be able to work in order to enable them accessing treatment. Denial of work permit and visa will only limit their access to work and source of income which affecting their health conditions.
What are the concrete actions that government, CSOs and International Organisations can do in the next year to further the elimination of HIV-related restrictions?
Government should revisit the restriction policy with better understanding that by implementing the restrictions, they do not remotely protect their nationals because HIV is not a foreign problem. The review also has to be based on empirical and better data collection, sharing experience and separating health services from the immigration control. Especially for EU countries, there is a need to focus on the Czech Republic since this country is going to the opposite direction. The government and regional authorities have to take the lead in removing the restrictions within the region. Since EU countries endorsed the UNAIDS recommendations regarding travel restrictions, a significant step towards Czech Republic need to be taken.
Additional steps to engage broader range of stakeholders than just HIV-focused organisations is necessary. Particularly engagement with Human Rights-based organisations who can work together to hold the government accountable is highly suggested because HIV now had overlapped with a lot of other issues outside health.
Multi-pronged strategy that looks at building internal and external pressure on eliminating the restrictions is recommended. Political will and leadership from the government is essential.
The policies on access to treatment for immigrants need to be strengthened both by governments and NGOs. CSOs and NGOs should advocate on integrating HIV prevention and treatment into the agenda of strong migrants’ organisations in the countries of destination as well as advocating for inclusion of migrants and mobile populations into the agenda of National HIV/AIDS Prevention in the sending countries. Apart from that, government should conduct training on HIV/AIDS and the impact of travel restrictions to Immigration Officials in order to raise awareness.
What can we do to make sure that we achieve some of the points mentioned?
- Global Fund as a major funding agency could encourage grants to extent access to services for people on the move.
- Stop ignoring the evidence and use them strategically to impact at critical moment in political mobilisations.
- Engage Trade Unions and employers’ organisations. Link up with the upcoming International Labour Conference which theme is “HIV/AIDS in the World of Work”. Migrants and mobile populations should be specifically included in the documents for the conference.
- Build and raise awareness on separating health services and immigration control.
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