1

Malu S. MarinAction for Health Initiatives

(ACHIEVE), Inc./CARAM-Asia

Return and reintegration: Towards a comprehensive response to HIV

positive migrants

2

Context

• Mandatory HIV testing among migrant workers (pre-departure and onsite requirement)

• Denial of entry, employment and stay• In the Asian region, there are an estimated 55.6 million migrants, representing

29.6% of the total migrants in the world (UNDP HDR 2009). • In 2005, the estimated top three migrant-sending countries situated in Asia:

– China (35.0 million) – India (20.0 million) – Philippines (7.0 million)

• Continued incidence of HIV cases among migrant workers, especially in Asia (Bangladesh, Philippines, Pakistan, Indonesia)

• In 2008, the AIDS Commission Report noted that migration and mobility are among the driving factors in several of Asia’s HIV epidemics.

Action for Health Initiatives (ACHIEVE), Inc.

3

Conditions of HIV+ Migrants Upon Return

Economic Declared “unfit” to work abroad Lack of local employment opportunities Lack of or depletion of savings No reintegration programs in place High cost of living and health care

Action for Health Initiatives (ACHIEVE), Inc.

4

Social

“Fall from grace” (relationship with partner/spouse and children affected; family expectations of economic support)

Social stigma and discrimination (peers, community) Isolation, marginalization (unable to disclose) Self-policing in terms of social relationships

Conditions of HIV+ Migrants Upon Return

Action for Health Initiatives (ACHIEVE), Inc.

5

Psychological

Depression, suicidal thoughts, anger Resignation and fatalism Self-blame esp. if the spouses/partner is also infected Fear of being found out and stigmatized Constant fear of the future, esp. for children

Conditions of HIV+ Migrants Upon Return

Action for Health Initiatives (ACHIEVE), Inc.

6

Access to treatment and services

• Circumstances of return affect level of access– Deportation (as a result of compulsory testing) means lost

opportunity for interventions and referrals• Stigma and discrimination– Being a migrant, HIV status is a source of shame– Renewed calls for compulsory testing for returning migrants

• No specific treatment programmes for migrants, because as citizens, they fall within the national HIV programme.

• Unwillingness to return because of fear that treatment may not be available.

Action for Health Initiatives (ACHIEVE), Inc.

7

Main Challenges

• No comprehensive and sustainable reintegration programmes for returning HIV+ migrant workers– Economic– Social – Psychosocial and mental – Treatment access (limited, different treatment regimen from

other countries, access to second and third line drugs) • Need to address community preparedness towards

returning HIV+ migrants.

Action for Health Initiatives (ACHIEVE), Inc.

8

Proposed Actions

• Support formation of + migrant support groups, if needed. Build capacity and facilitate scaling up of their involvement in the response.

• Integrate migration issues into the National HIV response (prevention and TCS).

• Pursue regional and global action to address issues of deportation of HIV+ migrants and access to treatment care and support.

Action for Health Initiatives (ACHIEVE), Inc.

9Action for Health Initiatives (ACHIEVE), Inc.