Spain: Stigmatisation and bureaucratic barriers for LGBT migrants trying to exercise their right to health in Madrid.

Translated with Google translate. For original article in Spanish, please scroll down. 

“I have been treated like garbage”: when discrimination against LGTBI migrants also creeps into health.

The COGAM collective denounces the stigmatization and bureaucratic barriers that these people face when trying to exercise their right to health in Madrid. ‘Infobae’ talks to a young Venezuelan who has applied for asylum in Spain.

The LGTBI collective continues to be the subject of harassment and violence around the world, a particularly complicated situation in some Latin American countries, where they live in a reality marked by homicides, attacks and discrimination. This is what happened in Venezuela to K.C., a 33-year-old homosexual man who suffered a rape “perpetrated by a policeman” in 2016 from which he is still trying to recover. Due to that aggression for which he contracted HIV and that caused him a state of tension and permanent fear, he decided to leave and settle in Colombia, where he lived until July last year, when he moved to Spain. The reason why K.C. (fictitious name) left this second country is because he met one of his aggressors and was not willing to live in fear.

“The first shock I had in the consultation is that they spoke to me in a very derogatory way when I just wanted to advise me, because I still didn’t know how things worked here. A doctor asked me what my nationality was, when in reality it was not a relevant fact, but she gave me to understand that we were the foreign people who brought the diseases to Spain,” this young man explains to Infobae. “Being a migrant does not mean that we have no rights,” he criticizes.
K.C. claims to have felt stigmatized both “for being Latino and for his HIV diagnosis.” “The doctors don’t listen to me and make me feel like I’m stealing the medical care that should be for Spaniards. I’ve been treated like trash and I only go to the health center when I have an emergency because I don’t want to feel humiliated,” he says. In addition, he mentions wrong diagnoses and inadequate treatments that, far from improving his condition, have aggravated his health: “I know I accessed health care, but at what cost?” he asks himself.
The only time he has been properly cared for, he says, was when he went to the Sandoval medical center, the only one in Madrid specialized in the prevention, diagnosis and treatment of sexually transmitted infections. This young man also assures that in Spain is where he has really “been aware of his skin color,” because he lives episodes of racism every day, especially when he goes to the supermarket or when he travels by subway.

COGAM’s complaint

Like K.C., there are many LGTBI+ migrants for whom access to public health continues to be a challenge in the region, as denounced by the Collective of lesbians, gays, transsexuals and bisexuals of Madrid (COGAM), which criticizes “discrimination, stigmatization and bureaucratic barriers that these people face daily when trying to exercise their fundamental right to health.” The difficulties, they assure, not only respond to the lack of administrative regularization, but also “to the dehumanizing treatment and the lack of empathy in primary care centers and hospitals,” as this is reflected in some of the testimonies collected by the organization, which show “stigmatization by nationality, sexual orientation, gender identity and serological status“.

This is the case of Nicolás Henríquez, a 28-year-old Chilean, who denounces the lack of access to preventive treatments such as the pre-exposure prophylaxis pill or PrEP, which is taken to reduce the chances of contracting HIV infection, due to bureaucratic delays: “I wanted to start PrEP, but they didn’t give me an appointment until five months later. I was finally diagnosed with HIV, something that I could perhaps avoid if I had been treated before,” he says.

The situation is also complicated for Vitória Ribeiro, a 27-year-old Brazilian student, because the private insurance required for her visa, she explains, “is very expensive and inefficient,” so that if something happens to her outside of business hours, “she cannot receive help.” “This generates constant concern and anxiety in me.”

For all this, from COGAM they demand that the Madrid health authorities guarantee “real and universal access to public health for all people, regardless of their migratory status or identity,” as well as combating stigma and discrimination through awareness programs and training of medical personnel.

Another of the collective’s claims is the specific training for health personnel in terms of LGTBI+ diversity and care for migrants and they ask that access to preventive and specific treatments, such as PrEP and antiretrovirals, be facilitated, “without bureaucratic obstacles.” The health system, they conclude, “must be a safe space where anyone receives dignified and quality care.”

“Me han tratado como basura”: cuando la discriminación hacia las personas migrantes LGTBI también se cuela en la sanidad.

El colectivo COGAM denuncia la estigmatización y barreras burocráticas a las que se enfrentan estas personas al intentar ejercer su derecho a la salud en Madrid. ‘Infobae’ habla con un joven venezolano que ha solicitado asilo en España.

El colectivo LGTBI sigue siendo objeto de acoso y violencia en todo el mundo, una situación especialmente complicada en algunos países de América Latina, donde viven una realidad marcada por homicidios, ataques y discriminación. Así le ocurrió en Venezuela a K.C., un hombre homosexual de 33 años que sufrió una violación “perpetrada por un policía” en 2016 de la que aún trata de recuperarse. Debido a esa agresión por la que contrajo VIH y que le provocó un estado de tensión y miedo permanente, decidió marcharse e instalarse en Colombia, donde vivió hasta julio del año pasado, cuando se trasladó a España. El motivo por el que K.C. (nombre ficticio) se marchó de este segundo país es porque se encontró con uno de sus agresores y no estaba dispuesto a vivir atemorizado.

En Madrid, donde reside desde hace ocho meses y ha solicitado asilo por razones humanitarias, se encuentra más seguro, pero también ha atravesado enormes dificultades para acceder a la sanidad pública, barreras que acaban afectando a su bienestar físico y emocional, perpetuando situaciones de desigualdad y vulnerabilidad.

“El primer choque que tuve en la consulta es que me hablaron de forma muy despectiva cuando solo quería asesorarme, porque aún no sabía cómo funcionaban las cosas acá. Una doctora me preguntó cuál era mi nacionalidad, cuando en realidad no era un dato relevante, pero me dio a entender que éramos las personas extranjeras quienes traíamos las enfermedades a España”, explica a Infobae este joven. “Ser migrante no significa que no tengamos derechos”, critica.

K.C. asegura haberse sentido estigmatizado tanto “por ser latino como por su diagnóstico de VIH”. “Los médicos no me escuchan y me hacen sentir como si estuviera robando la atención médica que debería ser para españoles. Me han tratado como una basura y ya solo acudo al centro de salud cuando tengo una urgencia porque no quiero sentirme humillado”, relata. Además, menciona diagnósticos erróneos y tratamientos inadecuados que, lejos de mejorar su estado, han agravado su salud: “Sé que accedí a la sanidad, pero ¿a qué costo?”, se pregunta.

La única vez que le han atendido adecuadamente, sostiene, fue cuando acudió al centro médico Sandoval, el único en Madrid especializado en la prevención, diagnóstico y tratamiento de las infecciones de transmisión sexual. Este joven también asegura que en España es donde realmente “ha sido consciente de su color de piel”, porque vive a diario episodios de racismo, especialmente cuando va al supermercado o cuando viaja en metro.

Denuncia de COGAM

Al igual que K.C., son muchas las personas migrantes LGTBI+ para las que el acceso a la sanidad pública continúa siendo un desafío en la región, tal y como ha denunciado el Colectivo de lesbianas, gais, transexuales y bisexuales de Madrid (COGAM), que critica “la discriminación, estigmatización y barreras burocráticasque enfrentan estas personas a diario al intentar ejercer su derecho fundamental a la salud”. Las dificultades, aseguran, no solo responden a la falta de regularización administrativa, sino también “al trato deshumanizante y la falta de empatía en centros de atención primaria y hospitales”, pues así lo reflejan algunos de los testimonios que ha recogido la organización, que evidencian “estigmatización por nacionalidad, orientación sexual, identidad de género y estado serológico“.

Es el caso de Nicolás Henríquez, chileno de 28 años, denuncia la falta de acceso a tratamientos preventivos como la pastilla de profilaxis preexposición o PrEP, que se toma para reducir las posibilidades de contraer la infección por VIH, debido a retrasos burocráticos: “Quise iniciar la PrEP, pero no me dieron cita hasta cinco meses después. Finalmente fui diagnosticado con VIH, algo que quizá pude evitar si me hubieran atendido antes”, relata.

La situación también es complicada para Vitória Ribeiro, estudiante brasileña de 27 años, pues el seguro privado exigido para su visado, explica, “es muy caro y poco eficiente”, de forma que si le ocurre algo fuera del horario de atención, “no puede recibir ayuda”. “Esto me genera una constante preocupación y ansiedad”.

Por todo ello, desde COGAM reclaman a las autoridades sanitarias madrileñas que garanticen “un acceso real y universal a la sanidad pública para todas las personas, independientemente de su estatus migratorio o identidad”, así como combatir el estigma y la discriminación a través de programas de sensibilización y formación del personal médico.

Otro de los reclamos del colectivo es la formación específica para el personal sanitario en materia de diversidad LGTBI+ y atención a personas migrantes y piden que se facilite el acceso a tratamientos preventivos y específicos, como la PrEP y los antirretrovirales, “sin trabas burocráticas”. El sistema sanitario, concluyen, “debe ser un espacio seguro donde cualquier persona reciba atención digna y de calidad”.

Colombia: USAID Suspension cuts off lifesaving HIV medications for migrants

Translated with Deepl.com – Scroll down for original article in Spanish

Migrants with HIV in Colombia and others affected by the USAID suspension.

Undocumented Venezuelan migrants with HIV are facing a difficult situation: due to the suspension of USAID funds, they are unable to receive essential medicines from the organisations that used to provide them. The NGO Red Somos, for example, had to retain 3,000 units of medicines, as they are not yet authorised to deliver them.

In Soacha, Bogotá, Alfredo*, a doctor, says he is overwhelmed with work. ‘There is a collective fear,’ he says. ‘People believe they are going to run out of HIV medication, and the worst thing is that yes, they are at risk.’

The people Alfredo is referring to are Venezuelan migrants in an irregular situation, who do not have valid and current documentation to be in Colombia. He works for Red Somos, a non-profit organisation that provides support to this population with HIV. But since 20 January — on his first day in office — US President Donald Trump suspended funding for international cooperation, that humanitarian aid was left hanging by a thread: its main funder for medical care and delivery of treatments was the United States Agency for International Development (USAID).

In the face of the 90-day suspension of that agency, notice was given to stop all activities, including the delivery of medicines. In the words of Miguel Barriga, director of the Somos Network, this means putting at risk 350 Venezuelan migrants in an irregular situation who can only access medication through this NGO in Soacha, Bogotá and Barranquilla. Of those 350 people, Barriga says that 104 are in very advanced stages of HIV and require prioritisation. All of them receive antiretroviral drugs, which reduce the burden of the virus in the body, allowing patients a better quality of life. Some even manage to lower the virus load in their body.

Although Venezuelan migrants in an irregular situation can go to a Colombian health centre in the event of a life-threatening emergency, this does not apply to complex treatments such as cancer or HIV. Donna Catalina Cabrera Serrano, lecturer and researcher in international migration at the Javeriana University, explains it in simple terms: only those who have a PPT (Temporary Protection Permit), which is linked to the Temporary Protection Statute for Venezuelans (ETPV), as well as those who have a visa or dual Colombian nationality with their respective valid citizenship card, can access it.

‘The main response to undocumented migrants living with HIV is provided by international cooperation,’ adds Barriga.

In addition, the Somos Network has 3,000 bottles of antiretrovirals that correspond to the last donation made by USAID with an expiration date of October 2025, as well as 125 bottles of Dolutegravir that expire in July of the same year. The latter medicine is recognised as one of the most modern for treating the virus. ‘Although we have the medicine in storage, we cannot deliver it given the 90-day suspension. Normally, we supply patients with three months‘ worth of medication and, on some occasions, two months’ worth. The people with three months‘ worth will arrive at our headquarters on or around 28 February looking for their dose, and there is a risk as to how we are going to deliver it to them’, explains Barriga.

The Somos Network also delivers another type of medication, called PrEP (Pre-Exposure Prophylaxis), aimed at people who do not have HIV but who are at high risk of contracting it. ‘Some of the migrants who depend on our PrEP deliveries are in a highly vulnerable situation, as they engage in sex work or transactional sex in order to make a profit,’ says Barriga.

This NGO is able to provide this medication to 250 people for a month thanks to another of its sponsors, the French Development Agency (AFD), but Barriga emphasises that this is not enough to meet current demand. ‘We have not received an official response from USAID as to what to do with the medication we have there, or how to guarantee coverage for our other patients. We are looking for other donors to ensure treatment,’ explains Barriga.

For now, an interruption in antiretroviral drugs would have serious consequences not only for patients, but also for public health. Miguel Ángel López, from the organisation Más que tres letras (More than three letters) – which is dedicated to educating and accompanying people living with the virus in Colombia – points out that ‘the most serious risk is that the viral load of the virus will increase in their bodies, and this can happen in months, weeks or even days’. In his words, this could lower the patients’ defences, increase their susceptibility to acquiring other diseases, or make them transmitters of the virus again, which would lead to an increase in cases and a direct impact on public health.

But, according to López, another consequence is that, faced with the abrupt pause, the person develops pharmacological resistance to the medication they were already taking. ‘It doesn’t always happen, but there is that risk. If it does happen, it means that the patient has to access other, more complex medications, which are not always available or are much more expensive,’ says López.

In our country, according to a study carried out in 2022 by the US university John’s Hopkins, the Ministry of Health and the Somos Network, there are 22,500 Venezuelans living with HIV. Of that number, 8,500 people receive treatment through the Colombian health system and international cooperation.

An international mess

At the same time as the suspension of USAID was announced, another of the US government’s major programmes, the US President’s Emergency Plan for AIDS Relief (PEPFAR), also ran the risk of being suspended. After organisations such as the World Health Organisation (WHO) and UNAIDS sounded the alarm, the US government backed down and applied an exemption for the programme so that its services would not be interrupted. However, according to a statement issued by the deputy executive director of UNAIDS, Christine Sterling, there is a lack of clarity about the future of the plan’s funds, which could have a negative impact on the people who benefit from PEPFAR.

According to the WHO, the programme has saved more than 26 million lives and provided treatment to another 20 million people living with HIV, including 566,000 children under the age of 15. Currently, the UN/AIDS deputy executive director explained, 20 million of the more than 30 million people living with HIV worldwide depend on US funding for their treatment. ‘If PEPFAR is not reauthorised between 2025 and 2029 and no other resources are found for the HIV response, there would be a 400% increase in AIDS deaths,” the agency calculated.

This fund sends its money to various US agencies, including the Centers for Disease Control (CDC) and USAID. In turn, these agencies have fund managers all over the world who hire local implementers. In the case of Red Somos, they had contact with Family Health International (FHI 360), which is a USAID implementer. ‘That is why we are in a state of uncertainty: although there is an exemption from PEPFAR, our resources for HIV treatments come from that programme through USAID,” explains Barriga.

Along the same lines, the International AIDS Society (IAS) also raised its voice and stated in a press release issued on 6 February that “although an exemption was subsequently granted for ” vital humanitarian assistance’, which included HIV testing and treatment and, to a limited extent, HIV prevention in pregnant women, many PEPFAR-funded clinics had already closed, staff were sent home and confusion persists. The future of PEPFAR is now uncertain, and more than 20 million people are at risk of losing access to life-saving medicines.

Although PEPFAR does not have a direct impact in Colombia, in 2019 the programme donated antiretroviral drugs to support HIV/AIDS treatment for Venezuelan migrants in our territory. ‘And, two years ago, PEPFAR entered the country to contribute to the situation of irregular migrants through USAID,’ says Barriga.

Barriers within the system

Donna Catalina Cabrera Serrano, from the Javeriana University, explains that, currently, migrants in an irregular situation can apply for valid legal documentation in several ways: by applying for a visa or refugee status, and through PEP-TUTOR, which is only available to carers or parents of children and adolescents who have temporary protection permits. Another alternative is to demonstrate a situation of risk that could give them refugee status. ‘For this, when a person is living with HIV, they must demonstrate that their life is at risk and that they came to Colombia due to a lack of guarantees for their health,’ explains Barriga.

On the other hand, Jorge Luis Díaz, technical director for Latin America of Aid For Aids (AFA), the non-profit organisation that attends to the largest number of irregular Venezuelan migrants in our country, explains that there are some difficulties for those who come from the neighbouring country to obtain valid documentation. For example, currently the Colombian visa with visitor status includes a modality for Venezuelans, but only those who have legally entered the territory can apply.

‘Another barrier is that not everyone has a valid passport, as it is very expensive to obtain one in Venezuela. In addition, there is a group of people who started the regularisation process but did not complete it,’ says the director. Díaz also points out that, even with their documentation in order, Venezuelan migrants can face difficulties in accessing the health system. Many, lacking the ability to pay, seek to enter the subsidised regime, which requires completion of the survey of the System for the Identification of Potential Beneficiaries of Social Programmes (SISBEN), which classifies the population according to their living conditions and income.

One of the requirements of the form is to have a fixed address, ‘and many migrants do not have a rental contract, but live temporarily in guesthouses, shelters, and hotels. For this reason, they can be left out of the system. Furthermore, entering the system does not guarantee the timely delivery of antiretroviral treatment, which can take between three and six months. Nor does it imply permanence: those who enter the contributory regime must demonstrate their ability to pay, which is not always possible because some have unstable jobs,’ explains Díaz.

For now, in the words of Barriga, the suspension of USAID support and the uncertainty about PEPFAR generate a high risk: although the Somos Network guarantees treatment for 350 people, they are part of the group of 4,500 irregular migrants who depend exclusively on international cooperation to receive HIV treatments.

Migrantes con VIH en Colombia, otros de los afectados por la suspensión de USAID

Los migrantes venezolanos en situación irregular que tienen VIH están enfrentándose a una situación difícil: debido a la suspensión de fondos de USAID, no pueden recibir medicamentos esenciales de las organizaciones que se los daban. La ONG Red Somos, por ejemplo, tuvo que retener 3 mil unidades de medicinas, pues aún no les autorizan a entregarlas.

En Soacha, Bogotá, Alfredo*, médico, dice que está desbordado de trabajo. “Hay susto colectivo”, comenta. “Las personas creen que se van a quedar sin medicamentos para el VIH, y lo peor es que sí, están en riesgo”.

Las personas a las que Alfredo se refiere son migrantes venezolanos en situación irregular, que no cuentan con documentación válida y vigente para estar en Colombia. Él trabaja para la Red Somos, una organización sin ánimo de lucro que brinda apoyo a esta población con VIH. Pero desde que el 20 de enero —en su primer día en el cargo— el presidente de Estados Unidos, Donald Trump, suspendió los fondos para cooperación internacional, esa ayuda humanitaria quedó en la cuerda floja: su principal financiador para la atención médica y entrega de tratamientos era la Agencia de los Estados Unidos para el Desarrollo Internacional (USAID).

Ante la suspensión de 90 días de esa agencia, se dio aviso de parar todas las actividades, incluyendo la entrega de medicamentos. En palabras de Miguel Barriga, director de la Red Somos, esto implica poner en riesgo a 350 migrantes venezolanos en condición irregular que solo pueden acceder a la medicación a través de esta ONG en Soacha, Bogotá y Barranquilla. De esas 350 personas, Barriga cuenta que 104 se encuentran en fases muy avanzadas de VIH y requieren priorización. Todos ellos reciben medicamentos antirretrovirales, que se encargan de reducir la carga del virus en el organismo, permitiéndoles una mejor calidad de vida a los pacientes. Algunos, incluso, logran bajar las cargas del virus en su cuerpo.

Aunque los migrantes venezolanos en condición irregular sí pueden acudir a un centro de salud colombiano ante una situación de emergencia que amenace su vida, eso no aplica para tratamientos complejos, como el cáncer o el VIH. Donna Catalina Cabrera Serrano, docente e investigadora en migración internacional de la Universidad Javeriana, lo explica en términos sencillos: solo pueden acceder aquellos que cuenten con PPT (Permiso de Protección Temporal), que está vinculado al Estatuto Temporal de Protección para Venezolanos (ETPV), además de quienes tengan visa o doble nacionalidad colombiana con su respectiva cédula de ciudadanía vigente.

“La respuesta principal a migrantes indocumentados que viven con VIH la brinda la cooperación internacional”,añade Barriga.

Además, la Red Somos tiene 3.000 frascos de antirretrovirales que corresponden a la última donación realizada por USAID con fecha de vencimiento a octubre de este 2025, así como 125 frascos de Dolutegravir que vencen en julio de ese mismo año. Esta última medicina es reconocida por ser una de las más modernas para tratar el virus. “Aunque tenemos el medicamento en bodega, no lo podemos entregar dada la suspensión de 90 días. Normalmente, suministramos a los pacientes con medicamentos para tres meses y, en algunas ocasiones, para dos. Las personas de 3 meses llegarán aproximadamente el 28 de febrero a nuestra sede en busca de su dosis, y está en riesgo el cómo vamos a hacerles entrega”, explica Barriga.

La Red Somos también entrega otro tipo de medicamentos, llamados PrEP (Profilaxis Pre Exposición), dirigidos a personas que no tienen VIH pero que están en alto riesgo de adquirirlo. “Algunos de los migrantes que dependen de nuestras entregas de PrEP se encuentran en alta situación de vulnerabilidad, pues ejercen el trabajo sexual o el sexo transaccional para adquirir algún beneficio”, cuenta Barriga.

Esa ONG tiene capacidad para entregar esta medicación a 250 personas durante un mes gracias a otro de sus patrocinadores, la Agencia Francesa para el Desarrollo (AFD), pero Barriga hace énfasis en que esto no es suficiente para cubrir su demanda actual. “No hemos conocido una respuesta oficial por parte de USAID para saber qué hacer con los medicamentos que tenemos ahí, o cómo garantizar la cobertura de nuestros demás pacientes. Estamos buscando otros donantes para asegurar el tratamiento”, explica Barriga.

Por ahora, una interrupción en los medicamentos antirretrovirales tendría unas graves consecuencias no solo en los pacientes, sino también en la salud pública. Miguel Ángel López, de la organización Más que tres letras -que se dedica a hacer pedagogía y acompañamiento a personas que viven con el virus en Colombia- señala que “el riesgo más grave es que la carga viral del virus aumente en sus organismos, y esto puede ocurrir en meses, semanas o, incluso, días”. En sus palabras, esto podría bajar las defensas de los pacientes, aumentar su susceptibilidad para adquirir otras enfermedades, o hacerlos nuevamente transmisores del virus, lo que conllevaría a un aumento de casos y un impacto directo en la salud pública.

Pero, según López, otra consecuencia es que, ante la pausa abrupta, la persona desarrolle resistencia farmacológica a la medicación que ya estaba tomando. “No siempre pasa, pero se corre ese riesgo. En caso de que sí suceda, eso implica que el paciente deba acceder a otros medicamentos más complejos, que no siempre están disponibles o que son mucho más caros”, afirma López.

En nuestro país, según un estudio realizado en 2022 por la universidad estadounidense John’s Hopkins, el Ministerio de Salud y la Red Somos, hay 22.500 venezolanos que viven con VIH. De esa cantidad, 8.500 personas reciben tratamiento mediante el sistema de salud colombiano y la cooperación internacional.

Un lío internacional

Al mismo tiempo que se declaraba la suspensión de USAID, otro de los grandes programas del gobierno de Estados Unidos, el Plan de Emergencia del Presidente de los Estados Unidos para el Alivio del SIDA (PEPFAR, por sus siglas en inglés), también corrió el riesgo de ser suspendido. Luego de que entidades como la Organización Mundial de la Salud (OMS) y ONU/SIDA prendieran las alarmas, el Gobierno de Estados Unidos reculó y aplicó una exención para ese programa, para que así no se interrumpieran sus servicios. Sin embargo, de acuerdo con un comunicado emitido por la subdirectora ejecutiva de ONU/SIDA, Christine Sterling, hay una falta de claridad sobre el futuro de los fondos del plan, lo cual podría tener un impacto negativo en las personas que se benefician de PEPFAR.

Según la OMS, ese plan ha salvado más de 26 millones de vidas y ha proporcionado tratamiento a otros 20 millones que viven con VIH, incluidos 566.000 menores de 15 años. En la actualidad, explicó la subdirectora ejecutiva de ONU/SIDA, 20 millones, de los más 30 millones de personas que viven con VIH en el mundo, dependen del dinero que gira Estados Unidos para su tratamiento. “Si el PEPFAR no se volviera a autorizar entre 2025 y 2029 y no se encontraran otros recursos para la respuesta al VIH, se produciría un aumento del 400 % en las muertes por SIDA”, calculó la agencia.

Este fondo envía su dinero a varias agencias de Estados Unidos, entre ellas los Centros de Control para las Enfermedades (CDC, por sus sigla en inglés) y USAID. A su vez, estas agencias tienen administradores de fondos que están en todo el mundo y que contratan implementadores locales. En el caso de Red Somos, ellos tenían contacto con Family Health International (FHI 360), que es una implementadora de USAID. “Por eso estamos en una incertidumbre: aunque está la exención a PEPFAR, nuestros recursos para los tratamientos de VIH provienen de ese programa a través de USAID”, especifica Barriga.

Por la misma línea, la Sociedad Internacional del Sida (IAS, por sus siglas en inglés), también levantó la voz y declaró en un comunicado emitido el pasado 6 de febrero que “aunque posteriormente se otorgó una exención para la “asistencia humanitaria vital”, que incluyó las pruebas y el tratamiento del VIH y, de manera limitada, la prevención del VIH en mujeres embarazadas, muchas clínicas financiadas por PEPFAR ya habían cerrado, el personal fue enviado a casa y la confusión persiste. El futuro de PEPFAR es ahora incierto, y más de 20 millones de personas corren el riesgo de perder acceso a medicamentos que salvan vidas.

Aunque PEPFAR no tiene impacto directo en Colombia, en 2019 ese programa donó medicamentos antirretrovirales para apoyar el tratamiento del VIH/SIDA a los migrantes venezolanos que se encontraban en nuestro territorio. “Y, hace dos años, PEPFAR ingresó al país para aportar a la situación de los migrantes irregulares a través de USAID”, dice Barriga.

Barreras dentro del sistema

Donna Catalina Cabrera Serrano, de la Universidad Javeriana, cuenta que, actualmente, los migrantes en condición irregular pueden solicitar documentación legal vigente por varias vías: mediante la solicitud de una visa o refugio, y a través del PEP-TUTOR, que solo está disponible para cuidadores o padres de niños, niñas y adolescentes que tengan PPT. Otra alternativa es que se demuestre una situación de riesgo que les pueda dar el estatus de refugiados. “Para esto, cuando una persona vive con VIH, se debe demostrar que está en riesgo su vida y que vino a Colombia por falta de garantías para su salud”, explica Barriga.

Por otro lado, Jorge Luis Díaz, director técnico para Latinoamérica de Aid For Aids (AFA), -la organización sin ánimo de lucro que atiende mayor cantidad de migrantes irregulares venezolanos en nuestro país-, explica que existen algunas dificultades para que quienes provienen del vecino país obtengan documentación vigente. Por ejemplo, actualmente el visado colombiano con categoría de visitante incluye una modalidad para personas venezolanas, pero solo pueden aplicar quienes hayan ingresado legalmente al territorio.

“Otra barrera es que no todos tienen pasaporte vigente, ya que obtenerlo en Venezuela es muy costoso. Además, hay un grupo de personas que iniciaron el proceso de regularización, pero no lo completaron”, cuenta el director. Díaz también señala que, incluso con la documentación en regla, los migrantes venezolanos pueden enfrentar dificultades para acceder al sistema de salud. Muchos, al no contar con capacidad de pago, buscan ingresar al régimen subsidiado, lo que requiere completar la encuesta del Sistema de Identificación de Potenciales Beneficiarios de Programas Sociales (SISBEN), que clasifica a la población según sus condiciones de vida e ingresos.

Uno de los requisitos del formulario es tener un domicilio fijo, “y muchos migrantes no cuentan con un contrato de alquiler, sino que viven temporalmente en pensiones, refugios, y hoteles. Por este motivo, pueden quedar por fuera del sistema. Además, ingresar no garantiza la entrega oportuna de tratamiento antirretroviral, que puede tardar entre tres y seis meses. Tampoco implica permanencia: quienes entran al régimen contributivo deben demostrar capacidad de pago, que no siempre es posible porque algunos tienen trabajos inestables”, explica Díaz.

Por ahora, en palabras de Barriga, la suspensión del apoyo de USAID y la incertidumbre sobre PEPFAR generan un riesgo alto: aunque la Red Somos garantiza tratamiento para 350 personas, estas hacen parte del grupo de 4.500 migrantes irregulares que dependen exclusivamente de la cooperación internacional para recibir tratamientos del VIH.

France: Proposed immigration reform could leave thousands without vital treatment

Will foreigners in France have the right to stay for healthcare in 2025?

Translated with Google. Scroll down for original article in French.

In France, while thousands of seriously ill foreigners benefit from this residence permit every year to access treatments unavailable in their country of origin, a bill brought by Les Républicains (LR) wants to abolish it.

The stay for care is a device introduced in France in the late 1990s to allow foreigners with serious and incurable diseases to stay on the territory in order to receive care unavailable in their country of origin. This device was initially designed for people with HIV, before spreading to other chronic diseases such as diabetes, hepatitis, kidney failure or certain rare diseases.

Today, this right is threatened. A bill tabled by the Republicans (LR) group aims to abolish it. It will be examined in the National Assembly on February 6, 2025 as part of a “parliamentary niche” reserved for LR. This text arouses strong opposition from patients’ and human rights associations, who denounce an unfair reform with potentially fatal consequences for thousands of people.

Supporters of this bill believe that the stay for care is a factor of “migrational air call”. According to them, some foreigners would voluntarily come to France to benefit from medical care, thus representing too high a cost for public finances.

According to the figures put forward by the authors of the text, about 30,000 foreigners currently benefit from this residence permit, counting new beneficiaries and renewals. They consider this figure to be excessive and call for a redesign of the system to limit its access.

However, associations for the defense of the sick and the rights of foreigners refute these claims. According to them, in 2023, only 3,169 people obtained a first residence permit for care, a figure down 25.5% compared to 2021. They point out that the vast majority of beneficiaries have already been present in France for a long time and are not newcomers attracted by this device.

If the bill were to be adopted, thousands of foreign patients would risk being expelled to countries where they could not be properly treated. The risk is then twofold:

  1. A death sentence for certain patients, especially those with pathologies requiring heavy and continuous medical treatment, such as those with renal insufficiency who need regular dialysis.
  2. A deferral of applications to State Medical Assistance (AME), a partial coverage of care for foreigners in an irregular situation, whose access is already complex and restricted. This could further enclog the health care system and complicate the management of the most vulnerable patients.

Associations such as France Assos Santé, AIDES, SOS Hépatites, the French Federation of Diabetices and others, denounce an inhumane measure and a serious violation of the right to health. They also warn of risks to public health, as depriving patients of essential care could promote the spread of diseases and increase the burden on hospital emergencies.

On February 6, 2025, the bill will be considered in the National Assembly, but its future is uncertain. The Law Committee already rejected it on January 29, and it is in eighth position on the agenda of LR’s parliamentary niche, which significantly reduces its chances of being debated and adopted.

However, this project illustrates a broader tendency to tighten the conditions of access of foreigners to care in France. For several years, State Medical Assistance (AME) and nursing home have been in the crosshairs of several conservative political currents, which see it as an excessive financial burden and a factor of migratory attractiveness.

The outcome of the February 6 vote will therefore be an important indicator of the future orientations of health and immigration policy in France. Between humanity and budgetary rigour, the government will have to decide: will the protection of foreign patients remain a health and ethical priority, or will it give way to political and economic pressures?

Les étrangers en France auront-t-ils droits au séjour pour soins en 2025 ?

En France, alors que des milliers d’étrangers gravement malades bénéficient chaque année de ce titre de séjour pour accéder à des traitements indisponibles dans leur pays d’origine, une proposition de loi portée par Les Républicains (LR) veut le supprimer.

Le séjour pour soins est un dispositif instauré en France à la fin des années 1990 pour permettre aux étrangers atteints de maladies graves et incurables de rester sur le territoire afin de recevoir des soins indisponibles dans leur pays d’origine. Ce dispositif a été initialement conçu pour les personnes atteintes du VIH, avant de s’étendre à d’autres maladies chroniques comme le diabète, l’hépatite, l’insuffisance rénale ou encore certaines maladies rares.

Aujourd’hui, ce droit est menacé. Une proposition de loi déposée par le groupe Les Républicains (LR) vise à le supprimer. Elle sera examinée à l’Assemblée nationale le 6 février 2025 dans le cadre d’une “niche parlementaire” réservée à LR. Ce texte suscite une vive opposition de la part des associations de patients et de défense des droits humains, qui dénoncent une réforme injuste aux conséquences potentiellement mortelles pour des milliers de personnes.

Les partisans de cette proposition de loi estiment que le séjour pour soins est un facteur d’“appel d’air migratoire”. Selon eux, certains étrangers viendraient volontairement en France pour bénéficier d’une prise en charge médicale, représentant ainsi un coût trop élevé pour les finances publiques.

D’après les chiffres avancés par les auteurs du texte, environ 30 000 étrangers bénéficieraient actuellement de ce titre de séjour, en comptant les nouveaux bénéficiaires et les renouvellements. Ils considèrent ce chiffre comme excessif et appellent à une refonte du dispositif pour limiter son accès.

Cependant, les associations de défense des malades et des droits des étrangers réfutent ces affirmations. Selon elles, en 2023, seulement 3 169 personnes ont obtenu un premier titre de séjour pour soins, un chiffre en baisse de 25,5 % par rapport à 2021. Elles soulignent que la grande majorité des bénéficiaires sont déjà présents en France depuis longtemps et ne sont pas des nouveaux arrivants attirés par ce dispositif.

Une suppression aux conséquences dramatiques

Si la proposition de loi venait à être adoptée, des milliers de malades étrangers risqueraient l’expulsion vers des pays où ils ne pourraient pas être correctement soignés. Le risque est alors double :

  1. Une condamnation à mort pour certains malades, notamment ceux atteints de pathologies nécessitant un traitement médical lourd et continu, comme les insuffisants rénaux qui ont besoin d’une dialyse régulière.
  2. Un report des demandes vers l’Aide médicale d’État (AME), une prise en charge partielle des soins pour les étrangers en situation irrégulière, dont l’accès est déjà complexe et restreint. Cela pourrait engorger encore plus le système de soins et compliquer la gestion des malades les plus vulnérables.

Les associations comme France Assos Santé, AIDES, SOS Hépatites, la Fédération française des diabétiques et d’autres, dénoncent une mesure inhumaine et une atteinte grave au droit à la santé. Elles alertent également sur les risques pour la santé publique, car priver des patients de soins essentiels pourrait favoriser la propagation de maladies et augmenter la charge pesant sur les urgences hospitalières.

Une proposition de loi au destin incertain

Le 6 février 2025, la proposition de loi sera examinée à l’Assemblée nationale, mais son avenir est incertain. La commission des lois l’a déjà rejetée le 29 janvier, et elle est en huitième position dans l’ordre du jour de la niche parlementaire de LR, ce qui réduit considérablement ses chances d’être débattue et adoptée.

Toutefois, ce projet illustre une tendance plus large à durcir les conditions d’accès des étrangers aux soins en France. Depuis plusieurs années, l’Aide médicale d’État (AME) et le séjour pour soins sont dans le collimateur de plusieurs courants politiques conservateurs, qui y voient une charge financière excessive et un facteur d’attractivité migratoire.

L’issue du vote du 6 février sera donc un indicateur important des orientations futures de la politique de santé et d’immigration en France. Entre humanité et rigueur budgétaire, le gouvernement devra trancher : la protection des malades étrangers restera-t-elle une priorité sanitaire et éthique, ou cédera-t-elle face aux pressions politiques et économiques ?

 

Thailand: Exploring the impact of healthcare barriers on Myanmar migrants in Thailand

No Room for Illness: Myanmar Migrants’ Silent Struggle in Thailand

Myanmar refugees in Thailand face hardship and uncertainty, struggling with poverty, discrimination, and the constant fear of deportation, all while their access to healthcare remains limited.

Key Takeaways

  1. Myanmar migrants in Thailand face financial, legal, and language barriers that restrict access to healthcare.
  2. Limited healthcare access for migrants worsens issues like malaria, TB, and maternal health, impacting migrants and Thailand’s healthcare system.
  3. Expanding insurance, improving rural care, addressing language barriers, and ensuring legal protections are vital for migrant health and Thailand’s public health.

As of 2024, over 4.18 million Myanmar migrants reside in Thailand, many in irregular status, working in low-wage sectors like agriculture and construction. These migrants face significant barriers to healthcare, impacting both their well-being and Thailand’s public health system. This article explores the healthcare-seeking behavior of Myanmar migrant workers, the challenges they face, and the broader implications for Thailand’s healthcare system.

1. Background of Migration

Myanmar migrants make up one of Thailand’s most significant foreign worker populations, driven by economic instability, political turmoil, and ethnic conflicts, especially after Myanmar’s 2021 military coup. While 90,000 refugees live in border camps, millions live outside in precarious conditions. Around 1.8 million migrants are in irregular status, facing exploitation and limited access to essential services, including healthcare. Migrants enter Thailand through formal channels like MoU agreements or informal routes. While MoU workers have some legal protections, irregular migrants face significant barriers to healthcare and social services.

2. Current Migrant Healthcare Landscape in Thailand

To understand the migrant healthcare system in Thailand, it is essential to examine the broader landscape of the healthcare system first. While Thailand boasts a dual healthcare system comprising public and private sectors, access to these services remains challenging for many migrants.

2.1 Private Healthcare: Costly and Out of Reach

Thailand’s private healthcare sector offers high-quality services but at a steep cost. General practitioner consultations range from $30 to $80, while specialist consultations cost between $45 and $120, excluding additional hospital, treatment, and transportation charges. For migrant workers earning an average monthly income of $290 to $320, private healthcare is largely unaffordable.

Additionally, medical expenses in Thailand, which have been steadily rising since 2020, are expected to climb by an additional 15% in 2025. And these rising medical costs worsen healthcare access for underpaid migrant workers. Low wages make quality care unattainable, and unresolved pay issues heighten barriers. Addressing wage inequality and improving healthcare affordability is essential to protect the well-being of vulnerable migrants.

2.2. Public Healthcare: Affordable but Limited

The public sector, including government hospitals and clinics, provides cost-friendly healthcare options. However, irregular migrants face significant barriers due to their legal status. Fear of deportation or arrest often deters them from seeking care at public facilities. Language and cultural differences further complicate their access to essential services.

2.3. Insurance Schemes and Their Shortcomings

To address these challenges, Thailand has introduced several health insurance schemes over the years, including Social Security Fund (SSF) (1991), Workman’s Compensation Fund (WCF) (1994), Migrant Health Insurance Scheme (MHIS) (1998), Migrant-Fund (M-Fund) (2017), and Health Insurance for Non-Thai People (HINT) (2024). While these schemes aim to provide coverage, their impact has been limited. The SSF, WCF, and MHIS cater primarily to specific employment sectors and exclude undocumented migrants. The M-Fund and HINT are designed to address these gaps, offering access to irregular migrants. However, challenges remain in raising awareness among migrants about these schemes and ensuring they understand how to utilize the benefits effectively.

2.4. Rural and Border Areas: A Greater Challenge

Healthcare access is even more restricted in rural and border areas, where many migrants reside. Free clinics run by NGOs and INGOs, such as the Mae Tao Clinic, World Vision, and the International Organization for Migration (IOM), fill healthcare gaps. However, these services are often insufficient to meet the growing demand.

2.5. Migrant Health Volunteers: Bridging the Gap

Migrant Health Volunteers (MHVs) connect migrants to healthcare services, particularly in remote regions. Working alongside local NGOs, MHVs raise awareness about available services and rights as a crucial link between migrants and healthcare providers.

3. Impact of Migration on Thailand’s Public Health Sectors

The recent surge of migrants from Myanmar into Thailand, especially after Myanmar’s February 2024 conscription law, has raised concerns in Thailand’s public health sector, with challenges in disease prevention, healthcare coverage, and achieving a sustainable healthcare system. Key health concerns include:

  1. Malaria: Migrants in border provinces like Tak face heightened malaria risks due to limited access to prevention and healthcare services. In 2023, Thailand reported nearly 17,000 malaria cases, a sharp rise from 9,989 in 2022, with 42% imported from neighboring countries, primarily Myanmar. Tak province, a hotspot for malaria, accounted for over half of these cases, experiencing sporadic outbreaks. Challenges in addressing malaria among migrants include their mobility, remote living conditions, and social barriers such as isolation, discrimination, and limited community integration.
  2. Tuberculosis (TB): TB remains a critical issue for migrant workers in Thailand, especially in border regions with rising cases and drug-resistant strains. In 2023, TB incidence increased to 157 per 100,000 from 143 per 100,000 in 2021. Tailored community programs integrating TB, HIV/AIDS, and maternal health services can improve education, diagnosis, and treatment adherence.
  3. HIV and Syphilis: Unsafe sexual practices and inadequate access to sexual health education have led to elevated rates of HIV and syphilis among migrant populations in Thailand. Research shows that migrants from neighboring countries face an HIV prevalence up to four times higher than that of the general Thai population.
  4. Maternal, Neonatal, and Child Health (MNCH): Migrant women, especially those with irregular status, face numerous obstacles in accessing maternal care and sexual health services. Financial constraints, limited MHIS coverage, and discrimination, including refusal to renew MHIS during pregnancy, exacerbate these challenges. Fear of deportation and high healthcare costs often force undocumented pregnant women to choose unsafe home births over essential hospital services.
  5. Vaccination: Immunization rates among migrant children in Thailand, particularly those from Myanmar, remain suboptimal. The lack of access to routine vaccination services is exacerbated by irregular migration status, geographical isolation, and language barriers.

4. Limitations in Access to Healthcare

Despite the availability of healthcare resources, Myanmar migrants in Thailand face numerous challenges in accessing adequate medical care. These barriers are multifaceted, rooted in policy gaps, socioeconomic factors, and legal constraints, creating a complex landscape for healthcare access.

4.1. Policy Gaps and Financial Barriers

Eligibility for social protection programs like the Social Security Fund (SSF) and Workmen’s Compensation Fund (WCF) is often tied to specific employment sectors and statuses, leaving many migrants without coverage. Data from the Thailand Migration Report 2024 reveals that as of February 2024, only 51% of migrants were enrolled in a health insurance scheme, indicating that nearly half of eligible workers lack health insurance. For those without coverage, the steep upfront costs of healthcare services significantly deter seeking timely medical attention. This financial strain is particularly severe for irregular migrants, who face disproportionate challenges in accessing affordable care.

4.2. Geographical and Gender-Based Challenges

Migrants in remote or border regions face significant healthcare access challenges, with long travel distances adding financial and time burdens. Female migrant workers, especially those in domestic roles, encounter additional barriers, such as clinic hours conflicting with work schedules, unwelcoming attitudes from healthcare providers, and clinic distances. These factors limit their access to essential sexual and reproductive health services, exacerbating gender-based health disparities.

4.3. Socioeconomic and Legal Factors

A significant portion of Myanmar migrant workers in Thailand earn below the minimum wage, with 37% earning less. Women earn an average of 350 THB per day, compared to 400 THB for men, and migrants in provinces like Tak earn even less. These low wages make healthcare and insurance unaffordable, while limited education leaves many unaware of their health rights, contributing to the underutilization of healthcare services.

4.4. Language Barriers and Communication Challenges

Language barriers are a critical challenge for migrant workers in accessing healthcare, leading to misunderstandings, misdiagnoses, and delayed treatment. Without adequate language support, many migrants resort to drug stores for minor ailments, risking improper medication. The lack of translators in healthcare facilities further exacerbates these communication issues, limiting access to essential care.

4.5. Fear of Legal Repercussions

Fear of legal repercussions is a significant barrier for irregular migrants in Thailand seeking healthcare. Many avoid medical facilities to prevent arrest or deportation, leaving health issues unaddressed. Without legal status, they rely on health posts or free clinics but face risks of arrest or bribery near official healthcare services, perpetuating mistrust and inadequate care.

5. Conclusions and Recommendations

The healthcare challenges faced by Myanmar migrant workers in Thailand are multifaceted, involving a complex interplay of legal, financial, geographic, and socio-cultural factors. To improve access to healthcare, Thailand must address the systemic barriers hindering migrant workers’ access to essential services. Key recommendations include:

  1. Enhancing Health Insurance Coverage: Expanding migrant health insurance schemes to cover all migrant workers, regardless of their legal status, is essential.
  2. Increasing Awareness and Outreach: Expanding awareness campaigns and outreach programs targeting migrant communities, especially in remote areas, can help increase knowledge of available healthcare services.
  3. Improving Healthcare Infrastructure in Rural Areas: Expanding healthcare facilities in rural and border regions and providing mobile health units will help bridge the access gap.
  4. Addressing Language Barriers: Increasing the availability of translators and culturally sensitive healthcare services will improve communication and reduce misunderstandings.
  5. Strengthening Legal Protections: Reducing the fear of deportation by strengthening legal protections for migrants seeking healthcare will encourage timely treatment and reduce the burden of preventable diseases.

In conclusion, addressing the healthcare needs of Myanmar migrant workers in Thailand is not only a moral imperative but also essential for safeguarding public health. By addressing these challenges through comprehensive policy changes, Thailand can ensure that all workers, regardless of their legal status, have the healthcare they need to lead healthy, productive lives. It can also help Thailand build a more inclusive and sustainable healthcare system that benefits migrants and the broader population.

US: Trump’s promise of mass deportations is deepening mistrust of the health care system among California’s immigrants

Community health workers say fear of deportation is already affecting participation in California’s Medicaid program.

President-elect Donald Trump’s promise of mass deportations and tougher immigration restrictions is deepening mistrust of the health care system among California’s immigrants and clouding the future for providers serving the state’s most impoverished residents.

At the same time, immigrants living illegally in Southern California told KFF Health News they thought the economy would improve and their incomes might increase under Trump, and for some that outweighed concerns about health care.

Community health workers say fear of deportation is already affecting participation in Medi-Cal, the state’s Medicaid program for low-income residents, which was expanded in phases to all immigrants regardless of residency status over the past several years. That could undercut the state’s progress in reducing the uninsured rate, which reached a record low of 6.4% last year.

Immigrants lacking legal residency have long worried that participation in government programs could make them targets, and Trump’s election has compounded those concerns, community advocates say.

The incoming Trump administration is also expected to target Medicaid with funding cuts and enrollment restrictions, which activists worry could threaten the Medi-Cal expansion and kneecap efforts to extend health insurance subsidies under Covered California to all immigrants.

“The fear alone has so many consequences to the health of our communities,” said Mar Velez, director of policy with the Latino Coalition for a Healthy California. “This is, as they say, not their first rodeo. They understand how the system works. I think this machine is going to be, unfortunately, a lot more harmful to our communities.”

Alongside such worries, though, is a strain of optimism that Trump might be a boon to the economy, according to interviews with immigrants in Los Angeles whom health care workers were soliciting to sign up for Medi-Cal.

Selvin, 39, who, like others interviewed for this article, asked to be identified by only his first name because he’s living here without legal permission, said that even though he believes Trump dislikes people like him, he thinks the new administration could help boost his hours at the food processing facility where he works packing noodles. “I do see how he could improve the economy. From that perspective, I think it’s good that he won.”

He became eligible for Medi-Cal this year but decided not to enroll, worrying it could jeopardize his chances of changing his immigration status.

“I’ve thought about it,” Selvin said, but “I feel like it could end up hurting me. I won’t deny that, obviously, I’d like to benefit — get my teeth fixed, a physical checkup.” But fear holds him back, he said, and he hasn’t seen a doctor in nine years.

It’s not Trump’s mass deportation plan in particular that’s scaring him off, though. “If I’m not committing any crimes or getting a DUI, I think I won’t get deported,” Selvin said.

Petrona, 55, came from El Salvador seeking asylum and enrolled in Medi-Cal last year.

She said that if her health insurance benefits were cut, she wouldn’t be able to afford her visits to the dentist.

A street food vendor, she hears often about Trump’s deportation plan, but she said it will be the criminals the new president pushes out. “I’ve heard people say he’s going to get rid of everyone who’s stealing.”

Although she’s afraid she could be deported, she’s also hopeful about Trump. “He says he’s going to give a lot of work to Hispanics because Latinos are the ones who work the hardest,” she said. “That’s good, more work for us, the ones who came here to work.”

Newly elected Republican Assembly member Jeff Gonzalez, who flipped a seat long held by Democrats in the Latino-heavy desert region in the southeastern part of the state, said his constituents were anxious to see a new economic direction.

“They’re just really kind of fed up with the status quo in California,” Gonzalez said. “People on the ground are saying, ‘I’m hopeful,’ because now we have a different perspective. We have a businessperson who is looking at the very things that we are looking at, which is the price of eggs, the price of gas, the safety.”

Gonzalez said he’s not going to comment about potential Medicaid cuts, because Trump has not made any official announcement. Unlike most in his party, Gonzalez said he supports the extension of health care services to all residents regardless of immigration status.

Health care providers said they are facing a twin challenge of hesitancy among those they are supposed to serve and the threat of major cuts to Medicaid, the federal program that provides over 60% of the funding for Medi-Cal.

Health providers and policy researchers say a loss in federal contributions could lead the state to roll back or downsize some programs, including the expansion to cover those without legal authorization.

California and Oregon are the only states that offer comprehensive health insurance to all income-eligible immigrants regardless of status. About 1.5 million people without authorization have enrolled in California, at a cost of over $6 billion a year to state taxpayers.

“Everyone wants to put these types of services on the chopping block, which is really unfair,” said state Sen. Lena Gonzalez, a Democrat and chair of the California Latino Legislative Caucus. “We will do everything we can to ensure that we prioritize this.”

Sen. Gonzalez said it will be challenging to expand programs such as Covered California, the state’s health insurance marketplace, for which immigrants lacking permanent legal status are not eligible. A big concern for immigrants and their advocates is that Trump could reinstate changes to the public charge policy, which can deny green cards or visas based on the use of government benefits.

“President Trump’s mass deportation plan will end the financial drain posed by illegal immigrants on our healthcare system, and ensure that our country can care for American citizens who rely on Medicaid, Medicare, and Social Security,” Trump spokesperson Karoline Leavitt said in a statement to KFF Health News.

During his first term, in 2019, Trump broadened the policy to include the use of Medicaid, as well as housing and nutrition subsidies. The Biden administration rescinded the change in 2021.

KFF, a health information nonprofit that includes KFF Health News, found immigrants use less health care than people born in the United States. And about 1 in 4 likely undocumented immigrant adults said they have avoided applying for assistance with health care, food, and housing because of immigration-related fears, according to a 2023 survey.

Another uncertainty is the fate of the Affordable Care Act, which was opened in November to immigrants who were brought to the U.S. as children and are protected by the Deferred Action for Childhood Arrivals program. If DACA eligibility for the act’s plans, or even the act itself, were to be reversed under Trump, that would leave roughly 40,000 California DACA recipients, and about 100,000 nationwide, without access to subsidized health insurance.

On December 9, a federal court in North Dakota issued an order blocking DACA recipients from accessing Affordable Care Act health plans in 19 states that had challenged the Biden administration’s rule.

Clinics and community health workers are encouraging people to continue enrolling in health benefits. But amid the push to spread the message, the chilling effects are already apparent up and down the state.

“¿Ya tiene Medi-Cal?” community health worker Yanet Martinez said, asking residents whether they had Medi-Cal as she walked down Pico Boulevard recently in a Los Angeles neighborhood with many Salvadorans.

“¡Nosotros podemos ayudarle a solicitar Medi-Cal! ¡Todo gratuito!” she shouted, offering help to sign up, free of charge.

“Gracias, pero no,” said one young woman, responding with a no thanks. She shrugged her shoulders and averted her eyes under a cap that covered her from the late-morning sun.

Since Election Day, Martinez said, people have been more reluctant to hear her pitch for subsidized health insurance or cancer prevention screenings.

“They think I’m going to share their information to deport them,” she said. “They don’t want anything to do with it.”

Increased risk of tuberculosis and HIV co-infection for migrants in the Uganda EU/EAA

Adult migrants in the UK and EU/EEA have worse TB outcomes than non-migrants

New research published today in the European Respiratory Journal found that adult migrants in the UK and EU/EEA fare worse on a range of TB outcomes than non-migrants in those countries.

Researchers led by Dr Heinke Kunst, Reader in Respiratory Medicine at Queen Mary University of London and Honorary Consultant in Respiratory Medicine at Barts Health NHS Trust, conducted a systematic review of current evidence on diagnosis of active TB in migrants entering the European Union/European Economic Area (EU/EEA) and UK.

The work, titled “Tuberculosis in adult migrants in Europe: a TBnet consensus statement” was delivered in collaboration with TBnetscientists with key contribution from Professor Christoph Lange, Professor of Respiratory Medicine.

The review included the clinical presentation and diagnostic delay, treatment outcomes of drug sensitive TB, prevalence and treatment outcomes of multidrug/rifampicin-resistant (MDR/RR)-TB and TB/HIV co-infection.

It showed that migrants have an increased risk of extrapulmonary tuberculosis (TB infection that occurs in organs other than the lungs) compared to pulmonary tuberculosis. It also showed that migrants have an increased risk of tuberculosis and HIV co-infection compared to non-migrants.

The findings also showed an increased risk for multi drug-resistant/rifampicin resistant tuberculosis in migrants with TB when compared to non-migrants with TB. Further to this, migrants with drug susceptible tuberculosis (TB which is not resistant to treatment drugs such as rifampicin) had an increased risk for unfavourable treatment outcomes when compared to non-migrants.

This is the first systematic review to show that migrants with tuberculosis in the UK and EU/EAA have worse outcomes compared to non-migrants with tuberculosis. Based on these findings and expert opinions consensus, the researchers provided recommendation statements to guide the management of migrants with tuberculosis in these countries.

Consensus recommendations include screening of migrants for tuberculosis/latent tuberculosis infection (LTBI) according to country data; a minimal package for tuberculosis care in drug susceptible and multidrug/rifampicin drug resistant tuberculosis; implementation of migrant-sensitive strategies; free healthcare and preventive treatment for migrants with HIV co-infection.

Dr Kunst said: “Migrant populations entering Europe have poorer tuberculosis outcomes than native populations. As cases of tuberculosis are rising in Europe, we need urgent robust strategies to strengthen screening, rapid diagnosis, and treatment in these hard-to-reach populations.”

Migrant-sensitive strategies have been shown to be effective to improve migrant health. These include availability of interpreters and language-appropriate written materials, healthcare provider training in culture-sensitive issues, health education of migrants, strengthening community engagement and social support.

Interestingly, there was no evidence on use of migrant sensitive strategies to improve outcomes of migrants with tuberculosis in the UK and EU/EEA. The researchers hope that the findings may influence public health policy nationally and internationally. Migrant sensitive strategies should be included into routine care of migrants not only for migrants with tuberculosis but also those with other infectious diseases such as viral hepatitis.

Tuberculosis research at Queen Mary

This work complements existing tuberculosis research at Queen Mary in migrants and tuberculosis. Dr Kunst has conducted The CATAPULT trial (Treatment of latent tuberculosis infection in migrants in primary care versus secondary care) funded by Barts Charity recently published in the European Respiratory Journal. The trial showed that the treatment of latent tuberculosis infection in recent migrants to the UK can be safely and effectively managed within primary care when compared to specialist secondary care services at a lower cost. Read more.

Dr Kunst has conducted a NIHR funded study on evaluating uptake of latent tuberculosis infection screening in migrants (Uptake, effectiveness and acceptability of routine screening of pregnant migrants for latent tuberculosis infection in antenatal care) and Prof. Adrian Martineau leads a tuberculosis research programme to develop a new diagnostic test for latent tuberculosis infection.

US: Restrictive immigration policies would undermine Public Health and economic stability

Expected Immigration Policies under a second Trump administration and their health and economic implications

Introduction

Immigration was a central campaign issue during the 2024 Presidential election with President-elect Trump vowing to take strict action to restrict both lawful and unlawful immigration into the U.S. Such actions would have stark impacts on the health and well-being of immigrant families as well as major economic consequences for the nation. As of 2023, there were 47.1 million immigrants residing in the U.S., and one in four children had an immigrant parent.1 Increased immigration boosts federal revenuesand lowers the national deficit through immigrants’ participation in the country’s economy, workforce, and through billions of dollars in tax contributions.

This issue brief discusses key changes to immigration policies that may take place under the second Trump administration based on his previous record and campaign statements, and their implications. President-elect Trump has indicated plans to restrict and eliminate legal immigration pathways, including humanitarian protections, and deport millions of immigrants, which would likely lead to separation of families, negative mental and physical impacts for immigrant families, and negative consequences on the nation’s workforce and economy.

Expected Policy Changes

Elimination of Deferred Action for Childhood Arrivals (DACA) Program

The future of the DACA program remains uncertain due to pending litigation, and President-elect Trump has indicated plans to eliminate it, which would lead to over half a million DACA recipients losing protected status. DACA was originally established via executive action in June 2012 to protect certain undocumented immigrants who were brought to the U.S. as children from removal proceedings and receive authorization to work for renewable two-year periods. During his prior term, President-elect Trump sought to end DACA but was blocked by the Supreme Court in 2020. The Biden administration issued regulations in 2022 to preserve DACA protections. In September 2023, a district court in Texas ruled the DACA program unlawful, preventing the Biden administration from implementing the new regulations while the case awaits a decision in the Fifth Circuit Court of Appeals. Under pending court rulings, while the Department of Homeland Security (DHS) is accepting first-time DACA requests, it is unable to process them. DHS is continuing to process DACA renewal requests and related requests for employment authorization. After the attempt to end DACA failed in 2020, the Trump administration saidthat it would try again to eliminate DACA protections, and, if the pending court ruling finds the program unlawful, the administration is unlikely to appeal the decision. There are over half a million active DACA recipients, a majority of whom are working and many of whom have U.S.-born children, who could be at risk of deportation if the program is eliminated.

A recent health coverage expansion to DACA recipients also is subject to pending litigation and would, if eliminated, leave many DACA recipients without access to an affordable coverage option. In May 2024, the Biden administration published regulations to extend eligibility for Affordable Care Act (ACA) Marketplace coverage with premium and cost-sharing subsidies to DACA recipients, who were previously ineligible for federally funded health coverage options. The regulation became effective November 1, 2024, allowing for enrollment during the 2025 Open Enrollment Period. In August 2024, a group of states filed a lawsuit against the federal government alleging that the ACA Marketplace coverage expansion for DACA recipients violates the Administrative Procedure Act. The case is currently under review at a district court in North Dakota and a decision is expected in the coming months. Elimination of the expansion could leave the nearly 100,000 uninsured DACA recipients it is estimated to cover without an affordable coverage option.

Changes to Public Charge Policy

President-elect Trump could reinstate changes to public charge policy that he made during his first term, which led to increased fears and misinformation among immigrant families about accessing programs and services, including health coverage. Under longstanding immigration policy, federal officials can deny entry to the U.S. or adjustment to lawful permanent resident (LPR) status (i.e., a “green card”) to someone they determine to be a public charge. During his prior term, President-elect Trump issued regulations in 2019 that broadened the scope of programs that the federal government would consider in public charge determinations to newly include the use of non-cash assistance programs like Medicaid and the Children’s Health Insurance Program (CHIP). Research suggests that these changes increased fears among immigrant families about participating in programs and seeking services, including health coverage and care. Prior KFF analysis estimated that the 2019 changes to public charge policy could have led to decreased coverage for between 2 to 4.7 million Medicaid or CHIP enrollees who were noncitizens or citizens living in a mixed immigration status family. The Biden administration rescinded these changes. However, as of 2023, a majority of immigrant adults said in a KFF survey that they were “not sure” about public charge rules, and roughly one in ten (8%), rising to about one in four (27%) of likely undocumented immigrant adults, said they have avoided applying for assistance with food, housing, or health care in the past year due to immigration-related fears (Figure 1). As of November 2024, President-elect Trump has not indicated whether his administration plans to reinstate his first term changes to public charge policy.

 

Expanded Interior Enforcement Actions

President-elect Trump has indicated that his administration plans to carry out mass detentions and deportations of millions of immigrants, including long-term residents, which could lead to family separations and negative mental and physical health consequences. President-elect Trump has stated that he will declare a national emergency and use the U.S. military to carry out mass deportationsof tens of millions of undocumented immigrants residing in the U.S., many of whom have been living and working in the country for decades. Such a policy could lead to family separations as well as mass detentions, which can have negative implications for the mental health and well-being of immigrant families and also put their physical health at risk. Tom Homan, who was the director of U.S. Immigration and Customs Enforcement (ICE) during the first Trump administration and has been selected as the incoming administration’s “border czar”, has said that it is possible to carry out mass deportations without separating families by deporting an entire family unit together, even if the child may be a U.S. citizen. As was the case during his first term, he may also carry out workplace raids as part of mass deportation efforts. Research shows that such raids can lead to family separations, poor physical and mental health outcomes for immigrant families, negative birth and educational outcomes for the children of immigrants, and financial hardship due to employment losses. Prior KFF research shows that restrictive immigration policies implemented during the first Trump administration, including detention and deportation led to increased fears and stress among immigrant families and negatively impacted the health and well-being of children of immigrants, most of whom are U.S. citizens.

Mass deportations could also negatively impact the U.S. workforce and economy, where immigrants make significant contributions. Immigrants have similar rates of employment as their U.S.-born counterparts and play outsized roles in certain occupations such as agriculture, construction, and health care. Research has found that immigrants do not displace U.S.-born workers and help foster job growth through entrepreneurship and the consumption of goods and services. Further, federal data show that unemployment rates for U.S.-born workers have not decreased between 2022 and 2023 and have remained similar to those for immigrant workers. In addition, immigrants, including undocumented immigrants, pay billions of dollars in federal, state, and local taxes each year. Mass deportation of immigrants could lead to workforce shortages in key sectors which could have negative economic consequences including an increase in the cost of essential goods such as groceries. Vice President-elect Vance has stated that immigrants are responsible for the U.S. housing crisis. While some studies show a link between immigration and rising housing costs, in general, economists are skeptical of immigration being a primary driver. Mass deportation of immigrants could also worsen housing shortages since immigrants make up a significant share of construction workers. Workplace raids can exacerbate existing labor shortages and have a negative impact on the local economies of the communities where they take place. Further, research shows that without the contributions undocumented immigrants make to the Medicare Trust Fund, it would reach insolvency earlier, and that undocumented immigrants result in a net positive effect on the financial status of Social Security. There also is likely to be a significant cost to taxpayers for the government to carry out large-scale detention and deportations.

Ending Birthright Citizenship

President-elect Trump has stated that he will sign an executive order to end birthright citizenship for the children of some immigrants despite it being a guaranteed right under the U.S. Constitution, which would negatively impact the health care workforce and economy. This proposed action would limit access to health coverage and care for the children of immigrants since they may not have lawful status. It could also have broader ramifications for the nation’s workforce and economy, potentially exacerbating existing worker shortages, including in health care. KFF analysis of federal data shows that adult children of immigrants have slightly better educational and economic outcomes than adult children of U.S.-born parents and make up twice the share of physicians, surgeons, and other health care practitioners as compared to their share of the population (13% vs. 6%) (Figure 2). Other research also has found that children of immigrants contribute more in taxes on average than their parents or the rest of the U.S.-born population, and that their fiscal contributions exceed their costs associated with health care, education, and other social services.

 

Reinstatement of “Remain in Mexico” Policy

President-elect Trump has stated that he will reinstate the “Remain in Mexico” border policy and that he may use military spending to carry out stricter border enforcement, which would leave an increased number of asylum seekers facing unsafe conditions at the border. The first Trump administration implemented Migrant Protection Protocols, often referred to as the “Remain in Mexico” policy, in 2019. Under this policy, asylum seekers were required to remain in Mexico, often in unsafe conditions, while they awaited their immigration court hearings. The Biden administration ended this policy in 2022, following some legal challenges, although it implemented a series of increasingly restrictive limits on asylum eligibility in 2023 and 2024 in response to a high number of border encounters. President-elect Trump said he plans to reinstate the Migrant Protection Protocols. He also has indicated that he will deploy the National Guard, as well as active duty military personnel, if needed, to the U.S.-Mexico border, although details of the plan remain unclear. Heightened military presence at the border can lead to increased fears among immigrant families living in border areas and using part of the military budget for border security could face legal challenges.

Restrictions on Humanitarian Protections

President-elect Trump said he plans to significantly limit the entry of humanitarian migrants into the U.S. during his second term by restricting refugee limits, shutting down the CBP One application for asylum seekers, and eliminating Temporary Protected Status (TPS) designations for immigrants from some countries.  During his first term, President Trump set the annual refugee admissions ceiling at its lowest levels, ranging from 50,000 in 2017 to a historic low of 18,000 in 2020. The Biden administration increased the limit to 65,000 in 2021, a level close to the annual ceilings prior to the first Trump term, and further increased the limits in 2022 and 2024 in response to humanitarian concerns. It is likely that President-elect Trump will reduce the admissions ceiling for refugees in his second term. The President-elect has also said that he will close the CBP One application created by the Biden administration which allows asylum seekers to seek lawful entry to the U.S. by making an interview appointment with the DHS. While there have been implementation challenges with the CBP One application, shutting down the application could lead to “mass cancellation of appointments” and possibly an increase in attempts to cross the border outside of ports of entry. President-elect Trump also has indicated that he will roll back TPS designations for some immigrants, including those from Haiti. TPS designations protect immigrants from countries deemed unsafe by the DHS from deportation and provide them with employment authorization but do not provide a pathway to long-term residency or citizenship. As of March 2024, over 860,000 immigrants from 16 countries were protected by TPS. Loss of TPS would put people at risk for deportation, which could contribute to family separation which in turn can have negative impacts on the mental and physical health of immigrant families, and broader negative consequences for the workforce and economy.

Endnotes
  1. KFF analysis of 2023 American Community Survey 1-year Public Use Microdata Sample.

Research papers explore challenges in HIV care for migrants and refugees, highlighting social and structural barriers

Report reveals how nations downplay migrants HIV care

A study has revealed how countries across the world have downplayed the health of international migrants who face barriers while accessing HIV care along the migration routes.

In many countries, the study shows that people on the move are confronted with stigma related to migration status, racialism, discrimination and unfavourable policies that run health care systems.

The study focused on migrants who are not aware of their HIV status but are either infected with or are vulnerable to acquiring HIV, and migrants who know their positive status and require linkage and adherence to HIV treatment.

“Migration is a common phenomenon and will remain an important health determinant when attempting to successfully strengthen health systems, including the access to continuity of HIV care,” the journal published by Lancet notes.

The worst hit are the undocumented migrants who due to fear of deportation and stigma may never seek HIV care from a health facility.

Although documented migrants have the right to access health care in some countries, they might still face barriers while accessing HIV care.

In some countries, documented migrants reportedly faced verbal abuse and discrimination in healthcare settings and were denied access to treatment even when they had the right to it, or were charged higher fees.

According to the study, the migration trajectory, including a pre-migration period in departure countries and transition periods before arriving at destination countries, presents HIV-related risks for migrants.

“Along this trajectory, migrants are likely to face different risk-inducing social, physical, political, and economic environments. Migrants’ departure countries might contribute to their overall determinants of HIV including specific vulnerabilities, practices around safer sex, and health-care seeking,” it reads in part.

The study cites a case where migrants arriving from countries with a patriarchal culture where sex is considered taboo, such as Arab countries, have been reported to experience a high burden of gender-related stigma associated with a high likelihood of acquiring HIV and delayed testing.

Additionally, the report says that experiences and familiarity with healthcare systems in departure countries might also shape migrants’ practices around seeking HIV care in transition or destination countries.

In the context of forced displacement, the research states that challenges related to accessing HIV care during the transition stage are major points of concern, especially where some migrants have to reside in refugee facilities in transition countries for long periods, which might substantially delay their access to HIV care.

These 2 research papers are part of the Lancet SERIESHIV in Migrant Populations Online first accessible freely after registration: 

Humanising and optimising HIV health care for refugees and asylum seekers

Interventions to ensure access to and continuity of HIV care for international migrants: an evidence synthesis

 

Italy: Legal issues and language difficulties restrict healthcare access for migrants in Southern Italy

Healthcare access in Southern Italy: the challenges faced by migrant communities

For many migrants in Southern Italy, protecting their health remains an uphill battle. The REACH OUT project, along with extensive field research, has revealed how access to care and the prevention of sexually transmitted infections are affected by a complex mix of social, cultural and economic factors.

Economic and legal difficulties, as well as language and cultural barriers, are among the primary obstacles preventing migrants in Southern Italy from accessing healthcare services.

Funded by the European Union and conducted in collaboration with Maastricht University and the University of Padua, the REACH OUT project has uncovered important data* on the health vulnerabilities of migrants in Southern Italy.

The project focuses on the prevention and access to care for HIV, hepatitis B and C, and other STIs, identifying real-world barriers that hinder the effective implementation of healthcare interventions in challenging contexts. One of the key findings is the role of Social Determinants of Health (SDH)– such as legal status, income, education level, and discrimination – which significantly impact healthcare access and infection risk.

Economic challenges are a major barrier: 67% of migrants interviewed live below the poverty line, with monthly incomes of less than 630 euros. Moreover, nearly half (48%) lack access to healthcare services, often due to limited awareness of their rights or complications in navigating administrative processes. This problem is especially severe in reception centers and informal settlements like Borgo Mezzanone, where healthcare registration is often absent.

Language and cultural barriers further compound the issue. Difficulties in translating sexual health information into various languages, combined with the stigma sorrounding STIs, create additional challenges in promoting preventive practices. While many migrants are aware of STIs and some prevention methods, shame and religious beliefs often prevent them from adopting protective behaviours.

Mental health data is equally concerning: 61.9% of migrants exhibited signs of psychological distress, while 30% reported having experienced intimate partner violence. Issues such as anxiety and depression are common, often stemming from prolonged stays in Italy without legal stability or social integration. Though these psychological factors do not directly block access to healthcare, they often isolate individuals, making them less likely to seek out healthcare services and support.

This research highlights the crucial need to improve communication about healthcare rights for migrants and to strengthen access to services for more inclusive protection. At INTERSOS, we are committed to using these insights to refine and expand our field initiatives, working closely with communities to build trust, provide targeted healthcare, and support long-term structural changes that enhance the quality of life for migrants in Italy.

*The data referenced here were gathered through three studies conducted by graduate researchers from Maastricht University and the University of Padua: Marije Pot, Martina Bugelli, and Antonia Laß.

New report documents key challenges for migrants on the move in the Darien region

PAHO Report Highlights Urgency of Improving Access to Health for Migrant Populations in Darien Region

Washington, DC (PAHO) – A report released today by the Pan American Health Organization (PAHO) documents the key challenges facing migrants in the Darien region and calls on countries in the Americas to collaborate to strengthen disease surveillance and improve policies and programs to ensure the health of migrants.

The new report, Challenges in access to health for migrants transiting the Darien region , reveals that migrants face significant health challenges as they cross the vast jungle territory between the Colombian and Panamanian border, including lack of access to emergency medical care, adverse environmental conditions, increased risk of violence and exploitation, and exposure to infectious diseases.

“In the Americas, millions of migrants continue to be disproportionately affected by health problems due to lack of access to care, and this is particularly the case in the dangerous Darien crossing,” said PAHO Director Dr. Jarbas Barbosa.

“It is essential that countries, partners and donors come together to address the number of variants that are hampering access to timely care for migrant populations,” he added.

Over the past two years, migration in the Darien region has continued to increase, with populations moving across borders from the south to the center and ultimately to North America. This phenomenon is not only due to political and economic instability in Latin America and the Caribbean, exacerbated by the COVID-19 pandemic, but also to conflicts and challenges in other parts of the world.

In the first three months of 2024, more than 135,000 people passed through this area, mainly from Colombia, Ecuador, Haiti, Peru and Venezuela, but also from Afghanistan, Angola, Bangladesh, China and India, to name a few.

While migrants are particularly vulnerable to health problems, caused by a lack of access to preventative care and medication for pre-existing conditions, the harsh terrain of the Darien region also exposes them to extreme weather, wild animals, violence and exploitation.

The report shows that levels of vulnerability among populations in transit have also increased in recent years due to an increase in the number of migrants with disabilities, women travelling alone, pregnant women and women with children under one year old, in addition to the number of unaccompanied children and adolescents.

Due to the lack of health care along the route, migrants are often deprived of vital antenatal care, as well as care for chronic diseases such as diabetes, hypertension and HIV. The lack of specialized services, including sexual and reproductive health, and mental health issues also compound migrants’ health problems.

Lack of access to health services, sanitation, basic hygiene and safe water, as well as consumption of unsafe and micronutrient-poor street foods and nights spent sleeping outdoors, have also increased the incidence of skin lesions, respiratory infections and foodborne diseases among children under five – the leading cause of death in this age group in both countries.

To help address these issues, the report makes six recommendations:

  • Strengthen coordination and partnerships between countries to ensure a more coherent and rapid response to health situations;
  • Improving access to health services for migrants in transit, as well as for host populations;
  • Strengthen health surveillance and information management in accordance with the International Health Regulations (IHR);
  • Strengthening institutional and community capacities to combat preventable diseases and deaths;
  • Support countries in developing and strengthening policies, programmes and frameworks to address migrant health;
  • Help create plans to promote preparedness, response and recovery in the context of a migrant health crisis.

PAHO continues to work with countries in the Americas to support the development of migration response plans to improve access to health for migrant and local populations, improve health surveillance, and strengthen partnerships and networks.

The Organization also works with host countries to implement health promotion campaigns on issues related to dengue prevention, sexual and reproductive health and other health topics, as well as to develop campaigns to combat xenophobia, stigma and discrimination.