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.

Peru: Congress approves exceptional health coverage for migrants and refugees with TB and HIV

Peru approves groundbreaking law to extend health coverage for migrants with HIV and TB

In a milestone decision, the Peruvian Congress has passed legislation that extends temporary health insurance coverage to migrants diagnosed with HIV and tuberculosis (TB). This law allows non-resident foreigners to access healthcare services through the public health insurance system (known by the Spanish acronym SIS) while they complete their immigration processes.

This law, which incorporates proposals from Law Bills 5253, 5554, and 7260, represents a significant step in reducing barriers for migrant populations, ensuring timely medical attention without the need for official residency documentation. Now, migrants affected by HIV or TB can receive vital healthcare services, including medical consultations and diagnostic exams, regardless of their immigration status.

The legislative breakthrough follows over two years of advocacy led by the Grupo Impulsor, a coalition that includes UNAIDS, alongside partners such as USAID’s flagship initiative Local Health System Sustainability Project (LHSS), IOM, UNHCR, the Peruvian Observatory of Migration and Health of the Peruvian University Cayetano Heredia (OPEMS-UPCH), Colectivo GIVAR, VENEACTIVA, the Peruvian TB Social Observatory, and Partners in Health.

Likewise, providing timely treatment for migrants with HIV or TB not only improves their quality of life but also reduces the risk of transmission, making it a crucial public health measure benefiting everyone. It also saves money: early care is far more cost-effective, preventing advanced cases that strain the health system.

A cost-benefit analysis reveals that Peru could save around 5 million soles ($1.33 million USD) annually by preventing new infections and another 54 million soles ($14.58 million USD) through avoiding productivity losses linked to AIDS and TB-related deaths.

Migrants living with HIV in Peru remain among the most discriminated groups in the country, with 70.7% reporting stigma, according to the Ministry of Justice and Human Rights. They also face heightened vulnerability due to xenophobia, violence, and exploitation—nearly half of them have experienced physical violence or sexual exploitation. Accessing healthcare is a major challenge, with only 2% of migrants with HIV covered by public health insurance, leaving the rest to pay out-of-pocket costs that many cannot afford.

“By extending health insurance to migrants, Peru is not only addressing these barriers but also aligning with global commitments, like the Sustainable Development Goals (SDGs), aimed at eradicating epidemics such as AIDS and TB by 2030”, says Luisa Cabal, UNAIDS Regional Director for Latin America and the Caribbean. “This legislative victory not only marks a turning point in health policy but also sets a precedent for future reforms, ensuring a more inclusive and equitable healthcare system for all.”

Protecting everyone’s rights protects public health.

Netherlands: Study explores factors influencing the uptake of HIV testing among heterosexual migrants

Barriers and enablers that influence the uptake of HIV testing among heterosexual migrants in the Netherlands

Background

Heterosexual migrant men and women in the Netherlands often face barriers to accessing health services, including HIV testing, that may lead to late-stage HIV diagnoses. This study explored factors of influence in the usage of HIV testing among heterosexual migrants.

Methods

Qualitative evaluation with semi-structured interviews at the Amsterdam-based AIDS Healthcare Foundation (AHF) Checkpoint and one focus group discussion (FGD) conducted during June-July 2023 with 19 participants: interviews with 12 heterosexual migrants from low- or middle-income countries (LMICs) and FGD (n = 5) and interviews (n = 2) with 7 key informants from the (public) health sector. Recorded interviews were transcribed and thematically analyzed, using the framework of Andersen’s Expanded Behavioral Model of Health Services Use.

Results

In total, 55 themes emerged from the interviews and the FGD. Examples include insufficient availability of information on HIV and testing services, and difficulty in accessing these services (e.g. the barrier of the online appointment system of the Centre for Sexual Health (CSH)). HIV test participants expressed free, rapid testing, no appointment required, and a positive experience during their HIV test as enablers to test in the future. Results from key informants showed that poor health literacy and lack of clarity on the healthcare system’s guidelines were barriers for heterosexual migrants in accessing information on HIV and testing services. It also revealed past initiatives and interventions that were successful in reaching at-risk groups such as the integration of HIV testing into sexually transmitted infection (STI) testing, but that were subsequently discontinued due to financial constraints.

Conclusion

Factors contributing to a low HIV test uptake were participants’ perception of limited accessibility of CSH facilities, insufficient available information on HIV (testing) services, and low perception of HIV risk. Unclear policies on accessing HIV/STI testing services at CSHs, and potential missed opportunities for HIV testing at general practitioners were contributing factors identified by key informants.

For the full text of the study, see: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0311114

 

France: New government wants to reform the law that gives free medical assistance for immigrants after three months

New French interior minister announces plan for tougher immigration policy

France’s newly appointed interior minister Bruno Retailleau signalled a rightward shift for French interior policy on Monday at his first public speech in office. Addressing police unions at the Cour de l’Hôtel de Beauvau, he vowed to end “illegal” migration and “restore order” in the country.

Concerning immigration, the senior senator with The Republicans (Les Républicains) party called for a much tougher policy in an interview on national TV, proposing to regularize as few people as possible while deporting as many as possible. He also urged legislative changes, such as a reform to the law that gives free medical assistance for immigrants after three months in the country, aiming to replace it with a much-reduced protection regime. Beyond this, he is targeting the “Circulaire Valls,” a law instated in 2012 under former President François Hollande which ended the criminal offense of illegal residence, preventing law enforcement from taking individuals in an irregular situation into custody. This would be contrary to decisions by the Court of Justice of the European Union (CJEU) on the Return directive and subsequent Cassation Court decisions.

Another proposed change consists of revoking a 1968 bilateral agreement with Algeria, signed in the context of decolonization, which grants special status and benefits for Algerian immigrants to France. However, the fact that the agreement is governed by international law, not French law, might make it more difficult to make it void. A cancellation would immediately affect Algerians and their rights in France. Moreover, Retailleau called for bilateral agreements with Maghreb countries to better retain migrants outside of Europe, following the examples of Italy’s agreement with Albania and the agreement between the EU and Tunisia.

Retailleau is a senior politician with plenty of experience who was first elected to the National Assembly in 1994, represented the Vendée department for the past 20 years and finally served as president of the LR senatorial group since 2014. He is part of France’s recently elected government following a snap general election in response to President Macron’s loss of support in public polls.

Russia: New bill introduces broader disease testing for migrants, including hepatitis

Migrant children should pass a Russian language test and their parents should be tested for dangerous diseases

Translated with Deepl.com. Scroll down for original article in Russian

The Russian government has already supported the bills against illegal migration. New initiatives are next – the introduction of a Russian language exam for foreign children and the expansion of the list of dangerous diseases, the presence of which is checked in visitors.

About it at a press conference in Moscow told Deputy Speaker of the State Duma, Head of the Migration Policy Commission Irina Yarovaya.

“Today, a commission on legislation in the government of the Russian Federation was held, and our bills are fully supported without comments”, – she said.

It is a question of recognizing the organization of illegal migration as a particularly serious crime in cases where it is committed by an organized group and for the purpose of committing serious or especially serious crimes. If today the punishment for this is from two months to seven years, which gives the court the right to apply even a suspended sentence against such criminals, then in the future this will be impossible. The lower threshold of responsibility increases to eight to fifteen years.

An increased level of responsibility is also established for forgery, manufacture and trafficking of forged documents for the purpose of illegal migration. If today it’s from two months to four years, then it will be from two to six years, Yarovaya noted.

In addition, it is proposed to amend the federal law on information and establish extrajudicial blocking of Internet resources containing offers of illegal services for migrants.

There are about 739 thousand illegal migrants on the territory of the Russian Federation.

“We are witnessing an increase in organized illegal migration: in the half of 2024, almost one and a half times more facts were revealed than in the same period last year. It must be said that 879 people were convicted of organizing illegal migration, of which 665 people are Russian citizens. <… > These crimes are committed by people who live near us and are involved in this organized criminal activity”,- explained Irina Yarovaya.

With regard to new initiatives that have yet to be prepared and introduced, it is the expansion of the list of diseases for which migrants will be tested and the introduction of a language test when children enter schools.

“We insist that the Ministry of Health expand the list of dangerous diseases for migration purposes, including hepatitis B and C,”- said the deputy.

Now migrants entering Russia are required to be tested for COVID-19, tuberculosis, leprosy (Hansen’s disease), syphilis, HIV. The presence of such diseases can be an obstacle to obtaining a residence permit or a work permit, as well as a reason for deportation.

Also, the State Duma Commission on Migration Policy is preparing changes in the legislation on mandatory diagnostics and training of migrant children before their admission to Russian schools, Irina Yarovaya said.

“Compulsory diagnostics for the knowledge of the Russian language of children who are admitted to schools is necessary… mandatory diagnostics and preparation before admission to school are necessary, the child must know exactly the language in which he will learn the material, communicate with the teacher and with peers… we have given the relevant instructions to the Ministry of Education, but at the same time we ourselves prepare changes to the legislation,”

– she said at a press conference in the multimedia press center “Russia Today”.

Previously “Nats Accent” wrote that the Investigative Committee of the Russian Federation will check the Kaliningrad school where children do not know Russian.

ДЕТИ-МИГРАНТЫ ДОЛЖНЫ СДАТЬ ТЕСТ ПО РУССКОМУ ЯЗЫКУ, А ИХ РОДИТЕЛИ – ПРОВЕРИТЬСЯ НА ОПАСНЫЕ БОЛЕЗНИ

Правительство России уже поддержало законопроекты против незаконной миграции. На очереди новые инициативы – введение экзамена по русскому языку для детей иностранцев и расширение списка опасных заболеваний, наличие которых проверяют у приезжих.

Об этом на пресс-конференции в Москве рассказала вице-спикер Госдумы, руководитель комиссии по вопросам миграционной политики Ирина Яровая.

«Сегодня состоялась комиссия по законодательству в правительстве РФ, и наши законопроекты полностью поддержаны без замечаний”, – сказала она.

Речь о том, чтобы признавать организацию незаконной миграции особо тяжким преступлением в случаях, когда оно совершается организованной группой и в целях совершения тяжких или особо тяжких преступлений. Если сегодня наказание за это – от двух месяцев до семи лет, что дает право суду применять даже условное осуждение в отношении таких преступников, то в будущем такое будет невозможно. Нижний порог ответственности увеличивается до восемь-пятнадцати лет.

За подделку, изготовление и оборот поддельных документов в целях незаконной миграции также устанавливается повышенный уровень ответственности. Если сегодня это от двух месяцев до четырех лет, то будет  – от двух до шести лет, отметила Яровая.

Кроме того, предлагается внести изменения в федеральный закон об информации и установить внесудебную блокировку интернет-ресурсов, содержащих предложения незаконных услуг для мигрантов.

На территории РФ находятся около 739 тысяч нелегальных мигрантов.

“Мы наблюдаем рост организованной незаконной миграции: за полугодие 2024 года выявлено почти в полтора раза больше фактов, чем за аналогичный период в прошлом году. Нужно сказать, что 879 лиц осуждено за организацию незаконной миграции, из них 665 лиц – это граждане России. <…> Эти преступления совершаются лицами, которые проживают рядом с нами и вовлечены в эту организованную преступную деятельность”,- пояснила Ирина Яровая.

Что касается новых инициатив, которые только еще предстоит подготовить и внести, то это расширение перечня заболеваний, на которые будут проверять мигрантов и введение языкового теста при поступлении детей в школы.

“Мы настаиваем на том, чтобы министерство здравоохранения расширило перечень опасных заболеваний для целей миграции, в том числе, включив него гепатит B и C”,- сказала депутат.

Сейчас въезжающих в Россию мигрантов в обязательном порядке проверяют на COVID-19, туберкулез, лепра (болезнь Гансена), сифилис, ВИЧ. Наличие таких заболеваний может стать препятствием к получению вида на жительство или разрешения на работу, а также причиной депортации.

Также комиссия Госдумы по вопросам миграционной политики готовит изменения в законодательстве об обязательной диагностике и подготовке детей мигрантов до принятия их в российские школы, отметила Ирина Яровая.

“Необходима обязательная диагностика на знание русского языка детей, которые принимаются в школы… необходима обязательная диагностика и подготовка до принятия в школу, ребенок точно должен знать язык, на котором он будет усваивать материал, общаться с педагогом и со сверстниками… соответствующие поручения нами даны министерству просвещения, но при этом мы сами готовим изменения в законодательство”,

– сказала она на пресс-конференции в мультимедийном пресс-центре “Россия сегодня”​.

Ранее «НацАкцент» писал, что Следственный комитет РФ проверит калининградскую школу, где дети не знают русский язык.

Vietnam: Vietnam and IOM sign MoU to promote migrant inclusion in National Health Systems

IOM and Ministry of Health sign partnership to promote migrants’ health

The International Organisation for Migration (IOM) and the Ministry of Health (MoH) on Wednesday afternoon strengthened their collaboration in promoting the health and well-being of migrants.

HÀ NỘI — The International Organisation for Migration (IOM) and the Ministry of Health (MoH) on Wednesday afternoon agreed to strengthen their collaboration in promoting the health and well-being of migrants by signing a new Memorandum of Understanding (MoU).

Under the MoU, they also agreed to promote migrants’ inclusion in national health systems and policies.

The MoU reflects nearly 40 years of collaboration between IOM and MoH, which began in the early 1980s.

Over the years, this partnership has grown from IOM health assessment programmes for populations moving to destination countries to public health efforts that facilitate better access to healthcare services for migrants and strengthen cross-border disease control and public health emergency response and preparedness.

Việt Nam has become a significant source of migrants, particularly those seeking employment opportunities abroad.

Recent data shows a resurgence in international labour migration, with approximately 155,000 Vietnamese citizens securing employment abroad last year alone, equivalent to nearly a third of the new workers entering the labour market.

Similar to other countries in the ASEAN region, the burden of health issues in Việt Nam remains complex, including infectious diseases, occupational health hazards and injuries, mental health challenges, non-communicable diseases such as cardiovascular disease and diabetes and maternal and child health problems.

Infectious diseases like human immunodeficiency virus (HIV), acquired immunodeficiency syndrome (AIDS), tuberculosis (TB) and malaria continue to be significant concerns.

Achieving Universal Health Coverage (UHC) remains a challenging goal and presents an even greater challenge for migrants.

Recent studies conducted by IOM in the region have highlighted the challenges faced by cross-border migrants in accessing healthcare, including language barriers, discrimination, financial constraints, lack of health insurance across borders and lack of official cross-border referral mechanisms for migrant patients.

They can be made even more vulnerable in pandemic situations due to inadequate access to needed health care and services, as shown during the COVID-19 pandemic.

Park Mi-Hyung, Chief of Mission of IOM in Việt Nam, stressed the importance of this collaboration to ensure the health and well-being of migrants, aligning with the goals of the Global Compact for Safe, Orderly, and Regular Migration (GCM) and the Sustainable Development Goals (SDGs).

“In a world where an increasing number of people are on the move, collaborations and partnerships are crucial to enhance the health and well-being of migrants. Healthy migrants contribute to healthy communities,” she said.

Nguyễn Tri Thức, Deputy Minister of Health, said that in recent years, the MoH and IOM have actively cooperated in many areas related to ensuring the health of migrants, including raising awareness of migrants’ health, strengthening bilateral cooperation in cross-border tuberculosis control and preparing for and responding to public health emergencies.

In addition, he said, IOM supported enhanced regional cooperation last year through regional workshops on migration and migrant health.

Goal 3 of the United Nations Sustainable Development Goals is good health and well-being.

“I hope we will continue to promote closer cooperation to successfully implement the United Nations Sustainable Development Goals,” said Thức. — VNS

US: Queer asylum seekers face uphill battle in U.S. immigration system

Think Immigration: Breaking Down Barriers – Improving Asylum Laws for Queer Migrants

AILA welcomes this blog post from Diversity, Equity, and Inclusion Committee Law Student Scholarship recipient Abby Leigh, part of a series intended to highlight the important ways in which diversity, equity, and inclusion inform immigration law and policy. More information about AILA’s DEI Committee and its important work is available on AILA’s website.

In more than 70 countries, some aspect of being lesbian, gay, bisexual, transgender, or queer (LGBTQIA+) is a crime. Many LGBTQIA+ people face harassment, discrimination, and violence that force them to flee. As U.S. immigration law evolved, sexual orientation and gender identity became a valid basis for an asylum claim. However, these asylum laws were still developed through the lens of straight relationships and cisgender perspectives.  As a result, asylum laws in the United States significantly disadvantage queer migrants, particularly transgender and non-binary individuals.

To start, a lack of an explicit acknowledgement that LGBTQIA+ is a protected ground within asylum means otherwise valid claims can fall through the cracks.  Sexual orientation and gender identity are not specifically enumerated as protected grounds for asylum, though they do often qualify as members of a Protected Social Group. Due to the lack of explicit inclusion, LGBTQIA+ asylum seekers often do not realize their sexual orientation/gender identity are grounds for asylum and are hesitant to speak up for fear they will experience the same persecution from which they fled. The one-year filing restriction on asylum claims and other expedited procedural constraints only make matters worse, as applicants with valid claims may not have sufficient time to file after learning they have a valid claim. To help remedy this problem, sexual orientation and gender identity should be explicitly adopted into the definition of refugee, and asylum officers should have an obligation to communicate this to applicants.

Beyond definitional limitations, the lack of culturally sensitive “credibility” determinations for asylum leaves the door open to improper judgment and mischaracterization. Because asylum is discretionary, adjudicators heavily rely on their own biases to determine whether an applicant’s described persecution is credible, often discounting queer identities that fall outside of what would be familiar to mainstream – often white – Americans.  The expectation of white Western gender and sexuality performance is not only demeaning, but it also narrows the likelihood of eliciting valid asylum claims.

Furthermore, studies demonstrate that immigration adjudicators conflate sex with sexuality, routinely discrediting applicants without sexual or romantic histories. As a result, asylum practitioners are often forced to limit and contextualize their description of persecution to fit within the confines of white Western culture. Adverse credibility findings are further exacerbated by applicants’ hesitancy to discuss their sexual orientation/gender identity with an asylum officer, especially if they are unaware that their identity forms the basis of a valid asylum claim. Thus, additional leeway should be granted for minor inconsistencies between asylum applications and an applicant’s testimony. The evidentiary standard of corroboration should also be relaxed, particularly for applicants who were forced to conceal their identities in their country of origin and may be hesitant to reveal their true identities once in the United States. Furthermore, sexual orientation, gender identity, sex assigned at birth data, and HIV status should be integrated into U.S. registration and data management systems that process asylum claims. Demographic questions should be subject to change throughout the asylum process without negative repercussions for the applicant.

Decision-makers are hesitant to grant asylum claims that allege violence similar to what is experienced domestically because it disrupts the illusion that the United States is the “good guy.” This leaves applicants walking a strategic tightrope, forced to perform their gender/sexuality in a manner satisfactory to the American adjudicator. Similarly, the theory of the case requires casting the applicant as a “good” or “deserving” gay, a narrative that juxtaposes the unspoken converse of a “bad” or “less-deserving” gay.

There is a need for more research and publicly available data, as federal agencies do not publish statistics on asylum claims based on sexual orientation, gender identity, or HIV status. As U.S. State Department country conditions reports are heavily considered in determining asylum (and often contain no information about the LGBTQIA+ community or those living with HIV), decision-makers should examine country-specific laws, policies, and cultural attitudes towards each subpopulation of the LGBTQIA+ community as well as those living with HIV when relevant. Immigration judges should also proactively submit evidence from credible sources sua sponte, especially for pro se litigants or when U.S. State Department reports lack proper evidence. Finally, because most immigration officers and immigration judge’s ideas about LGBTQIA+ identity are based on U.S. norms and stereotypes, all immigration officials must receive queer-sensitive interview training.

Research shows that the process of applying for asylum can by itself have “deleterious effects on LGBTQI+ persons, and immigration policies harm them based on the compounding effects of their intersectional identities.” It is important to address the challenges faced by queer migrants in the asylum process, including the need to “come out” in a way that is “credible” and “legible” to asylum adjudicators, as well as harmful stereotypes that question the validity and realness of these identities. Until our laws move beyond the existing cis-heteronormative legal structure, they cannot offer LGBTQIA+ asylum seekers a meaningful chance to claim protection and live up to America’s promise of safety for those fleeing persecution.

Libya: Migrants with critical health conditions sent home

Authorities in Tobruk deport over 120 migrants due to health issues

The Anti-Illegal Immigration Authority in Tobruk has confirmed the deportation of 121 illegal migrants from various nationalities as part of ongoing efforts to combat and eliminate illegal immigration.

According to the Authority’s media office, the deportees include Egyptians, Syrians, Sudanese, Pakistanis, and Chadians.

Many of the deported migrants suffer from critical health conditions, including 18 cases of viral hepatitis and two cases of HIV/AIDS, according to the same source.

Australia: Criminalisation fuels healthcare disparities for migrants living with HIV

HIV in Australia: shades of injustice remain

Elimination is the goal, but migrants living with the virus experience a criminalised environment that thwarts access to care.

Health Minister Mark Butler painted a largely rosy picture of the progress towards elimination of HIV in Australia today, speaking on the second morning of the ASHM HIV/AIDS Conference in Sydney.

A legal academic, however, said people with HIV in Australia were still living under a pall of criminalisation, none more so than migrants.

Mr Butler praised the Australian response to the epidemic, especially in NSW, which was most affected in the early days.

“Since HIV was first detected more than 40 years ago in Australia, Australia’s response has been one to be proud of,” he said.

“When you go back to those early years, AIDS was highly feared here as it was around the world. There was huge stigma, misinformation, homophobia and such loss and so much grief for communities.

“But Australia’s response early on was characterised by partnership and collaboration: governments, people living with HIV, communities affected by HIV, non-government organisations, health professionals and academics all came together and worked together.”

He said HIV notifications were declining in Australia, at one of the fastest rates in the world – “but as you have all heard, I’m sure, transmission has also gone up in 2023, reminding us there is always more work to be done”.

“Eliminating transmission of HIV here in Australia is ambitious, but I am absolutely assured it is now achievable,” he said today, citing inner Sydney – once the epicentre of the epidemic – as a place that had effectively achieved elimination.

Mr Butler set up the HIV Taskforce last year with a goal to “virtually” eliminate transmission by 2030. The Ninth National HIV Strategy covers from last year to 2030, continuing the work of the Eighth – whose goal was virtual elimination by 2022.

He said transmission rates had grown “among temporary residents who are here in Australia on work or study visas”.

“So we will provide subsidised access to PrEP to make healthcare more equitable for people who don’t have access to Medicare … We will make sure that at-risk populations can get free HIV self-testing kits through an expansion of the national HIV self-test mailout program [run by the National Association of People with HIV Australia (NAPWHA)] as well as HIV self-testing vending machine programs,” said Mr Butler.

For David Carter, Scientia Associate Professor at the faculty of Law & Justice at UNSW, the necessary changes for people on visas won’t be found in any vending machine but in immigration policy.

Professor Carter, who leads the Health+Law Research Partnership for social justice for people living with HIV or hepatitis B, walked through the history of “unjust and unhelpful” HIV criminalisation in Australia – a public policy environment that includes but is not limited to action by law enforcement and courts. It begins with the creation of a “suspect population”.

He quoted the very first National HIV Strategy in 1987, which warned of the “temptation” of criminalisation measures, including “universal or selective testing, closure of gay venues, criminal penalties for transmission, compulsory notification of HIV infection and restrictions on freedoms of infected people through limitations on employment, quarantine or compulsory detention”, and noted these would jeopardise health measures to prevent transmission.

A working party in 1992 concluded that “even in the face of decisions by individuals that generate harm, it was the wrong decision to restrict the free choice of individuals in modern society, as draconian measures would merely alienate people at risk of infection and deter them presenting for counselling, testing and treatment”.

While pressure to enforce such measures may have been largely resisted, and the situation for Australians has greatly improved, migrants living with HIV are still experiencing an alienating and hostile environment, said Professor Carter.

Characterising them as posing potential harm to Australians “establishes an adversarial relationship between the person living with HIV and the state” and compromises health care by promoting defensive behaviour.

He and his team have interviewed migrants in Australia living with HIV over the past two years, for whom “criminalisation is indeed very active, and it is producing serious, negative health and other impacts of individuals or communities and respects”.

He quoted one interviewee, “Sergio”, who told the team: “I don’t have to face any court, but I did have to prove that I wasn’t a bad person just because I have HIV.”

Others spoke of experience going through the migration process as being “subject to an unending interrogation”.

“Laurence” told his interviewer: “It’s like a tattoo on your mind. The government will treat you different for every single step of your life from here on out.”

“Manish”, who was on a temporary visa, avoided getting tested for 10 months after beginning to suspect he had HIV, for fear of having his visa revoked. His health deteriorated during this time.

“The elevated threat levels produced by the interaction of migration law and public health law … significantly harmed Manish’s health, caused psychological distress and steered him towards coping responses that denied him the testing and treatment, access to medical care and other supports that he deserves and that we all collectively affirm are essential and are his right,” said Professor Carter.

“Manish said to us: ‘I feel like if I had reassurance that nothing’s going to happen to me if I tested positive for this, I would not have been afraid to go and get a test for HIV’.”

Others described feelings of “hopelessness and depression, because there is no hope for us to stay permanently while living with HIV” (in fact there are pathways for permanent migration despite living with HIV). These people would go for weeks without medication in a form of self-sabotage “because they just don’t have hope for their future anymore”.

For these and other people like them, the Australian environment “is just a set of undifferentiated threats to autonomy, wellbeing and safety, to which they are forced to respond with adaptation, distancing and adopting a posture of self-defence”.

Professor Carter concluded that “it may be different today [from the 90s], but it is not over, and it won’t be over here or elsewhere until the stigma of HIV, unconventional sexuality and drug use are gone”.

The HIV/AIDS Conference is running in Sydney this week back-to-back with the 25th IUSTI World Congress.

Sweden: 96% of LGBTQI+ asylum seekers in Sweden rejected, violating legal protections

Asylum-seeking LGBTQI+ individuals deported on illegal grounds

Migration authorities are rejecting and deporting LGBTQI+ asylum seekers in violation of Swedish and international law. This is revealed by an extensive report by RFSL. “A legal scandal that continues in silence, behind confidentiality and secrecy,” says Aino Gröndahl, asylum law specialist at RFSL.

Despite the Swedish Migration Agency having taken several actions since RFSL’s last legal investigation in 2020, the situation for LGBTQI+ individuals seeking asylum in Sweden has not improved. A staggering 96 percent of the decisions and judgments reviewed in the new investigation were rejections, a higher percentage than the data RFSL’s asylum law specialist reviewed in 2020. The latest report also shows that illegal demands in SOGIESC asylum cases persist. This results in LGBTQI+ asylum seekers, who are entitled to protection in Sweden, being deported to countries where they risk persecution, torture, and the death penalty.

“Sweden continues to deport LGBTQI+ individuals on illegal grounds. It is a legal scandal that occurs in silence, behind confidentiality and secrecy. A shame for a country that claims to be a rule-of-law state,” says Aino Gröndahl, asylum lawyer at RFSL.

Stop the deportations of asylum-seeking LGBTQI+ individuals if safe and fair assessments cannot be guaranteed

RFSL is now calling for a decision and enforcement halt until safe and fair investigations, reviews, and assessments consistent with current law are guaranteed in SOGIESC asylum cases.

“The government must now ensure that the asylum process for LGBTQI+ individuals follows Swedish and international law. Until then, RFSL wants all illegal rejections and deportations of LGBTQI+ individuals to be stopped,” says Peter Sidlund Ponkala, Chairman of RFSL.

Summary of the Report

In the report “Rejection motivations in SOGIESC asylum cases in Sweden” RFSL has reviewed the Migration Agency’s assessments. This involves 1,360 decisions and judgments in SOGIESC asylum cases between November 2020 and May 2023. The report is authored by Aino Gröndahl, asylum lawyer at RFSL.

The report shows that:

  • The Migration Agency assessments of SOGIESC asylum cases violate Swedish and international law.
  • The Migration Agency continues to reject and deport asylum seekers on illegal grounds to countries that persecute and also apply the death penalty to LGBTQI+ individuals.
  • A full 96 percent of the decisions and judgments reviewed in the new report were rejections. This is a higher percentage than in the data RFSL’s asylum law specialist reviewed in 2020.
  • The right to an individual review and objective assessment is not met in SOGIESC asylum cases.
  • Discretionary requirements still occur, meaning that asylum seekers are required to have hidden their SOGIESC status in their home country to avoid persecution. This is despite discretion requirements having been prohibited in Swedish law for nearly two decades and in international law for over a decade.
  • Requirements for internal emotional processes and risk considerations in credibility and reliability assessments are solely based on stereotypes and prejudices about SOGIESC individuals. This violates, among other things, EU law and UNHCR guidelines.
  • The Migration Agency often demands that SOGIESC asylum seekers display negative emotions such as shame. This means that Swedish authorities condition the right to protection on LGBTQI+ individuals showing self-hatred to appear credible.

RFSL’s recommendations to the government

  • Halt decision-making and deportations until safe and fair investigations, reviews, and assessments consistent with current law are guaranteed in SOGIESC asylum cases.
  • Promptly appoint the investigation promised in the Tidö Agreement to review the legal safety in SOGIESC asylum cases.
  • Provide clear instructions and requirements to the Migration Agency for quality assurance in the investigation, review, and assessment of SOGIESC asylum cases.
  • Task the Migration Agency with continuously training all operational staff in the investigation, review, and assessment of protection needs based on sexual orientation, gender identity, and gender expression.
  • Task the Migration Agency with compiling statistics on SOGIESC asylum cases and the grounds on which an asylum case should be granted or rejected.