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.

US : Report uncovers systemic abuse of LGBTQ+ and HIV-Positive immigrants in U.S. detention facilities

Report: No human being should be held here

A new report, “No Human Being Should Be Held Here,” claims that nearly a third of immigrant detainees interviewed (18 out of 41) were sexually assaulted while in the custody of federal immigration authorities. Almost all of those interviewed (35 out of the 41) reported being harassed for being LGBTQ+ or an immigrant in custody.

For this report, Immigration Equality, the National Immigrant Justice Center (NIJC), and Human Rights First (HRF) surveyed 41 LGBTQ and HIV-positive immigrants who were detained by CBP and ICE. This survey revealed:

  • Approximately one third of survey participants (18 out of 41) reported sexual abuse, physical assaults or sexual harassment in immigration detention due to their LGBTQ identity;
  • Nearly all of the participants (35 out of 41), reported being targets of homophobic, transphobic, xenophobic, racist, or other verbal and nonverbal abuse in ICE and CBP jails that included threats of violence and assault;
  • A majority of participants (28 out of 41) reported receiving inadequate medical care or asking for medical care and not receiving it while in ICE or CBP detention.
  • Nearly half of participants (20 out of 41) interviewed reported new or increased mental health symptoms while in detention, including hives, panic attacks, mental health crises, flashbacks, and self-harm;
  • Roughly half of participants (20 of 41) were subject to solitary confinement;
  • Nearly half of participants (18 of 41) reported having their sexual orientation, gender identity, HIV status or other confidential medical information disclosed in custody without their consent;
  • More than a quarter of survey participants (12 out of 41) reported that ICE or CBP separated them from their loved ones, whether a partner, spouse, or sibling;
  • Survey participants routinely struggled to access their attorneys or find one, while in ICE or CBP detention;
  • The majority of survey participants living with HIV (13 out of 17 participants) reported medical neglect or denial of medical HIV treatment.

India: India’s informal migrant workers face challenges accessing HIV and social protection services

Reaching Unreached Migrants In Unorganised Workforce With Health Services – OpEd

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According to the Ministry of Labour and Employment of Government of India, the workers in the unorganised sector constitute about 93% of the total workforce in the country. A lot of them are informal migrant workers who live in difficult conditions and are most likely to be left behind when it comes to accessing healthcare and social protection services.

“My humble submission is that unorganised sector workers should be put first for serving their healthcare and social protection needs,” said Syed Mohammad Afsar, who leads the global HIV/AIDS programme for ILO (International Labour Organization). ILO is one of the oldest United Nations agencies which focusses on social and economic justice by advancing labour standards.

“Gujarat is an Indian state that receives many migrant workers – they include those coming from neighbouring states as well as those who come from different districts of Gujarat. These migrants work in the informal sector and face a lot of hardships and challenges- such as violence, inadequate income, or vulnerable situations where their rights may not be protected. That is why since the last almost three years now, we have focussed on Gujarat to promote HIV testing among informal sector workers,” added Afsar. Addressing gender-based violence, income disparities which make people vulnerable to HIV, and other vulnerabilities is also vital.

India, along with other countries, has promised to end AIDS as a public health threat by 2030. Scientific evidence shows that if a person living with HIV is receiving lifesaving antiretroviral treatment and remains virally suppressed, then he/she/they can live normal healthy full lives and the risk of any onwards spread of HIV from that person is zero. At the same time, all others should have full access to HIV combination prevention options in an evidence- and rights-based manner.

Afsar shared that ILO intervention in Gujarat has been developed together with the government’s Ministry of Labour and Employment, local employers and trade unions, and other partners to address both: HIV and TB among informal sector workers. Ending discrimination and building capacities is so key, says Afsar. Community-based HIV testing was one of the hallmarks of these efforts.

GAP is filling the gap in health service coverage of unorganised workforce

One such project of ILO was implemented by organisations like GAP (Gujarat AIDS awareness and Prevention unit – GAP – which is part of the International Society for Research on Civilization Diseases and on Environment – ISRCDE).

“GAP has reached out to those who were unreached,” said Afsar while speaking with CNS founder head Shobha Shukla on the sidelines of world’s largest AIDS conference this year (25th International AIDS Conference or AIDS 2024). “It is critically important to reach the first HIV target – which is to ensure that at least 95% of people living with HIV should know their status. People need to get diagnosed to receive the lifesaving treatment.”

GAP-led initiative found that the HIV rate in the informal sector workers they served was 0.36%, which is higher than the national average of 0.23%.

GAP leaders Jogendra Upadhyay and Pankaj Patel both spoke to CNS. They also serve on the leadership of INN – a pan-India network of over 350 groups working on issues related to HIV/AIDS- and were among the distinguished presenters at AIDS 2024.

“Well-planned targeted interventions of National AIDS Control Organisation (NACO) of the government of India also serve the migrant workforce. But it has perhaps not reached everyone, such as construction workers, small scale industry workers, farm workers, agriculture market informal workers, fruit and vegetable market workers, quarry workers, among others. We have to reach them with full cascade of comprehensive health and social protection services so that no one is truly left behind,” said Jogendra Upadhyay.

“Put human being first is a mantra of our founder late Dr Radium Bhattacharya as our first accountability is to the people we serve who are our first stakeholder too,” said Pankaj Patel.

GAP took the challenge of serving those who are left behind

“One problem is that migrant workers in unorganised or informal workforce change every year. They work for a few months and then go back to their native place because of ‘seasonal migration’. One example is of those who work in cold storage warehouses in Gujarat. Cold storage warehousing involves the storing of perishable or other temperature sensitive goods like food, at a specific temperature range to maintain their shelf-life and quality. About 10,000 workers from eastern Uttar Pradesh, Bihar, Odisha, and other states, work in cold storages in Gujarat for six months. Next year, all those who turn up to work could be different. This increases vulnerability to HIV, TB, sexually transmitted infections (STIs), and also breaks the continuum of care,” said Jogendra.

GAP engaged employers and employers’ associations at local and state level, along with trade unions, district TB offices (DTOs), Gujarat State AIDS Control Society of the government, and other partners who could help provide comprehensive care to the workers. “Engaging the local contractor who hires labour workforce is also very important,” points out Jogendra.

GAP organised over 15 meetings of all those who had a role to play in helping support the initiative to reach the unreached informal sector workers.

“First step was to survey over 1,200 people from labour workforce for a range of vulnerability-related factors,” said Pankaj. “20% of them reported to have multiple sexual partners. We could also connect with few who reported to be gay men and other men who have sex with men or female sex workers. These were hidden communities,” rightly says Pankaj and Jogendra of GAP as these people were not able to benefit from the existing interventions for migrants.

Four-Fifths did not go to health centre so as not to lose their daily wage

“Our survey shows that 78% of these persons did not go to the health centres of integrated counselling and testing centres of the government as they did not want to lose their daily wages – and rather preferred if such a service was available at their workplace,” said Jogendra.

“That is why, all programmes of GAP are done at the workplace of workers,” emphasised Jogendra.

Community-based HIV and TB screening, community-based HIV testing, linkage to HIV and TB care services, and a range of comprehensive support services are key elements which makes GAP’s intervention at workplaces of migrant workers so successful.

Game: Ladder signifies Do’s – and Snakes signify Don’ts

GAP not only uses flipcharts for raising awareness, but also uses the widely popular ‘snakes and ladders’ board game, but with a difference: ladder is for those who give the right answer (they move upwards in the game), and snake is for those who give a wrong one (they go downwards in the game).

Games help us engage people more and convey important messages related to HIV (and STIs, TB, hepatitis) prevention, testing and treatment in a more effective way, says Jogendra.

Agrees Afsar of ILO: “I have seen how GAP volunteers use ‘snakes and ladders’ game to engage people at workplaces. If you give the right answer, you go upwards, and if you give the wrong answer, you go downwards. These are inter-educational approaches that need to be leveraged upon to enhance health seeking behaviour.”

GAP’s impact

In a span of three years, GAP (via its community-based intervention), has screened almost 40,000 migrant workers for HIV and TB at the workplace of informal or unorganised workforce in few districts of Gujarat. Out of those screened and tested, 87% were first-time testers for HIV in their lifetime, informed Jogendra.

Thanks to GAP’s important work in bridging the divide between the reached and unreached with services, 116 people were diagnosed with HIV and 37 with active TB disease (and one worker with drug-resistant form of TB, HIV and cervical cancer) – and all of them were linked to the nearest government-run treatment and care services.

“It is important to note that 96% of those diagnosed with HIV were asymptomatic – they had no symptom. Worksite interventions help find people early and link them with public care services,” said Jogendra.

Once found positive for HIV (or active TB disease), every person is linked to the government-run programmes without any delay. We link those with HIV to the nearest centre which provides antiretroviral treatment, and those with active TB disease to the district TB programme, said Jogendra.

“In addition, we also help them avail of the benefits from government-run social protection schemes, such as e-Shram Card (for labour and employment) and Ayushman Bharat Card (for health coverage),” said Jogendra.

Community-based services are critical to reach the unreached

Afsar shares that “Community-based HIV testing was an important part of migrant workers testing project – they got rapid test kits from Gujarat State AIDS Control Society of the government. These kits were given to community volunteers after proper training, so that they could take those test kits and offer a test in communities.”

Jogendra reflects: “Our next step is testing family members (spouse, children, or others) for HIV and TB – and linking them to care as needed. But our project is a humble initiative whereas India is a large and diverse nation. There is an urgent need to scale up interventions to reach the unreached workers of informal or unorganised sector in every other state and ensure continuum of care.”

GAP partners with local district TB office of the government’s National TB Elimination Programme, which trains them in doing community-based TB screening (looking for classical TB symptoms), collecting sputum samples and handing them to laboratory of primary health centre or sub-centre for TB testing. If active TB disease is detected, then GAP supports the person through the TB treatment and ensures completion. GAP also ensures that the person is availing government-support schemes such as those that provide INR 500 per month of financial support (directly in the bank account of the patient) during treatment. GAP also provides supplementary nutritional support like protein powder, vitamin syrup, or other local nutritious food.

Over 96% of people screened for HIV were also screened for TB voluntarily, says Jogendra. Many were also screened (and referred as indicated) for hepatitis and a range of STIs.

One recent example of a person-in-need supported by GAP is of a female labour worker of a cold storage warehouse. She was diagnosed with HIV, multidrug-resistant TB, and cervical cancer. She received her treatment through local government-run antiretroviral clinic, treatment for drug-resistant TB through local government-run TB clinic, and referred to a gynaecologist for cervical cancer management, informed Jogendra. “Her son was linked to government-run scholarship programme for education in Gujarat state.”

Comprehensive care is vital, feel Jogendra and Pankaj. For instance, they also screen people for diabetes and blood pressure. Diabetes can heighten risk for TB as well as complicate outcomes of HIV care.

Every six months a person with HIV is offered a TB test.

No wonder that ILO has recognised GAP’s work several times as a best practice example, share Jogendra and Pankaj – for helping make a difference and doing justice to the legacy of Dr Radium Bhattacharya and GAP.

Do we know how to reach those who are currently unreached?

We are aiming to reach 95% of people living with HIV by 2025 so that they can know their status, and 95% of those who know their status should receive the treatment, and 95% of those on treatment should be virally suppressed. But do we have the right programmatic mix to reach those we are leaving behind- the unreached?

GAP’s intervention, supported by ILO and many other partners, provides some insights.

“We must reach the places where we have not reached earlier – such as places where migrant workers sit, work or live. They often do not have time to go to a health facility and get tested – if they go there then there is an opportunity cost – they do not get the daily wage for that day – therefore we have to take the services where they are,” reemphasises Afsar.

“A large number of people have been tested (for HIV), and those who are found positive are put on treatment. These are the people who were asymptomatic and a lot of them were young people, who are now on treatment and virally suppressed so that they can lead happy and productive lives,” rightly says Afsar.

Awareness or health literacy is key

We have to enhance risk perception for both TB and HIV so that people consider taking a TB test or HIV test and linkage to public services. “That is why in our workplace programmes we take help of peer educators, who go and create awareness, and enhance risk perception – this cannot be done in a lecture-driven or PPT driven approach,” said Afsar.

“We never impose HIV (or TB) testing. Testing is not the first step. First step is awareness generation – and do it in an environment where people’s rights are protected. That is why we engage and sensitise the employers and government agencies too along with other stakeholders to give confidence to workers that if they are found positive (for HIV or TB) they will not risk losing their job. Instead, they will get support, care and treatment to live healthy and well,” said Afsar.

Health justice in a socially unjust world

We all have to strive for health justice, and eventually social justice, which is ecologically sustainable. HIV, TB, hepatitis or STIs responses are part of this overarching approach. Let us hope GAP continues to bridge the gap in access to healthcare and social protection for those in informal or unorganised sector – and such people-centred approaches get scaled up everywhere.

US: City initiative aims to combat rising STIs rates among vulnerable populations

NYC to launch STD outreach program for uninsured New Yorkers, migrants

The city is launching a new outreach program to try to curb sexually transmitted diseases among uninsured New Yorkers, including migrants, The Post has learned.

Health Department officials reported a significant 36% spike in syphilis cases among women and an 11% jump in the gonorrhea rate among men in the city in 2022 — when a tidal wave of migrants began flooding the Big Apple, according to the most recent data available.

For both sexes combined, the city saw a 3% increase in syphilis cases that year compared to 2021, a 3% increase in chlamydia cases and 10% increase in gonorrhea cases.

“Assuring comprehensive and timely screening and treatment for STIs [Sexually Transmitted Infections], including chlamydia, gonorrhea, and syphilis, is critical for preventing … infertility, increased susceptibility to HIV, and congenital syphilis—as well as preventing onward spread to sex partners,” the department said in a pitch to potential bidders to run the program.

“Those who have immigrated to the US face barriers including insurance ineligibility (for undocumented and DACA recipients), delays in eligibility to access public health insurance programs (for documented immigrants), and barriers in understanding eligibility standards,” it added.

More than 212,000 migrants have sought assistance since arriving in the city starting in mid-2022, with 63,000 currently in the Big Apple’s shelter system, Mayor Eric Adams said Tuesday.

Last year, Health Commissioner Ashwin Vasan raised the alarm that half the migrants entering the city had not been tested for the contagious and potentially deadly polio virus.

Most low-income citizens have access to health insurance such as Medicaid to be screened and treated for sexually transmitted infections including chlamydia, gonorrhea, syphilis and HIV.

But the department said it’s more difficult to reach the hundreds of thousands of uninsured New Yorkers, including asylum-seekers, undocumented migrants here illegally and other young people.

Residents who lack insurance are unlikely or unable to self-pay for treatment out of pocket or may resist testing on their own, too, officials said.

“Lack of insurance and financial instability are among the frequently noted barriers to STI care, and they are often correlated,” the department said in its “concept paper” explaining the outreach.

Younger residents, LGBT individuals, blacks and Latinos and the unemployed who are uninsured or underinsured are also less likely to get screening, officials added.

Reported STI cases in the city have risen steadily since 2018, the department said.

But officials said the increase may partially reflect the resumption of STI screening services that were suspended or postponed during the COVID-19  pandemic.

Such services were impacted by lockdown protocols and restrictions and nationwide shortages in testing supplies.

The department said it is seeking  up to three contractors to provide STI-related services to uninsured New Yorkers in neighborhoods with the highest rates of chlamydia, gonorrhea, and syphilis.

The services would include screening and treatment as well as providing vaccines for hepatitis A, hepatitis B, HPV, and mpox.

“The purpose of this RFP [request for proposals] is to ensure that these individuals have equitable access to STI services,” the proposal said.

The Health Department had no immediate comment on how much the initiative would cost or how much each contractor would be paid and over how many years.

Tajikistan: Rising HIV cases among migrants highlight urgent need for testing and repeal of HIV criminalisation law

Every third person with HIV in Tajikistan is a labour migrant

Translated with Deepl.com. For article in Russian, please scroll down. 

There are more and more people living with HIV among migrants

In Tajikistan, every third person with HIV is a labour migrant. Over the past five years, 5,463 cases of HIV infection have been detected, according to data from the Republican Centre for HIV/AIDS Prevention and Control. Of these, migrants account for 22 per cent of those infected. While in 2019 migrants accounted for only 17 per cent of those infected, by 2023 that figure had risen to 32.5 per cent.
Balajon Davlatov, a specialist of the dispensary department of the Republican HIV Centre, strongly recommends to take a free test at one of the HIV prevention and control centres in Tajikistan immediately after arrival.

“Every migrant, after returning home, should be tested for HIV infection if they have doubts about it,” Davlatov said.
More than 300 migrants are already on the Republican HIV Centre’s dispensary register, he said. Their identities and test results are not disclosed to third parties.
“Any information about each person should be confidential. It is possible to get express tests, which within 15 minutes by analysing saliva report the patient’s HIV status – completely anonymously,” he says.
Such tests are available free of charge at one of the 67 government HIV prevention and control centres in all regions of Tajikistan.
In addition to testing through blood at AIDS centres, self-testing using near-blood fluid is now available. Self-test kits are available in Dushanbe, Rudaki, Khujand and B.Gafurov through online ordering at hivtest.tj.

The ordering process involves filling out a simple form with a few questions. This platform helps people confidentially find out their HIV status and provides up-to-date information on protection and prevention methods.
Those who test positive for HIV can learn more about their result and get a follow-up confirmatory test at the AIDS Centre.

We had a case with a woman who tested positive for HIV,” says Balajon Davlatov, “after treatment with antiretrovirals, she gave birth to two HIV-negative children. Now she lives in Russia, and we send her the necessary medication and counselling.
This proves that HIV-infected people can give birth to healthy children and live a full life.

It is an offence to infect another person with HIV

However, a positive HIV status can carry certain risks, which are not only related to the state of health. If a person knows that he or she is HIV-positive but hides it from his or her sexual partner, he or she can be fined from 720 to 1440 somoni under Article 120 of the Code of Administrative Offences (CAO).

Evasion of treatment for HIV or other infectious diseases is also punishable by a fine of 1,440 to 2,160 somoni. This liability is stipulated in Article 119 of the Code of Administrative Offences.

If a person deliberately infects another person with HIV, he or she may be punished with restriction of freedom for up to 3 years or imprisonment for up to 2 years. If, knowing his/her HIV status, he/she infects another person, he/she may face 2 to 5 years in prison. The term of imprisonment can be longer, from 5 to 10 years, if more than one person was infected or if the victim was a minor. This punishment is already stipulated in article 125 of the Criminal Code, which characterises these actions not as an offence but as a criminal offence.

Therefore, it is very important to periodically take tests and check your status, especially if you are in a risk group.

Среди мигрантов всё больше людей, живущих с ВИЧ

В Таджикистане каждый третий человек с ВИЧ – это трудовой мигрант. За последние 5 лет выявлено 5463 случая заражения ВИЧ инфекцией, говорят данные Республиканского центра по профилактике и борьбе с ВИЧ/СПИД. Из них 22% инфицированных приходится на мигрантов. Если в 2019 году мигранты составляли всего 17% зараженных, то к 2023 году эта цифра увеличилась до 32,5%.
Баладжон Давлатов, специалист диспансерного отделения Республиканского центра ВИЧ, настоятельно рекомендует сразу после прибытия пройти бесплатный тест в одном из центров по профилактике и борьбе с ВИЧ-инфекцией в Таджикистане.

«Каждый мигрант после возвращения на родину должен пройти обследования на факт заражения ВИЧ, если у него есть сомнения по этому поводу», – говорит Давлатов.
По его словам, уже более 300 мигрантов находятся на диспансерном учете республиканского центра ВИЧ. Их личность и результаты теста не разглашаются третьим лицам.
«Любая информация о каждом лице должна быть конфиденциальной. Можно получить экспресс-тесты, которые в течение 15 минут путем анализа слюны сообщают о ВИЧ-статусе пациента – полностью анонимно», – говорит он.
Такие тесты можно получить бесплатно в одном из 67 государственных центров по профилактике и борьбе со ВИЧ во всех регионах Таджикистана.
В дополнение к тестированию через кровь в Центрах СПИД, сегодня доступно самотестирование с использованием околодесновой жидкости. Наборы для самотестирования можно получить в городах Душанбе, Рудаки, Худжанд и Б.Гафуров через онлайн-заказ на сайте hivtest.tj.
Процесс заказа включает заполнение простой формы с несколькими вопросами. Эта платформа помогает людям на конфиденциальной основе узнать свой ВИЧ-статус и предоставляет актуальную информацию о методах защиты и профилактики.
Те, у кого тест на ВИЧ оказался положительным, могут узнать о своем результате подробнее и пройти повторное подтверждающее тестирование в Центре СПИД.

«У нас был случай с женщиной с положительным ВИЧ статусом, – рассказывает Баладжон Давлатов, – после лечение антиретровирусными препаратами она родила двоих детей с отрицательным ВИЧ-статусом. Сейчас она живёт в России, и мы отправляем ей нужные медикаменты и даём консультации».
Это доказывает, что ВИЧ инфицированные люди могут рожать здоровых детей и полноценно жить.

Заражение ВИЧ другого человека – это преступление

Однако положительный ВИЧ-статус может нести определенные риски, которые связаны не только с состоянием здоровья. Если человек знает, что у него положительный ВИЧ-статус, но скрывает это от своего сексуального партнера, то в рамках статьи 120 Кодекса об административных правонарушениях (КоАП) РТ ему могут выписать штраф от 720 до 1440 сомони.

За уклонение от лечения от ВИЧ или других инфекционных заболеваний тоже выписывается штраф от 1440 до 2160 сомони. Эта ответственность предусмотрена статьей 119 КоАП.
Если человек умышленно заражает другого ВИЧ, он может быть наказан ограничением свободы до 3 лет или лишением свободы до 2 лет. Если, зная о своем ВИЧ-статусе, он заразил другого человека, ему может грозить от 2 до 5 лет тюрьмы. Срок лишения свободы может быть больше – от 5 до 10 лет, если было заражено более одного человека или жертвой стало несовершеннолетнее лицо. Это наказание предусматривается уже в статье 125 Уголовного кодекса РТ, что характеризует эти действия не как правонарушение, а как уголовное преступление.
Поэтому очень важно периодически сдавать анализы и проверять свой статус, особенно, если человек находится в группе риска.

New Zealand: Seasonal workers will no longer be screened for HIV, in line with other temporary visas

RSE Scheme Revamped, Cap Raised

The coalition Government is supporting the growth of New Zealand’s horticulture and viticulture industries, by revitalising the Recognised Seasonal Employer (RSE) Scheme and increasing the cap for the coming season.

“We are making changes that can be delivered quickly, reduce costs and compliance for employers, and improve flexibility for RSE workers,” Immigration Minister Erica Stanford says.

“Our Government is committed to increasing the number of RSE workers over time in line with industry demand, while balancing the availability of New Zealanders and accommodation for workers. That’s why the cap on the number of workers is increasing by 1,250 to 20,750 for the 2024/25 season.

Other changes include employers being required to pay workers an average of 30 hours a week over four weeks. The pause on accommodation cost increases will be lifted and the requirement to pay RSE workers 10 percent above the minimum wage will only apply to experienced workers, recognising their productivity.

“The RSE scheme is central to our relationships in the Pacific and has delivered tremendous benefits to everyone involved,” Foreign Affairs Minister Winston Peters says.

“New Zealand is committed to supporting Pacific priorities. That is why these changes include broader opportunities for skills development, greater flexibility in visa settings, and pay based on experience.”

Further changes are:

  • Improved flexibility for RSE workers to move between employers and regions.
  • Workers’ visas will be multi-entry during a season.
  • RSE workers will be able to undertake training and skills development not directly related to their role.
  • RSE workers will no longer have to be screened for HIV, aligning them with other temporary visa applicant requirements.
  • Timor-Leste will be included in the scheme.

Most of these changes will be in place in early-September. Further time will be needed to set up the infrastructure and processes on the ground for Timor-Leste to participate. The cap increase fulfils a commitment from the coalition agreement between National and Act.

“These changes are just the start. The next phase of our work programme will consider substantive, longer-term options to further improve the wider RSE system and worker welfare settings,” Ms Stanford says.

Tajikistan: Migrants can get tested and access treatment for HIV anonymously and free of charge

Where to get an anonymous HIV / TB test and free treatment in Tajikistan

HIV and tuberculosis are two complex diseases that require a multi-faceted approach that includes medical, social and educational interventions. It’s crucial to tackle these diseases not only to reduce the number of infections but also to improve the quality of life of people living with them.

 The number of people living with HIV among migrants is increasing

In Tajikistan, one in three people with HIV is a labour migrant. Over the past five years, 5,463 cases of HIV infection have been identified, according to data from the Republican Centre for Prevention and Control of HIV/AIDS. Migrants make up 22% of the infected. While in 2019 migrants accounted for only 17% of those infected, by 2023 this figure had increased to 32.5%.

Balajon Davlatov, a specialist in the dispensary department of the Republican HIV Centre, strongly recommends taking a free test at one of Tajikistan’s HIV prevention and control centres immediately after arrival.

“If migrants have doubts about their HIV status, they should be tested when they back home,” Balajon Davlatov said.

According to his words, more than 300 migrants are already on the dispensary registration of the Republican HIV Center. The identity and test results are not disclosed to third parties.

“Any information about each individual should be confidential. You can obtain rapid tests that report a patient’s HIV status within 15 minutes by analyzing saliva – completely anonymously,” says Balajon Davlatov.

HIV tests are available free of charge at one of the 67 state HIV prevention and control centres in all regions of Tajikistan.

In addition to blood testing at AIDS Centres, self-testing using near-blood fluid is now available. Self-testing kits are available in Dushanbe, Rudaki, Khujand and B.Gafurov via online ordering at hivtest.tj.

The order process involves filling out a simple form with a few questions. The platform helps people confidentially know their HIV status and provides up-to-date information on protection and prevention methods.

Those who tested positive for HIV can learn more about their result and get a second confirmatory test at the AIDS Centre.

In Tajikistan, there is an example of an HIV-positive mother who gave birth to two healthy children by stopping the virus from growing in her organism:

“We had a case of an HIV-positive woman. After she was treated with antiretrovirals, she gave birth to two healthy children who were HIV-negative. She’s now based in the Russian Federation and we send her the necessary medication and support. This shows that people infected with HIV can have children who are healthy and lead a full life”, says Balajon.

HIV is a human immunodeficiency virus that attacks the immune system. Most people do not experience any symptoms when they are infected. Sometimes a flu-like condition develops a few weeks after infection. But if abandoned and left untreated, HIV can develop into the final stage, AIDS, when the body is so weak it cannot protect the body from various infections and diseases.

Infecting another person with HIV is a Crime

However, a positive HIV status can bring certain risks, not only related to the state of health, if a person knows that he/she has a positive HIV status, but hides it from his/her sexual partner, within the framework of article 120 of the Code of Administrative Offenses of the RT, he or she may be fined from 720 to 1440 somonis.

Avoiding treatment for HIV or other infectious diseases is also subject to a fine from 1440 to 2160 somoni. This responsibility is stipulated in Article 119 of the Administrative Offenses Code of the RT.

If an individual intentionally infects another person with HIV, he or she can be punished by up to 3 years’ restriction of freedom or up to 2 years’ imprisonment. When a person infects another person with HIV knowing their HIV status, they can face 2 to 5 years in prison. The prison term can be longer – from 5 to 10 years in case more than one person was infected or the victim was a minor. This punishment is stipulated in Article 125 of the Criminal Code of Tajikistan, which characterises these actions not as an ordinary offence, but as a criminal act.

Therefore, it is crucial to have regular tests and status checks, especially if a person is at risk of infection.

How to recognise TB in the early stages

Having an HIV diagnosis, however, a person is not only at risk of committing offences but is also at risk of contracting serious infectious diseases, such as tuberculosis. We should also talk about this disease in more detail since the working conditions of many labour migrants can contribute to the infection of tuberculosis and its progression to more severe stages. Moreover, TB infection may have no connection with the presence or absence of HIV in a person. It is a separate disease that is also prevalent among different population groups, including labour migrants. In 2023, 4,048 TB patients were registered in Tajikistan.

In its initial stages, TB can easily be mistaken for the common flu, making it difficult to diagnose. However, several symptoms may indicate the presence of the disease:

  • Cough that lasts for more than 3 weeks.
  • The cough may be dry or with sputum that may contain blood.
  • Feeling tired for no apparent reason, even a rest.
  • Appetite loss and weight loss for no apparent reason.
  • Slight fever (up to 37-38°C), in the evening or at night.
  • Heavy sweating during sleep, even in a cool room.
  • Chest pain, which may increase with coughing or deep breathing.
  • Decrease in performance and shortness of breath with minor physical exertion.

Farkhod Dzhumayev, a phthisiologist, said the flu is not as exhausting: symptoms last 1-2 weeks, while TB is treated for 6 months to 2 years. Tuberculosis is treated with TB drugs, but without treatment, it can lead to death. Discontinuing medication prematurely or without consulting a doctor is dangerous, as it can lead to drug resistance of the pathogen.

To keep your family safe, if you suspect you are at risk of TB, you can contact one of the 69 public TB diagnostic and treatment centres. This service is provided free of charge by the state in Dushanbe, DRS, Sughd, Khatlon and GBAO.

“A patient who lives in a large family of 8 people in a 3-room apartment approached us,” says the doctor. “He went to hospitals, where he was prescribed treatment for flu, which did not relieve the patient from high fever, cough, exhaustion and headache. Fortunately, on the recommendation of the family doctor, he had a sputum test, which enabled us to detect tuberculosis in time and prescribe effective treatment.”

As Farhod Dzhumayev recalls, during the 2 months when the patient didn’t know his true diagnosis, his family also managed to get infected with TB:

“We checked his family, tested their sputum, conducted chest X-rays, and took a Mantoux immunologic test, and those who had active TB were prescribed TB treatment,” says the phthisiologist.

It’s easier to prevent the disease

HIV and tuberculosis are not a verdict. You can live a normal life with proper treatment like others.

In addition, advances in modern medicine make it possible to hope for a complete recovery from tuberculosis in a relatively short time. Scientists are also close to obtaining a cure for HIV. They are still at the testing stage, and it takes time to study their actions and potential risks. However, likely, HIV will soon move from being an “incurable” disease to a treatable one.

At this point, despite the availability of current or potential treatment, it is important to make efforts to prevent infection with serious diseases such as HIV and tuberculosis, because in any case, it is easier to prevent the disease than to spend energy, time and resources on recovering health.

Read more for addresses of treatment and testing centres in Tajikistan: https://asiaplustj.info/en/node/339434