Interview: Musarrat Perveen from CARAM Asia on the urgent need for migrant HIV policy changes

Addressing Migrant Workers’ Vulnerability to HIV

We spoke with Musarrat Perveen, regional coordinator at Coordination of Action Research on AIDS and Mobility in Asia (CARAM Asia), who advocates at regional and global levels for policy reform of discriminatory practices that put migrant workers at risk of HIV and AIDS.

Continuing our coverage of AIDS 2024, the 25th International AIDS Conference, we spoke with Musarrat Perveen, regional coordinator at Coordination of Action Research on AIDS and Mobility in Asia (CARAM Asia), who advocates at regional and global levels for policy reform of discriminatory practices that put migrant workers at risk of HIV and AIDS, sexually transmittable infections (STIs), and other health conditions, as well prevent them from accessing health care services.

CARAM Asia, established in 1997, is a regional network of 42 migrant and migrant support organizations across 18 countries in Asia that focuses on coordinating research on AIDS and mobility. It helps to target the important challenges individuals face throughout the migration process and support community-based organizations in their efforts to both promote and protect migrant workers’ health rights, including sexual and reproductive health rights. These efforts aim to empower migrant communities by developing research, awareness publications, campaigns, and policy recommendations to protect migrant workers’ rights and address their health and welfare at national and regional levels.

The American Journal of Managed Care^® (AJMC^®): Can you explain the research you presented at the International AIDS Conference and what motivated you to undertake this study?

Perveen: Migration is a historical and global phenomenon driven by disparities in income and quality of life. Economic migration is driven by various factors. There are push factors that include inadequate labor standards, high unemployment rates, poverty, political instability, and weak economies, and there are pull factors such as higher wages, improved job prospects, and increased demand for labor. Migrant workers boost economic development by addressing workforce shortages in such sectors as construction, agriculture, services, and domestic work in receiving countries and by increasing the gross domestic product in sending countries through their remittances. For example, in 2015, the Philippines, Pakistan, and Bangladesh received $29.7 billion, $20.1 billion, and $15.8 billion, respectively.

Despite these contributions, migrant workers are still treated as commodities by the governments of sending and receiving countries, which neglect their human, labor, and health rights, resulting in their exploitation and abuse, and putting them at risk of HIV/AIDS, STIs, and other health conditions. Social, economic, and political factors further influence HIV risk among migrant workers, due to their separation from families, poor living conditions, and exploitative working conditions; they go abroad alone and experience cultural shocks, stigma, discrimination, and isolation. The resulting isolation and stress, combined with these policy restrictions, often leads to risky behaviors—migrant workers belong to sexually active and reproductive age groups—while seeking intimacy in a foreign country. Additionally, policies in receiving countries frequently prioritize short-term labor needs while overlooking the essential human needs and health rights of migrants. This results in limited access to crucial HIV prevention information and health care services, which, in turn, increases their vulnerability to HIV/AIDS, STIs, and other health conditions. Further restrictive in-migration policies dehumanize migrant workers by limiting their ability to bring spouses, get married, or become pregnant in receiving countries.

In 2005 and 2007, CARAM Asia conducted 2 regional research studies under the main title, “State of Health of Migrants.” The 2005 study focused on migrant workers’ access to health information and services in sending and receiving countries,² and the regional research in 2007 focused on migrant workers’ mandatory health testing across various countries in Asia.³ These studies in Asia were groundbreaking, identifying numerous policy barriers and challenges experienced by migrant workers at every stage of the migration process, and highlighting that governments in the region generally failed to reform and implement policies protecting migrant workers’ health and rights despite international guidance on health provision for all. As a result, there has been limited policy and program work focusing on HIV/AIDS prevention, treatment, and care for migrant workers.

The purpose of our research presented at AIDS 2024 was to gather current information and monitor the development of policies and programs concerning migrant workers’ health rights over the years. Our principal research objective was to evaluate the current status of health rights for migrants in 5 Asian sending countries: Cambodia, the Philippines, Bangladesh, Sri Lanka, and Pakistan. The research looked at how HIV- and AIDS-related policies and practices have changed over time and identified any positive changes in protecting migrants workers’ health rights, especially regarding HIV. It also identified remaining obstacles in this area. HIV is an important indicator because it is a sensitive health condition with wider social consequences of stigma and discrimination.

AJMC: What criteria guided your selection of Bangladesh, Cambodia, Pakistan, the Philippines, and Sri Lanka for this research?

Perveen: The selected countries for the study in South and Southeast Asia are some of the major migrant-sending countries. These countries are experiencing an increase in the working-age population entering the workforce while facing limited opportunities within their local job markets. Labor-exporting countries rely on policies that promote out-migration to relieve the pressure of underemployment. Simultaneously, exporting the surplus workforce provides considerable income to the countries’ coffers through foreign exchange generated by migrants’ remittances.

Many countries are willing to compromise their citizens’ rights by allowing or even helping them to move to countries that lack proper protections for migrants’ rights. Migration policies often prioritize securing macro benefits, leading them to neglect upholding migrants’ rights. Migrants’ health rights are quietly violated regularly, with the most dramatic incidents being labor exploitation, physical abuse, and trafficking.

We selected the 5 countries for our study for several reasons. First, Bangladesh, Cambodia, Pakistan, the Philippines, and Sri Lanka were recognized as some of the major sending countries in Asia, with a significant number of migrant workers moving abroad in search of employment opportunities. These countries were important for studying changes in HIV/AIDS policies and obstacles in protecting migrant health rights, and they were previously included in CARAM Asia’s “State of Health of Migrants” reports.

Second, these countries had migrant workers who returned from various receiving countries, including the Middle East and the Gulf Cooperation Council countries of United Arab Emirates and Saudi Arabia, and the Southeast Asian countries of Malaysia, Thailand, and Singapore. These returning migrant workers brought valuable experiences and insights into the barriers they faced in accessing health services in different receiving countries, particularly concerning HIV/AIDS. Due to the lack of resources to conduct the study in the above-mentioned receiving countries, we analyzed the migrants’ self-reports and reviewed the sending countries’ policies.

Third, some of these sending countries were known for practicing strict policies that criminalized the transmission, disclosure, and nondisclosure of HIV. For example, in Bangladesh, Cambodia, Sri Lanka, and Pakistan, mandatory policies dictate HIV testing for employment abroad and disclosure of HIV-positive status to their families and prospective sexual partners. However, we belive that mandatory HIV testing violates human rights by infringing upon personal rights to privacy and confidentiality. No one should have the authority to demand an HIV test from any other individual, thus undermining their fundamental rights.

These policies say that informing partners and families about HIV is important to prevent its spread, but doing so can also cause stigma, discrimination, and treatment delays. Disclosing HIV status should be done in a way that reduces risks to individuals, such as through voluntary disclosure with informed consent and by providing psychosocial support to help them cope with partners’ and families’ reactions. Considering this illustration of criminalization policies, a comprehensive investigation was indispensable to examine the evolution of the reform of the aforementioned policies, and others, about safeguarding migrants’ rights, particularly their health rights concerning HIV/AIDS.

AJMC: What are some examples of discriminatory health practices and policies that migrants face, particularly concerning health screenings?

Perveen: First, mandatory health screening as a prerequisite for migrant workers entering destination countries is discriminatory and dehumanizing; it violates such basic rights as the right to employment and to access health services. Most receiving countries in Asia enforce strict health policies that discriminate against migrant workers based on their HIV status.

Before their work permit applications are accepted, migrant workers must undergo mandatory medical testing at the predeparture stage; their employment documents will only be processed if the test results show they are fit to work. Second, they have to undergo mandatory testing upon arrival in receiving countries, and if they test positive for conditions such as HIV, tuberculosis, or pregnancy, they are immediately subjected to criminalization, arrest, detention, and deportation by those governments—who also do not cover the cost of their return to the sending country. If they pass, they receive a 1-year work permit. This process repeats every year.

Failure to pass these tests results in arrest, detention, and deportation. Migrant workers filling unskilled or semiskilled jobs are specifically targeted for these examinations. Consequently, they are treated differently from locals and are excluded from the protection offered by existing laws and policies on HIV in both sending and receiving countries.

Second, HIV testing standards are often disregarded, including confidentiality and informed consent. Migrant workers often do not receive detailed information about the testing procedures or the conditions being tested for. They do not fully understand the consequences of a positive result and often feel pressured to sign documents without understanding them. Health officials frequently assume implicit consent or accept consent from recruiters, which is very problematic. The testing procedures can be invasive and may cause embarrassment, as they may require migrants to be completely unclothed or examined by health care providers of the opposite gender. Confidentiality is often breached, as test results are sent directly to recruiters, sometimes before the migrant is informed. Also, migrants are often not given their reports and are only told if they are eligible to work abroad or not, with little explanation if they are considered unsuitable.

Third, in some of the receiving countries, migrant workers are required to pay very high costs for public health care services compared with the locals, but their minimal salaries often place these costs far beyond their means. And if they try to access public health services, undocumented migrant workers who do not possess legal documents in receiving countries also face the risks of arrest, detention, and deportation. CARAM Asia advocates for universal health coverage for all regardless of their legal documentation status or if someone is living with HIV.

Fourth, there is a marked lack of awareness programs to prevent HIV among potential migrants who are in the process of leaving a country and there are no specific health services for returnee or deported migrant workers based on if they are living with HIV. Therefore, they may go back to their communities without even knowing the reason for deportation and transfer infections. There also are no data to identify these returnees, nor are there government programs to help locate and provide them with health services.

AJMC: Can you provide examples of health and migration policies reviewed in your study that discriminate against migrant workers?

Perveen: There are several examples of these policies:

Bangladesh: The National Strategic Plan for HIV/AIDS (2011-2015) introduced strategies for combating HIV/AIDS among migrant workers, such as predeparture preparation; distribution of information, education, and communication materials; airport advertisements, and establishing voluntary counseling and testing centers. However, implementation of these strategies remains unclear, suggesting inconsistent access to health care services for migrant workers. This indicates that the policy inadequately addresses their health needs, particularly regarding HIV/AIDS.
The Philippines: The Republic Act 8504 (1998) and other laws on HIV-related support and insurance have helped to improve HIV-related services. However, implementation and program sustainability remain challenges, especially in HIV testing and treatment for overseas Filipino workers, and there are persistent gaps in service coverage.
Pakistan: The National AIDS Control Program (1986-1987)provided health access for migrant workers. However, treatment centers are more concentrated in major cities, making access to and awareness of these centers difficult for migrant workers who largely hail from rural areas.
Cambodia: The National Plan of Action of the National Committee for Counter Trafficking (2014-2018) and National AIDS Authority’s 7-point Policy Directives do not specifically address migration health issues.
Sri Lanka: Migrant workers receiving care throughGulf Approved Medical Centers Association–certified centers face mandatory HIV testing, but the centers do not ask for their consent for testing. If a migrant receives a positive results, they are immediately deported and blacklisted from employment in any Gulf country through a shared database.

The American Journal of Managed Care^®(AJMC^®): Why have migrants historically been excluded from national AIDS programs in the regions you studied?

Perveen: Migrants have been excluded from the national AIDS program in Bangladesh, Cambodia, Pakistan, the Philippines, and Sri Lanka due to the governments’ lack of recognition of the workers’ vulnerability to HIV/AIDS and sexually transmitted infections (STIs) in their national AIDS plans. Instead of being labeled as most at risk for contracting HIV, they are often only considered vulnerable populations. However, in the past, they also were not always considered vulnerable. Although these policies and perceptions have changed due to intense advocacy by CARAM Asia and other stakeholders in the region, the governments still are not recognizing the risk factors migrant workers face, highlighting the ongoing discriminatory treatment they face through the health policies of sending and receiving countries.

Annually Reported HIV diagnoses by Age and Sex

From 2013 to 2022 in Sri Lanka

For example, the countries studied categorize men who have sex with men, persons who inject drugs, sex workers and their clients, and Hijras as most at risk. Migrant workers are excluded from this classification despite data showing an annual increase in cases of HIV and a significant number of returnee migrants now living with HIV. In Sri Lanka, for example, 187 of 607 (30.8%) reported HIV cases in 2022 had a history of external migration, as shown in the figure.

AJMC: How are migrant workers more vulnerable to HIV vs nonmigrant populations, and what unique risk factors do they face in the receiving countries you studied?

Perveen: Migrant workers are more vulnerable to HIV compared with local nonmigrant populations because sending and receiving countries often treat migrant workers as commodities, neglecting their fundamental human, labor, and health rights. Their young ages when going abroad for employment also predisposes them to culture shock due to unfamiliar policies and conflicting cultural norms. This can lead to stress and anxiety, and neglect that make them more susceptible to rights violations, violence, abuse, and exploitation. Other unique risk factors for migrant workers in receiving countries include the following:

Single-entry visas
Prohibitions on marriage with locals
Restrictions on bringing spouses
Isolation in a foreign country
Neglect of their human need of intimacy

The stress and anxiety also can result in behavioral changes that include unprotected sexual behavior, which raises the risk of contracting HIV. A lack of awareness about HIV prevention measures further increases their vulnerability to HIV and other sexual and reproductive health rights issues due to limited access to health information and services. Women also may experience sexual abuse and exploitation, particularly those working in the entertainment sector or as domestic workers, who often live in their employers’ private homes with no access to social support. In many cases, women are forced into the sex industry, which also increases their risk of contracting HIV and where they encounter many other health problems.

AJMC: What were the top health priorities identified by migrants in your focus group discussions, and what challenges did they highlight as barriers to equitable HIV/AIDS health care in the countries studied?

Perveen: Among the top health priorities identified by migrant workers during the research was HIV/AIDS, STIs, tuberculosis, and mental health. Challenges they highlighted as barriers to equitable HIV/AIDS health care include the following:

Stigma and discrimination: People living with HIV/AIDS often face considerable stigma and discrimination from their families and society. This stigma leads many to conceal their HIV status, resulting in isolation and a lack of support.
Financial burden: Migrant workers are required to undergo regular annual health checks, including tests for HIV and sexual health. These expenses are typically paid out of pocket by the workers, either directly or through salary deductions. This financial strain is particularly challenging for those with low incomes.
Lack of health care coverage for undocumented migrants: In some receiving countries, registered migrants must undergo tests to qualify for health insurance coverage. However, undocumented migrants also often lack health care coverage, leaving them without access to essential medical services.
Lack of access to embassy and consulate services: There are significant gaps in accessing embassy, consulate, and Philippine Overseas Labor Office services for overseas Filipino workers living with HIV. Reports from these migrant workers who were deported between 2012 and 2016 indicate they were quarantined without access to their embassies. Furthermore, receiving country health ministries or immigration offices are not obligated to notify embassies about workers’ health issues, resulting in a lack of connection to repatriation and reintegration services. Most embassies and consulates also lack funds and facilities to help migrant workers, and some even don’t even answer phone calls.
Immediate deportation and blacklisting: Migrants who receive a positive result following an HIV test are often deported immediately and blacklisted from migrating to any Gulf country via the shared database. This deportation frequently occurs without providing information or referral services, leaving migrants unaware of their HIV status and its implications.

AJMC: Based on your research findings, what specific recommendations do you have for improving health policies for migrant workers in these countries?

Perveen: Sending and receiving countries should invest sufficient funds in HIV education for migrant workers to provide awareness about HIV/AIDS and STI prevention, and provide access to health services at all stages of the migration cycle. Also, most receiving countries should eliminate discrimination against labor migrants by reforming health policies that criminalize—via arrest, detention, and deportation—migrant workers based on HIV status, and ensure unrestricted access to health services for documented and undocumented migrant workers.

Governments of receiving countries also should ensure migrant workers get proper days off and, when possible, provide affordable, accessible, and healthy recreational activities as alternatives to risky behaviors for relaxation and holidays, including those that permit spouses. In addition, national AIDS strategies, strategic frameworks, and programs need to include migrants, migrant workers, and families and partners of migrants more prominently and address their specific needs with comprehensive services that are supported by appropriate levels of funding and interagency coordination.

It is also important to standardize laws and policies on HIV testing to ensure that any testing migrants must undergo adheres to internationally accepted standards that include informed consent, confidentiality, pre- and posttest counseling, and proper referral to treatment, care, and support services. The goal of testing also should become to prevent HIV infection, not to criminalize migrant workers.

Sending and receiving countries also should work to eliminate stigma and discrimination against people living with HIV and respect gender and sexual orientation among migrant workers, and receiving countries especially should provide employment access returning migrant workers.

AJMC: What final thoughts or messages would you like to share for future advocacy and policy change?

Perveen: Readers of CARAM Asia’s research might include important stakeholders in both receiving and sending countries, such as government agencies, politicians, policymakers, migrant nongovernmental organization, journalists, and other influential groups. We hope that our research on discriminatory policies and obstacles in protecting migrants’ health rights, along with our recommendations for improved health policies for migrants, reach this audience and they are able to highlight the necessity in addressing these ongoing issues. Through this research, we also strive for a deeper understanding of the impacts of discriminatory policies in receiving and sending countries on marginalized populations like migrant workers, in term of their health.

Prioritizing the voices and experiences of migrant workers in the fight against HIV is crucial, and we advocate for this through participatory action research and other means. Effective advocacy for the health rights of migrant workers requires active collaboration with various stakeholders, including migrant nongovernmental, civil society, community-based, and government organizations. This approach ensures that evidence-based knowledge is grounded in the lived realities of migrant workers.

For future advocacy and policy changes to be effective, it is essential to develop inclusive policies with active participation from migrant workers, enhance access to legal and health services, decriminalize and protect labor migrants, and foster ongoing collaboration among researchers, activists, health care professionals, and policymakers. This strategy underscores the transformative power of research-informed advocacy in creating equitable HIV/AIDS health care, particularly for vulnerable populations like migrant workers.

Reference

Perveen M. Lack of access to treatment and criminalization of labor migrants based on HIV-positive status: a review of HIV policy progression and migrant’s health rights in five origin countries in Asia. Presented at: AIDS 2024, July 22-26, 2024; Munich, Germany. Poster EPF198. https://aids2024.iasociety.org/cmVirtualPortal/_iasociety/aids2024/eposters#/PosterDetail/774

Canada: Migrants face significant healthcare gaps despite universal coverage promises

Op-ed: Failing Migrant Rights, Failing Public Health

Janet Butler-McPhee, Anne-Rachelle Boulanger, and Nadia Fyfe

Canada prides itself on being a welcoming country with a universal healthcare system — and is lauded for both around the world. But for people without citizenship, significant healthcare gaps exist and access is often barred. This is true for many people living with HIV who require antiretroviral therapy to treat the condition and ensure that it can’t be transmitted. Having marked World Hepatitis Day this month, we also know that many people living with hepatitis C (HCV) in Canada cannot access healthcare and face the needless prospect of liver damage, cancer, and even death without treatment. The status quo is unacceptable for those who wish to call Canada home, and for Canadians who understand the critical importance of public health and human rights.

Accurately determining the number of people without citizenship in Canada who are living with HIV, HCV, and other sexually transmitted and blood-borne infections is challenging. However, it is well-recognized that migrants are disproportionately affected by some of these conditions but may never have had access to treatment. Migrants account for roughly 30% of people living with HCV in Canada and 70% of those living with hepatitis B. In 2017, it was estimated that up to 500,000 people in Canada were living without health insurance, primarily due to their lack of citizenship. And with more and more people immigrating since then, we can assume that these numbers have now increased.

Accessing healthcare is a complicated ordeal for newcomers, as all provinces and territories have their own healthcare insurance plans. Most require people to have lived in their jurisdiction for six months to be eligible for healthcare, and then impose another three-month waiting period before coverage kicks in. In some jurisdictions, access is even further limited for people living with HIV, as antiretroviral therapy is only available at specific pharmacies, or coverage is only available with a specialist’s recommendation, even though those specialists already have lengthy waiting lists. These requirements delay access to essential healthcare and worsen outcomes.

Newcomers to Canada will, in most cases, pay out of pocket during these long waiting periods. In a 2023 study that looked at the impact of waiting periods in Ontario, 32% of participants reported delaying necessary healthcare for themselves or immediate family members due to lack of coverage. Media outlets have regularly reported on harms (both financial and otherwise) caused by such delays. One individual avoided getting gender-affirmative care. Another woman was charged $35,000 for a life-saving hospitalization. A couple was also denied an appointment with an obstetrician unless they paid $10,000 upfront. None of this bodes well for public health.

Access to healthcare is even more restricted for people without immigration status — a situation in which people often become trapped because of legal technicalities. People in this position cannot obtain status in Canada, nor are they afforded their basic human right to healthcare, as immigration status is required to access any public healthcare plan. We know that people living with HIV and HCV can be — and are — caught in this position, unable to access care critical to their well-being and survival. The United Nations has frequently called on Canada to ensure that our public healthcare is accessible to all people, regardless of their immigration status; the world may soon realize how “un-Canadian” some of our policies really are.

The Interim Federal Health Program (IFHP) attempts to fill some of these gaps by providing temporary healthcare coverage to refugee claimants, recognized refugees, and other protected persons in Canada. Through IFHP, these individuals should have access to the same coverage provided by the province or territory in which they live. But the program often fails to provide consistent access to essential healthcare to those in need, as noted by service providers. Following extensive cuts to the program in 2012, the Federal Court confirmed that the cuts put “lives at risk and… serve to perpetuate the historical disadvantage suffered by members of an admittedly vulnerable, poor and disadvantaged group.” Today, a change in political will could threaten its very existence. If we are really committed to protecting people in need, as we claim on the world stage, their access to healthcare should be a no-brainer.

Addressing the barriers non-citizens face in accessing treatment for HIV, HCV, and other health conditions isn’t just a matter of fairness — it’s a public health necessity. Canada must eliminate wait times for health insurance, increase funding for temporary healthcare coverage, and ensure provincial requirements do not hinder access to life-saving care. Only then will Canada have any hope of a truly universal healthcare system where no one is left behind.

Janet Butler-McPhee is a Co-Executive Director of the HIV Legal Network and a member of the steering committee of Action Hepatitis Canada.

Anne-Rachelle Boulanger is a Policy Analyst with the HIV Legal Network.

Nadia Fyfe is a law student at the University of Western Ontario.

Syria: Syrian trans woman’s HIV status shared by media, leading to deportation and death

Refuge trans woman deported by Turkey over HIV status killed in Syria

A Syrian refugee trans woman, who was deported by Turkey after her HIV status was exposed on social media, was killed by the Free Syrian Army in collaboration with her family in Syria.

Adana LGBTI+ Solidarity on July 27 announced that a Syrian trans woman who were deported by Turkish authorities to Syria over her HIV status were killed in there five days ago.

LGBTI+ news outlet KaosGL reported that she was killed by Free Syrian Army and her family.

On July 5, local news outlets and several social media users shared medical documents about the refugee woman with serious hate speech.

Even though it is illegal to disclose any person’s medical information in Turkey, authorities decided to deport the refugee woman instead of punishing those involved in the crime.

The Adana LGBTI+ Solidarity stated, “In Adana, a Syrian trans woman had her private health information shared without consent and faced hate speech. This violated her personal rights and privacy. Trans woman M.E. was deported through the Cilvegözü Border Gate following these events. Unfortunately, we learned that she passed away five days ago.”

New Zealand’s healthcare system difficult to navigate for migrant mothers

Migrant moms return home due to New Zealand health system struggles

Migrant mothers face a confusing and frustrating time when it comes to navigating New Zealand’s healthcare system, new research has found. But there are ways to make the process easier.

The Asian population is the fastest growing ethnic group in New Zealand, currently making up 15% of the total population. Three-quarters are migrants.

And yet, research has found Asian women have poorer maternal and perinatal outcomes when compared with New Zealand Europeans.

One recent study found that while pregnant Asian mothers were more likely to see a doctor than New Zealand European mothers, they were less likely to have their first-choice lead maternity caregiver (LMC).

Speaking with migrant mothers from China and India, our research identified overarching themes describing their experiences with healthcare in New Zealand. The interviewees also outlined ways their needs could be better integrated into the health system.

A lack of understanding

New Zealand’s maternal healthcare is considered relatively unique. Midwives are the lead maternity carer for more than 90% of women.

But that uniqueness can cause problems for migrant mothers. Most of the research participants said they were not aware of the different health services available to them and their children.

As one Indian mother said:

[I had] a pretty hard time to find a good midwife because when I was pregnant for the first time, I didn’t know anything, and New Zealand is a new country. And I didn’t have anyone, didn’t know anyone, and had no family and no friends.

Having to manage a language barrier was another challenge. At times, this prevented the mothers from accessing the care they needed.

As one Chinese mother explained:

For any kind of appointment including GP and doctor, the first thing is to make an appointment. No matter how much time it takes, I have to use translation. And I need to ask others to help make the call every time… Sometimes I don’t want to bother others, so I would rather not see the doctor.

Another barrier mentioned by the mothers we spoke to was that their child’s access to some services – such as Plunket – depended on their visa status.

One mother we spoke with sent their young toddler back to India to live with family when the cost of care became too much:

[W]e were spending a lot of money for [my daughter’s] daycare because she was under three years, so she wasn’t getting any free hours for daycare. So, we were spending more than $60 per day for her daycare, so it was quite expensive for us. So that’s why me and my husband decided to leave her with my mum and dad [in India].

Going home rather than waiting

Many of the mothers we spoke with said doctors in New Zealand were friendly. But the research participants also expressed a general lack of trust of the GPs.

One mother spoke of how a New Zealand doctor used the internet to search for information regarding their symptoms. This undermined her trust and confidence in the doctor.

Many of the research participants were also frustrated by the lack of diagnostic tests. They reported feeling dismissed when they asked for them.

These factors contributed to them travelling back to their home country to receive care. As a Chinese mother recounted:

My kid had an extra teeth [sic] when she was three-years-old and we have been waiting for the dentist. Now two years have gone, and we are still in the line … When we went back to China, we paid ourselves and extracted the tooth.

The migrant mothers also spoke about a lack of support systems. In India, new mothers and their child were cared for by their family members. That support structure, however, was absent in New Zealand.

As one Indian mother explained:

when I got home, I was on borderline depression, so postpartum depression, and when I asked my midwife… I really didn’t receive any like, ‘Oh, you’ve got this, you can ask your GP to assess you, and then we can give you some mental wellbeing support’. It just seemed very difficult to ask for help in terms of postpartum.

Improving care

The responses from the migrant mothers highlighted the importance of a system that is inclusive of migrants’ needs. This includes wider access to translation and orientation services that help migrants navigate the different facets of life in New Zealand.

It’s not out of the realm of possibility. One Chinese mother explained how she had seen this model of migrant care while working in Japan:

In the first week when we arrived in Japan, they provided a whole week training including the national system, rubbish recycling, and medical system… Some basic trainings, for example, how and where to register GP, the process for seeing a doctor when you are sick, the emergency number, etc. These would be valuable for people that are new to New Zealand, especially those that cannot speak English.

New initiatives, such as the Healthy Mother Healthy Future, have been implemented to help Asian mothers during pregnancy.

But New Zealand also needs to address issues of access to childhood services, particularly for children whose parents are on work visas.

New Zealand’s healthcare system is built on the idea of universal access and fairness. Our research shows that, for many migrant mothers and their children, this is not the case.

This research was completed with the assistance of Dr. Hongxia Qi. This research was funded by a grant from the Health Research Council (19/263).

US: New report reveals dire conditions for LGBTQ and HIV-Positive asylum seekers in U.S. immigration detention facilities

“No Human Being Should Be Held There”: The Mistreatment Of LGBTQ And HIV-Positive People In U.S. Federal Immigration Jails

Asylum in the United States is a lifesaving necessity for LGBTQ and HIV-positive people. For decades, many have fled to the United States to seek refuge from persecution and torture. However, the United States subjects hundreds of thousands of people yearly, including LGBTQ and HIV-positive people, to its massive network of jails and prisons. These jails, run by U.S. Customs and Border Protection (CBP) and Immigration and Customs Enforcement (ICE), are infamous for their inhumane and abusive conditions. For LGBTQ and HIV-positive people, these conditions routinely include high rates of physical and sexual violence, improper and prolonged solitary confinement, and inadequate medical care among other forms of systemic abuse and neglect.

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.

The executive branch and Congress can take steps to end this unnecessary suffering and protect the rights of LGBTQ/H individuals. These include steps to apply parole authority, issue guidance on vulnerable populations, support legislative action and phase out immigration detention. Read the full report here.

Controversy around visa denials hits the International AIDS Society

Visas denied to many HIV activists in run-up to 2024 International AIDS Conference

Controversy around visa denials has hit the International AIDS Society (IAS) as it plans for the start of the 2024 International AIDS Conference (AIDS 2024) in Munich, Germany. In the week before the July 22 opening session, numerous delegates from African countries have said that they were denied visas to Germany or were still waiting to hear if they would be admitted into the country to attend the conference.

Some activists have criticized IAS for presenting their global meeting in a northwestern country—and suggested that if the conference occurred in the global south or in a low- to middle-income country, such visa troubles would not occur.

In the face of such critiques, IAS has leveraged its power to assist delegates. Bijan Farnoudi, M.Sc., the IAS director of communications, explained to TheBody that according to its ongoing feedback with 693 delegates who had reached out for assistance, 82% had obtained their visas, 6% were still pending, and 12% had been denied. The largest number of these delegates reporting that they’d obtained their visas were traveling from Kenya, Nigeria, and Zimbabwe. Meanwhile, many delegates from Uganda were still waiting to hear back from the German consulate.

When asked why some delegates were denied visas, Farnoudi explained that IAS only knows what people report back to them, but that historically the issues have included incomplete applications, missed timelines, missing documents, or authorities expressing doubts over the applicant’s explanation for attending. But he was quick to acknowledge that the reasons are impossible to definitively ascertain because the visa process is confidential between applicants and the consular service.

TheBody contacted the German Federal Foreign Office for comment about why so many visa applications were delayed or rejected. They had not responded by the time of publication.

No Clear Reason for Delays, Rejections, or Approvals

In addition to appealing to IAS, delegates whose visa applications are pending have also taken to tweeting about their experiences. Gloria Nawanyaga is a well-known HIV activist from Uganda who has been living with HIV for over 15 years. On July 18, she tweeted that her flight to Munich was set to take off the next day, but that because of “unjustified visa delays,” her passport was still being held by the German Foreign Office. As a result, she said, she may not be able to attend the conference.

Nawanyaga noted that it is common for delegates from the global south to face visa delays and rejections even when all necessary documents have been filed or when they have already had Schengen visas, which permit non-European Union nationals to visit any of the 29 countries in the Schengen area for up to 90 days.

Farnoudi retweeted Nawanyaga’s message soon after her post, with an added message to the German Foreign Office: “#AIDS2024 is nothing without community voices from the most affected countries in the world. We need Gloria and all others registered to attend. … Your urgent support here is much appreciated.”

TheBody asked Farnoudi whether he felt such messaging would prove effective. He responded in an email, “Only the Germans can answer that but what I can say is that we want everyone at this conference, especially the most marginalized who have always been the most affected. We also have staff dedicated to supporting delegates with their visa processes and have established direct channels with German authorities who ultimately decide on granting a visa.”

Linda Joseph Robert is an HIV advocate from Uganda who was a 2023 recipient of IAS’ Youth Hub Seed Grant and is a member of AVAC’s Advocacy Program. He was scheduled to speak during a pre-conference AIDS 2024 session called The People Living With HIV Pre-Conference (Living 2024) about using the science of undetectable equals untransmittable (#U=U) for advocacy. Though he submitted his visa application on June 24―including letters from his employer (AIDS Healthcare Foundation Uganda), sponsorship letters from GNP+ and Prevention Access Campaign (PAC), and a registration letter from IAS―his visa was denied on July 16.

He provided TheBody with an excerpt of the letter, which stated: “There are reasonable doubts about the reliability, the authenticity of documents submitted or their truthfulness. There are reasonable doubts about your intention to leave the territory of the Member States before the visa expires.”

IAS confirmed with TheBody that Joseph is a registered delegate for AIDS 2024. Additionally, Bruce Richman, the founder of PAC, confirmed with TheBody that Joseph was being sponsored by PAC and was scheduled to present at Living 2024. While expressing his disappointment over the visa rejection, Richman told TheBody that Joseph had also been selected by a committee to present on the future of U=U research at another session, the “Setting the U=U Research Agenda Forum,” hosted by the Lancet, Centers for Disease Control and Prevention, and PAC.

Whatever the reason for any delegate’s visa rejection or wait, it should be noted that the majority of conference participants who have applied for visas have been accepted.

Farnoudi noted that this success rate applied to visa applicants who were visiting Munich to attend pre-conference and satellite events. For instance, Erika Castellanos, director of programs at the Global Action for Trans Equality (GATE), told TheBody that out of 181 participants in a global trans pre-conference event she helped organize, 61 participants needed visas. Of that number 52 were accepted, while nine received rejection letters. Four of the delegates who were rejected came from North African countries.

In an email, Castellanos wrote, “We would wish for everyone to get their visas but these numbers are the best we have ever seen for a conference.” While noting that North African participation would be under-represented, she also shared that she wanted to recognize the support of German authorities in clearing so many visa applicants.

These outcomes are a big change from two years ago, when the Canadian government denied entry to hundreds of delegates to the 24th International AIDS Conference in Montreal.

A History of Visa Denials and Searching for Ideal Locations

In July 2022, Canadian and global media were filled with stories about delegates being denied visas to attend AIDS 2022, but these reports were not new. On June 17, the Canadian Press had already reported that hundreds of delegates from Asia, Africa, and Latin America had not yet been issued visas, while dozens of others had been rejected. This included scholarship recipients, whose funding was provided largely by Canada’s federal government as part of its bid to host the conference.

By the time the conference opened on July 29, it became known that many delegates from African countries had been denied entry. In response, numerous protestors interrupted the conference’s opening ceremony, accusing authorities of racism and other forms of discrimination.

But these complaints were far from new. For years, IAS has faced criticism for hosting conferences in countries in the global north. From 1985 to 1998, the conference was presented by European or North American countries all but two times; it was hosted by Yokohama, Japan, in 1994 and Manila, Philippines, in 1997. And it wasn’t until 2000 that the conference was held in an African nation, when South Africa was the host country. In fact, to date, all IAS conferences in Africa have been hosted by South Africa. Next year’s 13th IAS Conference on HIV Science in Kigali, Rwanda, will be the first break in that pattern.

Advocates who spoke to TheBody on the condition of anonymity also pointed to the conference’s history of being presented in countries that discriminate against many of the people it represents. For instance, though IAS moved AIDS 1992 from Boston to Amsterdam―due to immigration restrictions on people living with HIV that were in place from 1988 to 2010―the U.S. has long been openly hostile to sex workers and people who use drugs, two groups that are integral to the HIV response and recognized as key members of IAS. Yet IAS conferences were held in Atlanta in 1985, San Francisco in 1990, and Washington, D.C., in 1987 and 2012.

This says nothing of countries with HIV criminalization laws, such as Canada, which imposes a lifetime registry on the country’s sexual offender registry for people convicted of HIV exposure. All the same, since 1989, Canada has hosted an IAS conference five times.

Like many other northwestern countries, Canada subjects visitors from the global south to onerous paperwork―which can vary depending on the person reviewing each case―as well as proof that applicants have a certain amount of money in their bank account for every day that they are visiting; proof of secured housing; a long processing time (three weeks or more); and high application costs. And if a person is denied entry, they will not be refunded any fees that they paid.

The process can be incredibly stressful, especially for applicants with limited funds. But in 2022, that problem was made worse by Canada’s response to the planned-for influx of over 10,000 visitors: numerous rejections with no explanations given.

TheBody contacted Immigration, Refugees and Citizenship Canada for information about why so many AIDS 2022 delegates were denied visas. They had not yet responded as of the time of publication.

Logistics of Planning the International AIDS Conference

During AIDS 2022, IAS’ then-president Adeeba Kamarulzaman, M.D., told conference attendees that she was upset that registered delegates, including IAS staff and leadership, had been barred from entering Canada. Despite her call for change, she and the organization were still assailed by activists who insisted that the conference be held only in low- to middle-income countries in the future.

Though this might satisfy some, logistically it ignores the requirement that a host country have the necessary infrastructure to accommodate a major health and science conference. There are also concerns about safety and human rights―for instance, countries that criminalize LGBTQ people―as well as independence of the organization.

In an interview with Devex, Kamarulzaman said that the 2022 conference was originally scheduled to appear in a middle-income country in Asia. However, IAS ended negotiations after the prospective host government made vetting the conference program a condition of approval.

To that point, IAS demands absolute independence from its host countries to allay the possibility of governmental interference in or bias against sessions dedicated to empowering sex workers, using harm reduction, offering gender affirming care, or even engaging in protest―a celebrated right at IAS conferences.

As Farnoudi told TheBody in a previously published interview about the right to protest at the upcoming AIDS 2024 conference in Munich, “IAS endorses freedom of expression as an essential principle in the response to HIV. … Any authority that pitches to host an IAS conference knows this comes with our culture of allowing and welcoming peaceful protest. We wouldn’t select a location if that were completely impossible.”

While that offers a measure of comfort to delegates who will want to protest the current visa issue during the conference in Munich, it offers little comfort to those who have been denied entry. IAS is well aware of this. At next year’s conference in Rwanda, visa denials will almost certainly occur once again―even to delegates from other African countries. In those instances, IAS says it will continue to work to resolve issues.

What Happens Now?

When asked what IAS has done to help delegates gain entry to Munich, Farnoudi said the organization has been in bi-weekly communication with German authorities since February 2024 to help facilitate visa application processing.

In a follow-up email, Farnoudi wrote, “We regularly flag cases of registered conference participants who have not heard back from the authorities or encountered other challenges.” When asked about the likelihood of a visa being approved after receiving help, Farnoudi explained that IAS did not have a way to track the results of interventions because delegates did not always share when a problem had been resolved.

For now, the work to help delegates facing visa issues continues, mostly in the background. Though IAS has tweeted a call for “authorities to expedite the process for those pending,” there is no way to know whether German authorities will oblige.

IAS lists information about immigration for AIDS 2024 here. For support from the AIDS 2024 Immigration Support team, write to visa@aids2024.org.

Turkey: HIV-Positive Syrian refugee fights for access to treatment in Istanbul detention centre

HIV positive Syrian refugee ‘left for dead’ in İstanbul removal center

Ahmed Aaabo’s treatment has been disrupted by bureaucratic hurdles after his temporary protection status was removed, says his lawyer.

Ahmed Aabo was only 10 years old when his family left him at the Turkish border in 2011, seeking a safer life amidst the Syrian civil war.

Granted Temporary Protection Status upon entering Turkey, Ahmed’s life took a dramatic turn about eight months ago after he donated blood to the Turkish Red Crescent, which revealed he was HIV positive.

Ahmed began receiving treatment at Haseki Training and Research Hospital in Fatih, İstanbul, where he regularly took his medication. However, his situation worsened due to administrative decisions and bureaucratic barriers.

Losing protection status

His temporary protection status was deactivated under the G-78 restriction code, which is used for foreigners who are deemed to pose a public health threat due to infectious diseases. This deactivation prevented him from accessing his medications.

In an attempt to understand his situation and secure his medication, Ahmed visited the Kumkapı Foreigners’ Branch Directorate. There, he was detained and handcuffed for allegedly residing illegally and transferred to the Hadımköy Removal Center.

His lawyer, Hasan Kocapınar, filed a lawsuit to halt the deportation process. While awaiting the court’s decision, Ahmed was moved to the Adana Removal Center, where he could not access his medication, further deteriorating his health.

Kocapınar managed to get Ahmed transferred back to İstanbul, where he finally received his medication, but the interruption in his treatment had already severely affected his health.

Appeal to authorities

Kocapınar emphasized that denying Ahmed his right to treatment is a human rights violation. “Ahmed’s health has severely deteriorated due to the deprivation of his right to treatment and erroneous administrative actions. We will pursue all necessary legal avenues to restore his treatment rights,” he said.

He urged the authorities to honor international agreements and provide Ahmed with the care he needs, highlighting that sending Ahmed back to Syria would endanger his life, especially given his HIV status, which would make him a target for extremist groups.

Kocapınar also noted that Ahmed only has a three-month supply of medication left and emphasized the need for the Directorate General of Migration Management and the Directorate of Migration Affairs to resolve the issue. “Ahmed is currently held at the Arnavutköy Removal Center, where he does not have adequate access to his treatment. This is a human rights violation, and Ahmed’s right to health and life must be protected,” Kocapınar asserted.

G-78 Restriction Code

This code is applied to foreigners who carry infectious diseases that could threaten public health and safety, resulting in an indefinite ban on their entry to Turkey.

Russia: Immigrants deported for failing medical examination that includes HIV test

Bailiffs of Khakassia expelled 74 foreigners in six months

Translated from Russian by IA – Scroll down for article in Russian

In 2024, bailiffs of Khakassia expelled 74 foreign citizens from Tajikistan, Azerbaijan, Uzbekistan, Georgia and Belarus from the Russian Federation. According to the UFSSP of Khakassia, they mainly exceeded the period of stay in Russia, and some were expelled for evading the mandatory rules of stay in the country, such as passing a medical commission.

The Beysky District Court established that an Azerbaijani citizen, after one year from the previous medical examination, did not pass the second medical commission. He also did not provide documents on the absence of the use of narcotic drugs and psychotropic substances, the absence of infectious diseases that pose a danger to others, and a certificate of the absence of HIV infection.

The court found the foreign citizen guilty of committing an administrative offense and imposed a fine of 2 thousand rubles with subsequent administrative expulsion from Russia. Before the expulsion procedure, migrants are held in a specialized temporary detention facility. After purchasing travel documents, bailiffs of the special purpose department accompany foreign citizens to the checkpoint across the state border of Russia.

Судебные приставы Хакасии выдворили 74 иностранцев за полгода

В 2024 году судебные приставы Хакасии выдворили за пределы Российской Федерации 74 иностранных граждан из Таджикистана, Азербайджана, Узбекистана, Грузии и Белоруссии. Как рассказали в УФССП Хакасии, в основном они превысили срок пребывания в России, а некоторые были выдворены за уклонение от обязательных правил пребывания в стране, таких как прохождение медкомиссии.

Бейский районный суд установил, что гражданин Азербайджана, по истечении одного года с момента прохождения предыдущего медицинского освидетельствования, не прошёл повторную медкомиссию. Он также не предоставил документы об отсутствии фактов потребления наркотических средств и психотропных веществ, отсутствии инфекционных заболеваний, представляющих опасность для окружающих, и сертификат об отсутствии ВИЧ-инфекции.

Суд признал иностранного гражданина виновным в совершении административного правонарушения и назначил ему штраф в размере 2 тысяч рублей с последующим административным выдворением за пределы России. До процедуры выдворения мигранты содержатся в специализированном учреждении временного содержания. После приобретения проездных документов, судебные приставы отделения специального назначения сопровождают иностранных граждан до пункта пропуска через государственную границу России.

European Union: Call to safeguard the right to asylum in Europe

HRW and Amnesty International among NGOs urging EU to safeguard right to asylum in Europe

Human Rights Watch (HRW) and Amnesty International plus other NGOs signed a joint statement Monday urging the European Union (EU) and its member states to “safeguard the right to territorial asylum in Europe.”

The statement refers to the EU Charter of Fundamental Rights and emphasizes EU member states’ responsibility under Article 18, which guarantees the right to asylum. Over 90 organizations, also including Oxfam and Save the Children, signed the statement.

The statement criticizes member states’ attempts to shift asylum procedures and refugee protection to countries outside the EU (third countries). Such externalization measures allow states’ to “evade their asylum responsibilities,” which the statement asserts undermines the international refugee protection system and compromises states’ “commitment to the rule of law.”

The signatories criticize the European Commission’s facilitation of these arrangements between member states and non-EU countries as policies seeking to “contain and deter” the migration of refugees toward the EU. This is despite the Commission’s earlier assertion that such policies were “neither possible nor desirable,” and given EU law, “not legally or practically feasible.” Arrangements between countries, such as the Italy—Albania migration agreement, were denounced in the statement as “shortsighted measures” that lacked “genuine human rights safeguards or monitoring mechanisms.”

The UNHCR Note on the “Externalisation” of International Protection establishes that such measures are in contravention of the 1951 Refugee Convention and fundamental principles of international cooperation, responsibility-sharing and solidarity as they are designed to “avoid responsibility or to shift, rather than share burdens.” The statement echoes these sentiments, pointing to the significant consequences of externalization. Current EU law and the recently adopted Pact on Migration and Asylum do not include provisions concerning shifting asylum processing and refugee protection measures outside EU territory.

The statement warns of the human rights violations that have arisen where models externalizing asylum procedures have been implemented. Assigning low and middle-income countries that are unable to provide effective protection are already collectively “hosting 75 percent of the world’s refugees” has resulted in human rights abuses as the EU lacks “adequate tools and competencies to effectively monitor or enforce human rights standards” outside its territory.

HRW’s Europe and Central Asia advocacy director Iskra Kirova said, “Instead of wasting further time and resources on proposals incompatible with EU law and human rights commitments, the EU should support humane, sustainable, and realistic reception and asylum processing policies in EU territory.”

Migrants in Switzerland are in a situation of greater intersectional vulnerability to HIV

The authors of a study advise that specific preventive interventions be carried out that take into account the needs of this population.

Migrants in Europe are at much higher risk of acquiring HIV – and also developing AIDS – due to numerous social factors that place them in a vulnerable position. On the other hand, these vulnerabilities are enhanced by sexism, cisgenderism and racism, according to a Swiss study published in Culture, Health and Sexuality. All this is reflected in the fact that a significant number of these people are infected with HIV in their host country, so it is necessary to carry out specific preventive interventions for this population, which address the identified risk factors.

The conclusions of previous studies indicated that migrants faced not only particular legal and socioeconomic factors that put them in a situation of vulnerability, but that there were also other more specific aspects that also influenced that risk, such as not being a cis person, not being heterosexual or being a sex worker.

Intersectional inequality is produced by the interaction of several axes of inequality and oppression such as age, class, sex, sexual diversity, religious beliefs or national or ethnic origin, among others. The intersection of social vulnerabilities increases the risk that migrants will acquire HIV or develop advanced HIV disease due to lack of adequate care.

As a result, the Swiss public health authorities decided to collect data to inform HIV/STI prevention policies in the migrant population. To this end, a sociological, participatory and qualitative study was launched by a team of social researchers from the University of Freiburg. Special attention was paid to people coming from countries with high HIV prevalence, sex workers, gay men, bisexuals and other men who have sex with men (GBHSH), injecting drug users, trans and undocumented people or with temporary residence status in Switzerland.

All participants were over 18 years of age who were subjected to in-depth interviews. It was attended by prevention specialists working in the field of migration and HIV.

The results of the study reveal that the biographical, interactional and contextual dimensions are intertwined and create social vulnerabilities that affect this population. Thus, the team of researchers reports that, by not allowing irregular migrants to work, Swiss laws lead them to undeclared and poorly paid jobs. This exposes them to exploitation and deprives them of housing, social protection and health insurance. Lack of health care is very common among these people, who live with the constant fear of being reported or deported.

The link between the three dimensions and social vulnerabilities is also observed in relation to work. All these limitations can translate into both a precarious housing situation and the need to practice transactional sex in exchange for economic, housing and other resources.

That is, the difficulties faced by migrants in a host country condition their behaviours and sexual relations, and increase their vulnerability to HIV, especially due to an increase in transactional relationships. On the other hand, limitations to access antiretroviral treatment increase their risk of developing advanced HIV disease.

The structural conditions in which interactions with sexual partners occur may increase the vulnerability of these people to HIV. Thus, they can be seen in situations where they cannot negotiate safe practices. Added to this, in the case of needing post-exposure prophylaxis against HIV (PEP), you may find stigmatizing attitudes towards sex work.

In their conclusions, the study authors indicate that these findings have important implications for HIV prevention and HIV treatment in the context of migration. For example, they highlight the need for a structural shift towards greater equity in health care and universal access to it. In addition, if migrants had greater economic and legal security (for example, thanks to economic benefits and long-term residence permits) they would be less likely to enter into intimate relationships with an unequal balance of power. They also suggest that HIV and AIDS prevention among the migrant population requires a review of social and cultural structures and power systems, such as sexism, cisgenderism and racism.

These conclusions are in line with those from the aMASE study (Expanding access to health services for immigrants in Europe), carried out in 10 European countries. The study not only reflected that a large proportion of migrants were infected in their host country (agent the preconceived idea that they had been infected in their home country), but also advocated that migrant communities be considered more actively in HIV prevention campaigns.