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.”

Australia: Migrant teacher with HIV caught in residency limbo despite job offers

Luca is a teacher in a skills crisis, but his HIV means he’s not allowed to stay

A migrant teacher denied permanent residency because he has been diagnosed with HIV says he has been barred by a discriminatory policy overseen by the government during a national skills crisis.

Italian national Luca, who has chosen a pseudonym because of the stigma associated with his condition, has been stuck in a limbo of temporary visas after he was refused a permanent skilled visa in 2013, with Immigration Minister Andrew Giles powerless to intervene.

“We hear it on the news every day there is a shortage of teachers and nurses,” said Luca, who teaches languages at a Melbourne high school, adding he often received job offers because of the dire need for teachers across the nation.

“Things have changed since I was first diagnosed … the stigma is not as strong as it used to be. I’m as healthy as I’ve ever been.”

The government can bar migrants from settling in Australia if their health requirements are deemed to be too costly for the public purse, a system that has led to many families with disabled children being told they must leave the country.

Welcoming Disability migration policy adviser Dr Jan Gothard said it was common for migrants to fail the health requirement for being HIV positive. “People who take HIV medication can undertake any work except some specialised medical procedures,” she said.

“They’re no less productive than any other member of the community. It doesn’t make any sense.”

Giles last year ordered a review into the significant cost threshold, the mechanism, currently set to $51,000 over 10 years, that determines if a visa applicant’s needs are too burdensome for the community.

“The minister retains the powers to intervene in cases where there are compassionate and compelling reasons for someone to be granted a visa,” a spokesperson for his office told this masthead when asked about Luca’s case.

But an email to Luca from Home Affairs in September last year said Giles had no power to intervene after that opportunity had been exhausted under the previous government in May 2017, when former assistant immigration minister Alex Hawke determined it wasn’t in the public interest to step in.

Hawke’s refusal came three years after the former Migration Review Tribunal found that Luca possessed skills that would benefit the Australian community but decided not to overturn the government’s decision to bar him from gaining permanency because of his HIV status.

After Hawke refused to intervene Luca was given three weeks to leave the country, before his employer appealed to the then-government to allow him to stay. He was granted a special visa with temporary working rights, before switching to a partner visa with his New Zealand partner.

However, Luca questioned whether he could stay in the country permanently on a temporary basis when he is allowed to reapply next year. “This is a difficult question because it has taken a toll,” he said. “I spent the whole of my 30s with this thing on the back of my mind. I wasn’t able to see my family for many years, not able to settle down and buy a house. I’m running out of options.”

Greens immigration spokesman David Shoebridge said Luca’s was a clear case where Home Affairs’ attitudes and policies had failed to take into account changing community sentiment and advances in medical treatment.

“In 2024, an HIV diagnosis should not be a reason for Home Affairs to refuse permanent residency in Australia,” he said. “We need a federal government that fights this kind of misinformed stigma on HIV, not one that reinforces it.”

EU’s directive for people vulnerable to sexual discrimination is not always implemented

As countries tighten anti-gay laws, more and more LGBTQ+ migrants seek safety and asylum in Europe

RIETI, Italy (AP) — Ella Anthony knew it was time to leave her native Nigeria when she escaped an abusive, forced marriage only to face angry relatives who threatened to turn her in to police because she was gay.

Since Nigeria criminalizes same-sex relationships, Anthony fled a possible prison term and headed with her partner to Libya in 2014 and then Italy, where they both won asylum. Their claim? That they had a well-founded fear of anti-LGBTQ+ persecution back home.

While many of the hundreds of thousands of migrants who arrive in Italy from Africa and the Mideast are escaping war, conflict and poverty, an increasing number are fleeing possible prison terms and death sentences in their home countries because of their sexual orientation or gender identity, advocates say.

And despite huge obstacles to win asylum on LGBTQ+ grounds, Anthony and her partner, Doris Ezuruike Chinonso. are proof that it can be done, even if the challenges remain significant for so-called “rainbow refugees” like them.

“Certainly life here in Italy isn’t 100% what we want. But let’s say it’s 80% better than in my country,” Chinonso, 34, said with Anthony by her side at their home in Rieti, north of Rome. In Nigeria, “if you’re lucky you end up prison. If you’re not lucky, they kill you,” she said.

“Here you can live as you like,” she said.

Most European countries don’t keep statistics on the number of migrants who claim anti-LGBTQ+ persecution as a reason for seeking refugee protection under international law. But non-governmental organizations that track the phenomenon say the numbers are rising as countries pass or toughen anti-homosexuality laws — a trend being highlighted on Friday’s observance of the International Day Against Homophobia, Biphobia and Transphobia.

To date, more than 60 countries have anti-LGBTQ+ laws on the books, most of them in Africa, the Middle East and parts of Asia.

“The ultimate result is people trying to flee these countries to find safe haven elsewhere,” said Kimahli Powell, chief executive of Rainbow Railroad, which provides financial, legal and logistical support to LGBTQ+ people needing asylum assistance.

In an interview, Powell said his organization had received about 15,000 requests for assistance last year, up from some 9,500 the year before. One-tenth of those 2023 requests, or about 1,500, came from Uganda, which passed an anti-homosexuality lawthat year that allows the death penalty for “aggravated homosexuality,” and up to 14 years in prison for “attempted aggravated homosexuality.”

Nigeria also criminalizes consensual same-sex relations between adults and the public display of affection between same-sex couples, as well as restricting the work of groups that advocate for gay people and their rights, according to Human Rights Watch. In regions of Nigeria where Sharia law is in force, LGBTQ+ people can face up to 14 years in prison or the death penalty.

Anthony, 37, said it was precisely the threat of prison that compelled her to leave. She said her family had sold her into marriage, but that she left the relationship because her husband repeatedly abused her. When she returned home, her brother and uncles threatened to turn her into police because she was gay. The fear and alienation drove her first to attempt suicide, and then take up a trafficker’s offer to pay for passage to Europe.

“At a certain point, I couldn’t take all these sufferings,” Anthony said through tears. “When this man told me that I should abandon the village, I immediately accepted.”

After arriving in Libya, Anthony and Chinonso paid traffickers for the risky boat trip across the Mediterranean Sea to Italy, where they both claimed asylum as a member of a group – LGBTQ+ people – who faced persecution in Nigeria. According to refugee norms, applicants for asylum can be granted international protection based on being a “member of a particular social group.”

But the process is by no means easy, straightforward or guaranteed. Privacy concerns limit the types of questions about sexual orientation that migrants can be asked during the asylum interview process. Social taboos and a reluctance to openly identify as gay or transgender mean some migrants might not volunteer the information immediately. Ignorance on the part of asylum interviewers about anti-gay laws in countries of origin can result in unsuccessful claims, according to the EU Agency for Asylum, which helps EU countries implement asylum norms.

As a result, no comprehensive data exists about how many migrants seek or win asylum in the EU on LGBTQ+ grounds. Based on estimates reported by NGOs working with would-be refugees, the numbers in individual EU countries ranged from two to three in Poland in 2016 to 500 in Finland from 2015-2017 and 80 in Italy from 2012-2017, according to a 2017 report by the EU Agency for Fundamental Rights.

Peru: Venezuelan migrants in Peru face severe challenges in HIV care and basic services, report finds

Biobehavioral Survey (BBS) in Venezuelan Migrants living in Lima/Callao and Trujillo – Final report

Translated with Google translate – Scroll down for article in Spanish

The persistent and serious economic and social crisis that Venezuela is experiencing has led more than 5.5 million Venezuelans to leave their country in search of guaranteeing the right to health and life, access to basic services and job opportunities. Peru, with more than 1.57 million Venezuelan migrants, is the second country in Latin America with the most reception. This situation represents one of the largest migratory movements, comparable to that seen in war situations, such as in Syria or Afghanistan. From 2018 to date, changes have been observed in migratory dynamics, which could result in the modification of the conditions faced by migrants, and have an impact on their access to basic services.

Faced with this situation, different government bodies and some NGOs have created different channels to offer support to Venezuelan migrants in Peru. Despite the commitment and effort of the Peruvian government to support the refugee and migrant population, 91.5% of the Venezuelan population residing in the country does not have health insurance.[ 1] Many of them do not have the necessary legal and economic means to access these services and not having legal identification in the country, they do not have the national health insurance or Comprehensive Health Insurance (SIS).

The number of Venezuelan migrants living with HIV and residing in Peru has been increasing. In 2021, according to USAID figures through the LHSS (Sustainability of Local Health Systems Project) project, more than 8,000 migrants living with HIV were estimated, of which less than 50% received antiretroviral treatment. Worrying is the large percentage of migrants who stopped receiving treatment when leaving their country or during their journey to Peru, and who have encountered significant barriers to access to comprehensive HIV services during their stay.

National regulations ensure universal access to antiretroviral treatment to all people with HIV in the national territory, regardless of the country of origin, but research carried out by cooperation agencies reports that only 2% of migrants with HIV have Comprehensive Health Insurance (SIS) and that 23% of them arrive with or develop advanced stages of HIV or AIDS.

This document reports a prevalence of HIV of 1.01% in the Venezuelan migrant population in Lima/Callao and Trujillo, which is higher than the prevalence of 0.4% in the Peruvian adult population (15-49 years) [UNAIDS] and the prevalence of 0.5% in the adult population in Venezuela (15-49 years) [UNAIDS]. As in Peru, the HIV epidemic in the Venezuelan migrant population is concentrated in key population (gay men and men who have sex with other men-MSM, transgender women-MT, sex workers-TS and intravenous drug users), as well as in the young population. However, higher prevalence of HIV was found in the MSM population of Venezuelan migrants (15.6%) than the Peruvian MSM population (10%) [UNAIDS] and higher prevalence in Venezuelan male STs (43.39%) than Peruvians (3%) [10].

The findings of the cascade of the care continuum of migrants with confirmed HIV diagnosis that showed low levels of treatment initiation, continuation of care and virological suppression are worrying: 25% had started antiretroviral treatment, 20.6% reported receiving HIV care at the time of the study and 38.8% were on virological suppression. Virological suppression was higher among those with old diagnosis (85.7%) than in those with new diagnosis (17.4%). Figures well below the 95-95-95 targets of the Global AIDS Strategy 2021-2026.

The migrant population with HIV has multiple basic needs, and confronts different forms of discrimination based on their origin (xenophobia), gender expression and identity (transphobia), sexual diversity (homophobia or lesbophobia), age, or living with HIV (serophobia), which, when superimposed, determine an intersectional discrimination that, together with other social determinants, are barriers to access to health services, decent work, food and housing, and also present great difficulties in regularizing their migratory status and accessing a foreign identity card that would enable them to process the SIS. The main difficulties faced by the Venezuelan migrant population are financial (52.6%), food (21.6%) and housing (17.3%).

70.7% of migrants participating in this study report having had an experience of stigma or discrimination. With regard to the experiences of violence in the last 12 months during their stay in Peru, a total of 45.5% reported psychological violence, 47.7% physical violence, 48.7% reported having suffered forced sex and 44.2% reported having been sexually exploited in exchange for resources.

It is necessary to address these barriers through responses focused on and directed by the affected communities such as expanding the supply of diagnostic services and combined HIV prevention in the primary health care sector, which includes pre-exposure prophylaxis (PrEP) and self-testing in health services free of discrimination and with a gender equality approach.

The findings of this report provide solid evidence on the vulnerability factors and social and health determinants of the Venezuelan migrant community in Peru. It portrays the health situation of migrants in general and migrants living with HIV and identifies gaps in access to education, work, health, justice and equality for all. It is a resource for the generation of focused and differentiated policies for combined prevention, early diagnosis and timely treatment of HIV, the elimination of discrimination, the efficiency of investments in HIV, and the strengthening of other programs aimed at social welfare, food security and the elimination of poverty.

From UNAIDS we welcome the findings of this work that describes the HIV epidemic in this population in two of the Peruvian regions with the largest number of migrants and provides government decision-makers with the necessary evidence to sustain inclusive public policies aimed at eliminating the barriers to access to services, generated by the inequalities faced by the migrant population, with HIV and belonging to the key populations in Peru.

Joint United Nations Programme on HIV/AIDS (UNAIDS) – Equipo Peru

[1] [Proposal for Increasing Health Care Coverage for Venezuelan Refugees and Migrants Living with HIV. Update in Response to the COVID-19 Pandemic. PAHO/UNAIDS/CDE/COVID-19/21-0013 © PAHO/WHO and UNAIDS, 2021].
[10] Degtyar A, George PE, Mallma P, Diaz DA, Cárcamo C, Garcia PJ, Gorbach PM, Bayer AM. Sexual Risk, Behavior, and HIV Testing and Status among Male and Transgender Women Sex Workers and their Clients in Lima, Peru. Int J Sex Health. 2018;30(1):81-91. doi: 10.1080/19317611.2018.1429514. Epub 2018 Mar 27. PMID: 30224942; PMCID: PMC6138045.

The report in Spanish can be downloaded here: https://peru.iom.int/sites/g/files/tmzbdl951/files/documents/2024-01/oimreportefinal_es.pdf

Encuesta Bioconductual (BBS) en Migrantes Venezolanos que viven en Lima/Callao y Trujillo – Reporte final

La persistente y grave crisis económica y social que vive Venezuela ha llevado a más de 5.5 millones de venezolanos a abandonar su país en búsqueda de garantía al derecho a la salud y a la vida, acceso a servicios básicos y oportunidades laborales. Perú, con más de 1.57 millones de migrantes venezolanos, es el segundo país de Latinoamérica con mayor acogida. Esta situación representa uno de los mayores movimientos migratorios, comparable con el visto en situaciones de guerra, como en Siria o Afganistán. De 2018 a la fecha, se han observado cambios en la dinámica migratoria, que podrían traducirse en la modificación de las condiciones que afrontan los migrantes, y repercutir en su acceso a servicios básicos.

Ante esta situación, diferentes instancias gubernamentales y algunas ONG han creado distintos canales para ofrecer apoyo a los migrantes venezolanos en el Perú. A pesar del compromiso y el esfuerzo del gobierno peruano en apoyar a la población refugiada y migrante, el 91,5 % de la población venezolana residente en el país no cuenta con seguro de salud.[1] Muchos de ellos no cuentan con los medios legales y económicos necesarios para acceder a estos servicios y al no disponer de identificación legal en el país, no les corresponde el seguro nacional de salud o Seguro Integral de Salud (SIS).

El número de migrantes venezolanos que viven con VIH y reside en el Perú ha ido en aumento. En el 2021, según cifras de USAID a través del proyecto LHSS (Proyecto de Sostenibilidad de los Sistemas Locales de Salud) se estimaron más de 8,000 migrantes viviendo con VIH, de los cuales menos del 50% recibían tratamiento antirretroviral. Es preocupante el gran porcentaje de migrantes que dejaron de recibir el tratamiento al abandonar su país o durante su trayecto al Perú, y que han encontrado importantes barreras para el acceso a los servicios integrales de VIH durante su estancia.

La normativa nacional asegura acceso universal al tratamiento antirretroviral a toda persona con VIH en el territorio nacional, independientemente al país de origen, pero investigaciones realizadas por las agencias de cooperación informan que solo el 2% de los migrantes con VIH disponen de Seguro Integral de Salud (SIS) y que el 23% de ellos llegan con o desarrollan etapas avanzadas de VIH o SIDA.

El presente documento reporta una prevalencia del VIH de 1.01% en la población migrante venezolana en Lima/Callao y Trujillo, la cual es más alta que la prevalencia de 0.4% en población adulta peruana (15-49 años) [ONUSIDA] y que la prevalencia de 0.5% en la población adulta en Venezuela (15-49 años) [ONUSIDA]. Al igual que Perú, la epidemia de VIH en la población venezolana migrante está concentrada en población clave (hombres gay y hombres que tienen sexo con otros hombres-HSH, las mujeres transgénero-MT, las trabajadoras sexuales-TS y usuarios de drogas intravenoso), así como en población joven. Sin embargo se encontró mayor prevalencia de VIH en la población HSH de migrantes venezolanos (15.6%) que la población HSH peruana (10%) [ONUSIDA] y mayor prevalencia en TS masculinos venezolanos (43.39%) que peruanos (3%) [10].

Son preocupantes los hallazgos de la cascada del continuo de atención de las personas migrantes con diagnóstico de VIH confirmado que mostro niveles bajos de inicio de tratamiento, continuación de cuidado y de supresión virológica: 25% había iniciado tratamiento antirretroviral, 20.6% reportó encontrarse recibiendo atención en VIH al momento del estudio y el 38.8% se encontraba en supresión virológica. La supresión virológica fue mayor entre aquellos con diagnóstico antiguo (85.7%) que en aquellos con diagnóstico nuevo (17.4%). Cifras muy por debajo de las metas 95-95-95 de la Estrategia Global de Sida 2021-2026.

La población migrante con VIH presenta múltiples necesidades básicas, y confronta distintas formas de discriminación por su origen (xenofobia), expresión e identidad de género (transfobia), diversidad sexual (homofobia o lesbofobia), edad, o vivir con el VIH (serofobia), que al superponerse determinan una discriminación interseccional que junto con otras determinantes sociales, son barreras de acceso a servicios de salud, al trabajo digno, a alimentación y vivienda, y presentan además, grandes dificultades para regularizar su estatus migratorio y acceder a un carnet de extranjería que les habilitaría a tramitar el SIS. Las principales dificultades a las que se enfrenta la población migrante venezolana son financieras (52.6%), de alimentación (21.6%) y de vivienda (17.3%).

El 70.7% de los migrantes participantes en este estudio refiere haber tenido una experiencia de estigma o discriminación. Con respecto a las experiencias de violencia en los últimos 12 meses durante su estadía en el Perú, un total de 45.5% reportó violencia de tipo psicológica, 47.7% violencia física, 48.7% reportó haber sufrido sexo forzado y 44.2% reportó haber sido explotado sexualmente a cambio de recursos.

Es necesario abordar estas barreras a través de respuestas enfocadas en y dirigidas por las comunidades afectadas como son ampliar la oferta de servicios de diagnóstico y la prevención combinada del VIH en el sector primario de atención a la salud, que incluya la profilaxis preexposición (PrEP) y el auto testeo en servicios de salud libres de discriminación y con enfoque de igualdad de género.

Los hallazgos de este informe aportan evidencia sólida sobre los factores de vulnerabilidad y determinantes sociales y de salud de la comunidad migrante venezolana en el Perú. Retrata la situación de salud de las personas migrantes en general y de los migrantes viviendo con VIH e identifica brechas en el acceso a educación, trabajo, salud, justicia e igualdad para todos. Es un recurso para la generación de políticas enfocadas y diferenciadas de prevención combinada, diagnóstico temprano y tratamiento oportuno del VIH, la eliminación de la discriminación, la eficiencia de las inversiones en VIH, y el fortalecimiento de otros programas que apunten al bienestar social, la seguridad alimentaria y la eliminación de la pobreza.

Desde ONUSIDA saludamos los hallazgos de este trabajo que describe la epidemia del VIH en esta población en dos de las regiones peruanas con mayor número de migrantes y brinda a los tomadores de decisión del gobierno, la evidencia necesaria para el sustento de políticas públicas inclusivas y orientadas a la eliminación de las barreras al acceso a servicios, generadas por las desigualdades que enfrenta la población migrante, con VIH y pertenecientes a las poblaciones clave en el Peru.

Programa Conjunto de las Naciones Unidas sobre el VIH/SIDA (ONUSIDA) – Equipo Perú

[1] [Proposal for Increasing Health Care Coverage for Venezuelan Refugees and Migrants Living with HIV. Update in Response to the COVID-19 Pandemic. PAHO/UNAIDS/CDE/COVID-19/21-0013 © PAHO/WHO and UNAIDS, 2021].
[10] Degtyar A, George PE, Mallma P, Diaz DA, Cárcamo C, Garcia PJ, Gorbach PM, Bayer AM. Sexual Risk, Behavior, and HIV Testing and Status among Male and Transgender Women Sex Workers and their Clients in Lima, Peru. Int J Sex Health. 2018;30(1):81-91. doi: 10.1080/19317611.2018.1429514. Epub 2018 Mar 27. PMID: 30224942; PMCID: PMC6138045.

https://peru.iom.int/sites/g/files/tmzbdl951/files/documents/2024-01/oimreportefinal_es.pdf

HIV services expanded for displaced migrants in wake of Ukraine war and regional turmoil

Navigating HIV services during migration crisis in Eastern Europe and Central Asia

Countries affected by the migration crisis in Eastern Europe and Central Asia, prompted by the war in Ukraine and other turmoil in the region, have had to put in place measures so that all displaced people have access to essential HIV services.

 Key Figures: 

  • In 2022, Europe was confronted by the largest refugee crisis since World War II.
  • As of February 2024, nearly one-third of Ukraine’s population remains displaced, with 6.3 million Ukrainian refugees globally, primarily concentrated in Europe, 62% of them are women.
  • In 2022, around one million Russian citizens emigrated, with many choosing prolonged stays abroad.
  • Central Asian countries witnessed the biggest influx of international migrants since their independence.
  • Up to 300,000 Belarusians left their country since May 2020.
  • Migration from Central Asia to Russia surged in 2023, with notable increases in Uzbek, Kyrgyz, and Tajik nationals entering for work purposes. (ICMPD Migration Outlook Eastern Europe and Central Asia 2024)
  • The HIV epidemic is growing in Eastern Europe and Central Asia, with Russia, Ukraine, Uzbekistan, and Kazakhstan accounting for 93% of new infections in the region combined.

Surviving the devastating events of March 2022 in Mariupol, Ukraine, uncertain of what the future held, Svetlana fled her hometown.

“Mariupol was a scene of utter destruction. I had a packed suitcase, but I left it behind, only taking with me a dog and a cat,” recalls Svetlana. “With assistance, we managed to reach the Polish border, eventually finding refuge in Lithuania.”

Living with HIV since 2000, Svetlana relies on anti-retroviral treatment (ARV) to keep the virus at bay by taking a tablet a day. In haste, she had only taken one pill box.

Upon her arrival in Lithuania, she connected with an online organization that within days helped her to obtain her life-saving medicine from a doctor.

Svetlana is one of 70  participants in 6 countries in the Regional Expert Group on Migration and Health (REG) study that assessed the healthcare access for Ukrainian refugees using qualitative methods. According to Daniel Kashnitsky, the lead REG expert, “insights from specialists and service recipients revealed that all HIV-positive refugees had access to treatment across EU host countries.”

After recovering from the initial shock, the European Union activated the Temporary Protection Directive, establishing legal guidelines for managing mass arrivals, offering humanitarian aid, and ensuring access to life-saving antiretroviral treatment and basic HIV services to those in need.

Outside the EU, in countries like Moldova and Georgia, special regulations ensure free access to HIV services. Moldova’s National AIDS Coordinator, Yuri Klimaszewski, underscored that Moldova provided HIV services to refugees like it does for its citizens.

The study also revealed that some refugees struggled in host countries, leading to challenges maintaining treatment adherence. Tatyana (name changed) left Odessa along the Black Sea in April 2022.

But she returned home because she could not find adequate support under the opioid maintenance therapy program in Poland. She found it complicated to reach the service point, the language barriers prevented her from communicating her needs with medical staff, and she lacked community support.

“Despite the unprecedented support shown by European countries to Ukrainian refugees, systemic issues, particularly bureaucratic complexities, require proactive intervention by social workers, community organisations and volunteers to effectively address these challenges,” said Mr Kashnitsky. Additionally, he added, “there is a pressing need to tackle the stigma faced by people living with HIV and other key populations, such as people who use drugs.”

Uladzimir, who left Belarus for Poland in the first days of the war in Ukraine, needed about a month to start receiving ARV treatment. First, he had to obtain “international protection”, then confirm his HIV status and wait for an appointment with a doctor. But once all that was cleared, he had access to all the necessary services. For many accessing services is not as straightforward as it is for Ukrainian refugees, according to the REG study “Forced migrants with HIV status: social psychological and medical aspects of adaptation”

Legislation in some countries makes accessing HIV prevention and treatment for migrants challenging. And in some cases, national healthcare systems may lack resources to meet the influx of people and their needs.

As the Russian Federation continues to deport migrants living with HIV, those who remain in Russia due to the inability to return home or for family reasons are compelled to stay in the country illegally. They are deprived of HIV treatment and health services. Some have succeeded by receiving treatment remotely (ARVs sent to them with the help of countries of origin).

Recommended strategies, as outlined by the REG study, include improving the system of informing people about potential risks and available HIV services abroad, establishing health insurance protocols, and supporting community organizations that provide HIV services.

Removing legal provisions that discriminate against migrants living with HIV will also reduce barriers to accessing antiretroviral therapy, resulting in significant improvements for public health in the region.

Eamonn Murphy, UNAIDS Regional Director for Asia Pacific and EECA regions, praises the collaborative efforts involving various stakeholders, including governments of countries of origin and host countries, community organizations, the Joint UN Programme on AIDS, and donors.

However, he says more needs to be done. “There is an urgent need to work on the legalization and standardization of such approaches to ensure all people on the move can access essential services and remain on treatment wherever they are.”