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

Report: No human being should be held here

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

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

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

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

Reaching Unreached Migrants In Unorganised Workforce With Health Services – OpEd

By Shobha Shukla

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

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

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

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

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

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

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

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

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

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

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

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

GAP took the challenge of serving those who are left behind

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

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

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

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

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

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

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

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

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

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

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

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

GAP’s impact

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

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

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

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

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

Community-based services are critical to reach the unreached

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

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

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

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

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

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

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

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

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

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

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

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

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

Awareness or health literacy is key

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

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

Health justice in a socially unjust world

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Every third person with HIV in Tajikistan is a labour migrant

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

There are more and more people living with HIV among migrants

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

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

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

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

It is an offence to infect another person with HIV

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

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

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

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

Среди мигрантов всё больше людей, живущих с ВИЧ

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

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

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

Заражение ВИЧ другого человека – это преступление

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

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

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

RSE Scheme Revamped, Cap Raised

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

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

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

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

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

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

Further changes are:

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

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

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

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

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

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

The number of people living with HIV among migrants is increasing

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

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

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

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

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

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

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

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

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

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

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

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

Infecting another person with HIV is a Crime

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

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

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

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

How to recognise TB in the early stages

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

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

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

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

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

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

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

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

It’s easier to prevent the disease

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

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

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

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

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).