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

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

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

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

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

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

Losing protection status

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

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

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

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

Appeal to authorities

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

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

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

G-78 Restriction Code

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

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

Bailiffs of Khakassia expelled 74 foreigners in six months

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

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

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

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

Судебные приставы Хакасии выдворили 74 иностранцев за полгода

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Canada: HIV status at the centre of legal fight against immigration barriers

Challenging the constitutionality of Canada’s “excessive demand” regime in Federal Court

The HIV Legal Network and a client of Battista Migration Law Group are challenging the constitutionality of Canada’s “excessive demand” regime in federal court. On February 2, 2024, we filed legal arguments and materials challenging the decision of Immigration, Refugees and Citizenship Canada (IRCC) to deny a work permit based on an applicant’s HIV status. The IRCC relied on s. 38(1)(c) of the Immigration and Refugee Protection Act, which prevents individuals from travelling to, or remaining in, Canada if they are living with a health condition that is expected to place an “excessive demand” on the public system — meaning that the cost of treating their health condition is expected to be above a certain financial threshold.

At the HIV Legal Network, we have been challenging the “excessive demand” provision since it came into effect in 2001, as the provision places an undue and discriminatory burden on people living with HIV. As recently as September 2023, when a new Minister of Immigration, Refugees, and Citizenship took office, the HIV Legal Network, together with the HIV & AIDS Legal Clinic Ontario (HALCO) and Coalition des organismes communautaires québécois de lutte contre le sida (COCQ-SIDA), called again for the immediate revocation of the provision.

In the February challenge, we argue that the decision to deny the individual applicant’s work permit was unreasonable and unfair. Moreover, we argue that the very existence of the “excessive demand” provision is discriminatory, and thus inconsistent with s. 15 of the Canadian Charter of Rights and Freedoms. We highlight clear evidence, confirmed by the House of Standing Committee on Citizenship and Immigration in 2017, that the provision is harmful to foreign nationals living with health conditions, not only by increasing application costs and delays compared to those without health conditions, but also by perpetuating stigmatizing views that people with disabilities are burdens on society and that migrants merely abuse public programs. We stress that the provision does not consider any of the value that these individuals bring to Canadian society — including economic, social, and cultural. Finally, we highlight the IRCC’s own evidence that the “excessive demand” provision is ineffective in protecting the public health care system, as the provision leads to minimal savings. Provinces and territories have regularly asked IRCC to reverse its “excessive demand” decisions and absorb the resulting minimal additional health care costs to benefit from the value that immigrants bring to Canada.

In 2018, the Minister of Immigration, Refugees and Citizenship promised to revoke the “excessive demand” regime, on the basis that “it no longer aligns with our country’s values on the inclusion of persons with disabilities in Canadian society.” We are calling on Canada to finally live up to this promise.

The affidavits of the anonymised applicant and of the HIV legal Network as well as the Applicant’s Memorandum of Argument are available to download here.

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.”

The Golondrinas strategy connects HIV positive migrants to medical care in LAC region

Golondrinas’ project seeks to guarantee care for migrants with HIV

Translated with Deepl.com; For original article in Spanish, please scroll down.

It is a strategy for people arriving in another country to continue with the necessary treatment.

A person with HIV who leaves his or her country may experience difficulties with treatment or care elsewhere. While anyone can access the Universal Health Insurance (SUS) in Bolivia, the issue is made difficult due to forms and other issues; however, access to medicines for migrants carrying the virus has been achieved, according to the head of Health and Human Rights Projects at the Institute for Human Development (IpDH) in Cochabamba, Karina Rojas.

The ‘Golondrinas’ strategy seeks to ensure health care for migrants with HIV in the countries through which they pass or stay.

The Americas and Caribbean Platform of Coalition Plus held its annual meeting earlier this year in Cochabamba. The director of the Institute for Human Development (IpDH), Edgar Valdez, explained that the Platform’s members are Colombia, Guatemala, Argentina, Dominican Republic, Canada, Ecuador and Bolivia.

The meeting is a space to address issues such as policies, human rights in each country, budgets and how to work together on this issue, as each country has differences and similarities regarding access to treatment, the vulnerability of people with HIV, stigma and discrimination.

Another issue that stands out is related to migration and the ‘Golondrinas’ strategy.

The head of IpDH’s Health and Human Rights Projects explained that the ‘Golondrinas’ project was born in one of the meetings of the Platform of the Americas and the Caribbean, because it is a necessity for this vulnerable population; migrants with HIV.
‘People who migrate, sometimes do so irregularly and, therefore, it is very easy to violate their rights’.
She said that, in response to this situation, they submitted a project to the French Development Agency, which is currently providing funding. It consists of providing sexual health services along the route taken, in the case of Bolivia, by people arriving from Venezuela, as well as Haiti, Peru, Colombia and other countries.
Valdez explained that the project is integrated between French Guiana, Ecuador, Guatemala, Colombia, Bolivia and Argentina.

‘In other words, we want to provide health care and their rights as immigrants. It is a health support to all people with HIV, to all migrants of sexual diversity and to all women who also come here to Bolivia. In general, they are in transit, but some of them also stay. So there is legal support.

She added that there are organisations, such as Caritas and the government, which also work on other aspects.
‘We are seeing how we can articulate how to respond to this population that is extremely vulnerable because of their migrant status, because of the discrimination they may suffer and the stigma. So it is a space for them to consult, receive care and, of course, medicines.

Rojas described how they have seen cases where it has been possible for people with HIV from other countries to access treatment.

‘By advocating and explaining that health comes before the legal situation, people with HIV who need treatment have been able to access and collect from Cdevir (Centro Departamental de Vigilancia y Referencia para casos de VIH), for example.
In Cochabamba, Bolivia, there is still not much progress. But there is a need.
‘We are contacted by people who migrate, who have HIV; they have contacted us because they want to pick up their retroviral treatment or they don’t want to stop taking their medication.

He stressed that the right to health comes before documents.

The director of the Red Somos de Colombia Community Medical Unit, Jhon Ramirez, said that his country receives Venezuelan migrants who are in transit through Colombia to South or Central America.

‘The project consists of being able to approach migrants, identify their HIV status, get them into treatment and, if they are passing through, refer them to the organisations that are part of the Americas and Caribbean Platform of Coalition Plus, which have resources from the Golondrinas strategy.

The risk in ‘survival sex’ practices
For a migrant person, in their need to move from one place to another, to have sex with a trailer driver, as an example, is a survival sex practice.

The director of the Red Somos de Colombia Community Medical Unit, Jhon Ramirez, explained that there are also known cases of migrants agreeing to sex in exchange for food or a room with a bathroom or other basic necessities.
Valdez described that countries such as Colombia and the Dominican Republic receive migrants from Haiti; in addition, people from Venezuela also arrive in Colombia and Ecuador. However, in most cases they are in transit to Chile, Argentina and others.

‘We are also trying to see if there are people who want to stay in Bolivia; we protect their rights to see how they can be legal, what Bolivian laws protect these people.

Karina Rojas, head of IpDH’s Health and Human Rights Projects, stressed the importance of offering sexual health services, that is, that they can access HIV testing, ‘women can access family planning’, and treatment for sexually transmitted infections.
‘As they are a vulnerable population, sometimes they do sex work. We want to partner with other organisations that work on migration from another point of view; for example, Caritas here in Cochabamba has a shelter, so we can refer them to the shelter and they can refer us to the health services.

The IpDH director explained that ‘Golondrinas’ is related to access, above all, to universal health care.
‘We focus specifically on people with HIV, sexual diversity and, of course, sex workers as well, so everything related to sexuality, violence (…). We are always reflecting on these issues, the issue of migration.
For Ramírez, there are complex issues.

‘But the most complex part of the situation is that people do not have access to condoms, access to antiretrovirals, access to combined prevention strategies, such as access to PREP (pre-exposure prophylaxis), access to post-exposure therapy, and this is closely linked to issues of survival sex practices,’ he said.

Aiming for a single international code for patient access to treatment
The director of the Red Somos de Colombia Community Medical Unit, Jhon Ramirez, said that the ‘Golondrinas’ strategy aims to ensure that migrants with HIV have access to a single code that allows them access to treatment in other countries, if they leave their own.

‘The strategy is to let the migrant population know that in Bolivia there is the IpDH, that here they can access prevention services, that they can access medical treatment, counselling; this is the most important thing we have to do (…), so that the person knows that on the route to South America they will find Kímirina in Ecuador, the IpDH in Bolivia and the Fundación Huésped in Argentina’.
These organisations will be able to guarantee some kind of medical support in their migratory transit, in order to be able to successfully refer people.
‘The idea is to have a referral and counter-referral system so that, if I give a doctor in Colombia, in Ecuador they can see what medication this person has and there are no barriers to access.
The aim is to have a system at international level, and that each person has a unique code to be used at the time of the interview with the doctor or nurse in the programmes.
‘The code will be for the professional to access their medical history, so that the doctor in Colombia can see the treatment in Bolivia, to continue the same treatment, because they can sometimes open the entire clinic; and also so that the person has a reference code so that they can access this information.

DATA IN COLOMBIA Ramírez explained that in his country there are 7 million Venezuelan migrants. Of these, according to Colombian immigration data, two million have a vocation to stay, and the rest are migrants who are passing through to other countries in the region.

‘We seek to address 3,700 migrants and refer them to sexual health, reproductive health and HIV prevention services, as a strategy to control indicators of public health interest in our countries. An important part of the Golondrinas strategy is to establish the needs of the migrant population in terms of sexual health, reproductive health and other pathologies.
He added that it is estimated that in Colombia there are around 22,000 Venezuelan migrants who could be living with HIV.
‘We have identified 4,500, who are in the health system in Colombia. We still need to look for another 18,000 people who may be living with HIV and do not know it at the moment.

She added that a study carried out with George Hawkins University showed an HIV prevalence rate of 0.9% and 5% for syphilis.
The head of IpDH’s Health and Human Rights Projects explained that in Cochabamba there are still no statistics available.
‘We have also tried to incorporate this nationality data, for example, into the Simone (Computer System for Monitoring and Evaluation of the National HIV Programme), which is the monitoring system of the Ministry of Health, but there is still no data that we can reflect,’ said Rojas.

However, he assured that the doors of the IpDH are open for those who need antiretroviral treatment if they have HIV; for those who had risk situations, sexual violence; for testing and others referred to sexually transmitted infections.
‘What we want is that they don’t cut off the health services they need along the way.

Proyecto ‘Golondrinas’ busca garantía de atención a migrantes con VIH

Se trata de una estrategia para que las personas que llegan a otro país puedan continuar con los tratamientos necesarios.

Una persona con VIH que deja su país puede atravesar dificultades en torno a su tratamiento o atención de salud en otros lugares. Si bien, cualquier persona puede acceder al Seguro Universal de Salud (SUS) en Bolivia, el tema se dificulta debido a los formularios y otros; sin embargo, se ha conseguido el acceso a medicamentos para migrantes que portan el virus, según describió la responsable de Proyectos de Salud y Derechos Humanos del Instituto para el Desarrollo Humano (IpDH) en Cochabamba, Karina Rojas.
La estrategia ‘Golondrinas’ busca que se garantice la atención en cuanto a salud a personas migrantes con VIH en los países por donde pase o permanezca.

La Plataforma de las Américas y el Caribe de Coalition Plus realizó su reunión anual en días anteriores, en Cochabamba. El director del instituto para el desarrollo Humano (IpDH), Edgar Valdez, detalló que son miembros de la Plataforma los países de Colombia, Guatemala, Argentina, República Dominicana, Canadá, Ecuador y Bolivia.
El encuentro es un espacio para abordar temas como las políticas, los derechos humanos en cada país, los presupuestos y cómo trabajar de manera conjunta frente a esta problemática, ya que cada país tiene diferencias y semejanzas respecto al acceso al tratamiento, a la vulnerabilidad de las personas con VIH, al estigma y discriminación.
Otro de los temas que resalta es el relacionado con la migración y la estrategia denominada ‘Golondrinas’.
La responsable de Proyectos de Salud y Derechos Humanos del IpDH expuso que el proyecto ‘Golondrinas’ nació en una de las reuniones de la Plataforma de las Américas y el Caribe, porque es una necesidad para esta población vulnerable; los migrantes con VIH.
“Las personas que migran, lo hacen, a veces, irregularmente y, por lo tanto, es muy fácil vulnerar sus derechos”.
Dijo que, ante esa situación, presentaron un proyecto a la Agencia Francesa de Desarrollo y, en la actualidad, otorga financiamiento. Consiste en dar servicios de salud sexual a lo largo del recorrido que hacen, en el caso de Bolivia, personas que llegan de Venezuela, además de Haití, Perú, Colombia y otros países.
Valdez detalló que el proyecto está integrado entre Guyana Francesa, Ecuador, Guatemala, Colombia, Bolivia y Argentina.

“Es decir que, queremos brindar atención de salud y sus derechos como inmigrantes. Es un apoyo de salud a todas las personas con VIH, a todas las personas migrantes de diversidad sexuales y a todas las mujeres que vienen también aquí a Bolivia. En general, son en tránsito; pero, algunas se quedan también. Entonces hay un apoyo jurídico”.

Agregó que existen organizaciones, como Cáritas y la Gobernación, que también trabajan en otros aspectos.
“Estamos viendo cómo articulamos para responder a esta población que es extremadamente vulnerable por su condición migrante, por la discriminación que pueden sufrir y el estigma. Entonces, es un espacio para que ellos puedan consultar, recibir atención y, por supuesto, los medicamentos”.
Rojas describió que atendieron casos en los que fue posible que personas con VIH de otros países accedan a sus tratamientos.
“Haciendo incidencia y explicando que antes que la situación legal está la salud, las personas con VIH que necesitaban tratamiento, han podido acceder y recoger del Cdevir (Centro Departamental de Vigilancia y Referencia para casos de VIH), por ejemplo”.
En Cochabamba, Bolivia, todavía no existen muchos avances. Pero, hay necesidad.
“Nos contactan personas que migran, que tienen VIH; nos han contactado porque quieren recoger su tratamiento retroviral o no quieren dejar de tomar sus medicamentos”.
Remarcó que por encima de los documentos está el derecho a la salud.
El director de la Unidad Médica Comunitaria Red Somos de Colombia, Jhon Ramírez, expresó que su país recibe migrantes venezolanos, que van de tránsito por Colombia hacia Suramérica o Centroamérica.
“El proyecto consiste en poder abordar a las personas migrantes, identificar su estatus serológico a VIH, entrarlos en tratamiento y, si van de paso, poderles referenciar a las organizaciones que hacen parte de la Plataforma de las Américas y el Caribe de Coalition Plus, que cuentan con recursos de la estrategia Golondrinas”.

El riesgo en las “prácticas de sexo por supervivencia”
Que una persona migrante, en su necesidad de traslado de un lugar a otro, tenga relaciones sexuales con un conductor de un trailer, como ejemplo, es una práctica de sexo por supervivencia.

El director de la Unidad Médica Comunitaria Red Somos de Colombia, Jhon Ramírez, explicó que también se conocen de casos de personas migrantes que acceden a relaciones sexuales a cambio de comida o de una habitación con baño u otros enseres o elementos básicos.
Valdez describió que países como Colombia y República Dominicana reciben migrantes de Haití; además a Colombia y Ecuador también llega gente de Venezuela. Aunque, en la mayoría de los casos son de tránsito a Chile, Argentina y otros.

“Nosotros estamos también tratando de ver si hay alguna persona que quiere quedarse en Bolivia; le protegemos sus derechos para ver cómo puede ser legal, cuáles son las leyes bolivianas que le protegen a esas personas”.
La responsable de Proyectos de Salud y Derechos Humanos del IpDH, Karina Rojas, remarcó la importancia de ofrecer servicios de salud sexual, es decir, que puedan acceder a pruebas de VIH, “las mujeres a planificación familiar”, tratamiento de infecciones de transmisión sexual.
“Como es una población vulnerable, a veces, hacen trabajo sexual. Entonces, es un riesgo también de violencia sexual en ese trayecto (…). Queremos asociarnos a otras organizaciones que trabajan la migración desde otro el punto de vista; por ejemplo, Cáritas de aquí de Cochabamba tiene un albergue; entonces, nosotros podemos referir al albergue y ellos pueden referirnos a los servicios de salud”.
El director del IpDH explicó que ‘Golondrinas’ tiene relación con el acceso, sobre todo, a salud a nivel universal.
“Nosotros nos concretizamos de manera específica en las personas con VIH, en las diversidades sexuales y, por supuesto, las trabajadoras sexuales también; entonces, todo lo relacionado a la sexualidad, la violencia (…). Siempre estamos reflexionando en esas temáticas, el tema de migración”.
Para Ramírez, existen temáticas complejas.
“Pero, lo más complejo de la situación es que las personas no tienen en su tránsito migratorio acceso a condones, acceso a antirretrovirales, acceso a estrategias de prevención combinada, como el acceso a la PREP (profilaxis previa a la exposición), el acceso a la terapia postexposición, y esto va ligado mucho a temas de prácticas de sexo por supervivencia”, sostuvo.

Apuntan al código único internacional para acceso al tratamiento de pacientes
El director de la Unidad Médica Comunitaria Red Somos de Colombia, Jhon Ramírez, expresó que la estrategia ‘Golondrinas’ apunta a que las personas migrantes con VIH tengan acceso a un código único que les permita el acceso a tratamiento en otros países, si es que sale del suyo.

“La estrategia es poder que la población migrante sepa que en Bolivia está el IpDH, que aquí pueden acceder a servicios de prevención, que pueden acceder a tratamientos médicos, a orientaciones; es lo más importante que tenemos que hacer (…), para que la persona sepa que dentro de la ruta hacia Suramérica va a encontrar en Ecuador a Kímirina, en Bolivia al IpDH y en Argentina a la Fundación Huésped”.
Estas organizaciones en su tránsito migratorio podrán garantizar algún tipo de soporte médico, para poder referenciar de manera exitosa a las personas.
“Se trata de tener un sistema de referencia y contrarreferencia que, si yo lo medico en Colombia, en Ecuador puedan ver qué medicación tiene esta persona y no tenga barreras de acceso”.
El objetivo es contar con un sistema a nivel internacional, y que cada persona tenga un código único para ser utilizado al momento de la entrevista con el médico o enfermero en los programas.
“El código será de acceso del profesional a su historia clínica, para que pueda ver el doctor de Colombia el tratamiento en Bolivia, para continuar el mismo tratamiento, porque pueden hacer apertura, a veces, de toda la clínica; y también que la persona tenga a la mano un código de referencia para que puedan acceder a esa información”.
DATOS EN COLOMBIA Ramírez detalló que en su país hay 7 millones de personas venezolanas migrantes. De ellos, según datos de inmigración Colombia, 2 millones tienen vocación de permanencia, y el restante son migrantes que van de paso hacia otros países de la región.
“Buscamos poder abordar 3.700 migrantes y poder referenciarlos hacia servicios en salud sexual, salud reproductiva, prevención del VIH, como una estrategia de control de los indicadores de cifras de interés en salud pública en nuestros países. Algo importante que tiene la estrategia Golondrinas es poder establecer las necesidades de la población migrante en cuanto a salud sexual, salud reproductiva y también en otras patologías”.
Agregó que se estima que en Colombia hay alrededor de 22 mil personas migrantes venezolanas podrían estar viviendo como VIH.
“Tenemos identificadas 4.500, que están ingresadas al sistema de salud en Colombia. Nos falta buscar esas otras como 18 mil personas que pueden vivir con VIH y en el momento no lo saben”.
Acotó que un estudio realizado con la Universidad de George Hawkins mostró una prevalencia para VIH en el 0.9%, para sífilis, un 5%.
La responsable de Proyectos de Salud y Derechos Humanos del IpDH explicó que en Cochabamba todavía no se cuenta con estadísticas.
“Hemos tratado también de incorporar este dato de nacionalidad, por ejemplo, al Simone (Sistema Informático de Monitoreo y Evaluación del Programa Nacional de VIH), que es el sistema de monitoreo del del Ministerio de Salud, pero todavía no hay datos que podamos reflejar”, expresó Rojas.
Sin embargo, aseguró que las puertas del IpDH están abiertas para quienes necesiten el tratamiento antirretroviral si tienen VIH; para quienes tuvieron situaciones de riesgo, violencia sexual; para hacerse pruebas y otros referidos a infecciones de transmisión sexual.
“Lo que queremos es que no corten los servicios de salud que necesitan en el trayecto”.