Migrants and H.I.V./AIDS in Asia

For migrant men, loneliness fuels sexual desires and both loneliness and increased sexual needs push migrant men into the arms of sex workers.

Tomorrow leaders of the richest countries in the world will meet at the G8 Summit from June 6 – 8. The G8 countries had spearheaded a universal access to AIDS treatment commitment in 2005. The Universal Access target on treatment is set at 9.8 million by 2010. However with only three years to 2010, the G8 is on the brink of missing the target. In 2006, treatment access grew by 700,000. At this rate of expansion the world will fall five million people short of the internationally declared Universal Access target of 9.8 million. It is timely to ask for an increase of funding for HIV/AIDS. There is a dire need to look into this issue in the case of Asia and specifically the mobile migrant communities who are among the most vulnerable groups to HIV/AIDS infection.

AIDS is invading Asia. There are now an estimated 8.6 million people living with HIV in Asia and the numbers have not been declining. This is according to the latest report: UNAIDS/WHO AIDS Epidemic Update: December 2006. In 2005, the numbers stood at 8.3 million people while there were only 7.1 million in 2003 according to the previous year’s UNAIDS/WHO AIDS Epidemic Update. With 60 percent of the world's population, Asia is showing the steepest infection curve and could fast become the region with the most HIV infections. By the end of this decade, HIV infections may reach 25 million in India and 15 million in China, according to the National Intelligence Council, an adviser to the CIA. Last year, India had already surpassed South Africa as the most heavily afflicted country. Yet, out of an estimated 8.6 million people living with HIV/ AIDS in June 2006, only 16% of this total received antiretroviral therapy. (UNAIDS/WHO AIDS Epidemic Update: December 2006)

One of the major modes of the HIV invasion throughout Asia is the mobility of its people. In 1999, 80 percent of the 1600 people with HIV/AIDS in Pakistan were prospective migrants and returnees to or from the Gulf, according to a report by Lawyers for Human Rights and Legal Aid (LHRLA) published in 2000. (Report of the National Consultation on Migration and LHRLA, 2000). By December 2003, some 1,965 recorded cases of Filipinos living with HIV/AIDS were registered with the National Registry of the Department of Health, of which Overseas Filipino Workers (OFWs) comprised 32 percent or 634 OFWs. It is worth noting that this figure represented a 2 percent jump from a recorded 30 percent in early 2003. In Bangladesh, the same figure for returning Bangladeshi migrants hovers around 41 percent. This statistic is derived from Bangladesh’s Pre-Departure Program, Preparatory Meeting of the Regional Summit on Pre-Departure, Post-Arrival and Reintegration Programs for Migrant Workers, CARAM Asia, 2000.

It is important to note that being a migrant is not a risk factor to HIV/ AIDS, it is the stresses and vulnerabilities associated with the migration process that are the risk factors.

Why? Migrants have no political rights, are economically under privileged and socially displaced in receiving countries. Poverty and income disparities among countries are forcing people from less developed countries to leave behind the security and comforts of home to seek better income in developed countries. Often when people leave for another country, they part with families and friends. This makes them feel lonely and more susceptible to have relationships with other people while working abroad. Illiterate & uneducated about the risk of having unprotected sex, migrant communities became easy prey to HIV infection.

For migrant men, loneliness fuels sexual desires and both loneliness and increased sexual needs push migrant men into the arms of sex workers. As for migrant women, they face the danger of being trafficked to cater for the lucrative sexual industry. The sex industry in Southeast Asia has grown in part due to the surge in recent years in the number of women in Asia's migrant force, where they now equal or outnumber male migrants. The actual number of prostituted women enslaved, trafficked or kept in prison in Southeast Asia was no more than 20 percent of the total number of women engaged in prostitution. This is noted in a Reuters report from 1998. (International Labor Organization, "UN labor body urges recognition of sex industry," Reuters, August 18, 1998.) Women migrants who are victims of trafficking also became victims of HIV not just due to being coaxed into unprotected sex work but also because of forced or induced drug usage and sharing of needles.

In comparison to locals, migrant communities are also more vulnerable to HIV infections due to their lack of access to health care services. Through CARAM Asia’s participatory action research involving migrant workers directly, it is found that even when workers are sent to see doctors, they face language barriers and thus are not well informed. Further compounding the situations are the fact that some doctors might only speak to their employers or only spend little time with migrant workers due to their negative perceptions of migrants in general.

Despite being subjected to mediocre health care services, migrant worker’s health rights are further compromised when they are required to pay more than locals to receive health services. A case in point is the Malaysian Double Fee policy. Foreigners in Malaysia are required to pay twice as much as locals for the same treatment. For a group that already makes significantly less money than the local population, the high cost of health care results in migrant workers’ increased reluctance to seek help.

Governments of receiving countries are primarily focused on protecting the health of their citizens. Migrant workers are merely resources to fill cheap labor gaps. Consequently, the health of migrants who enter the country is given minimal attention. National laws and policies generally do not take any responsibility for maintaining and protecting migrant workers’ health and welfare in the receiving country. This is exemplified by the minimal consideration given to pre- and post-test counseling, issues of cultural and gender sensitivity, informed consent and confidentiality, and a lack of referral services.

In most receiving countries, migrants are subjected to mandatory health tests only to ensure that they will not be infecting locals with diseases. Their health would be screened without prior explanation of what they are tested for and how they will be tested. Without pre- and post test counseling, even if migrant workers are found to be HIV positive, they would not know their sero-status and thus would be denied the opportunity to seek treatment at an early stage. Citing national health security reasons, receiving countries usually deport HIV positive migrant workers. While receiving countries protect their nation from HIV threats, they neglect the health of citizens in sending countries. Uninformed HIV positive migrant workers are sent home ignorant to the risk of spreading the disease back home.

In the case of migrants being informed of their HIV positive status, they are shamed by the disclosure, as there are no clauses in policies to keep their status confidential. Receiving countries are deporting migrant workers without referral services as to where and how they could further seek treatment back home.

The Philippines’ AIDS Prevention and Control Act 1998 however has legislated the prohibiting of mandatory testing in the Philippines. Furthermore, any voluntary testing requires written informed consent, guarantees the right to confidentiality, protects against discrimination in the workplace, and mandating HIV/AIDS information to all including travelers and migrants and access to treatment. Unfortunately such legislation is a rarity in the region.

A regional response with migrant participation AIDS knows no borders. Mobility and HIV issues cannot be contained isolated within a country. A regional response is imminent to cope with the AIDS epidemic amongst the Asian migrant community. Currently, although South Asian countries have higher recorded cases of HIV/AIDS, they have yet to come out with a regional framework to deal with it. ASEAN on the other hand, have a work program on HIV/AIDS planned until 2010. However, when it comes to HIV education and treatment programs for migrant communities, it is on the main frame. Intergovernmental dialogue on migrant workers issues is mostly focused on their economic value. Bilateral agreements are about how much workers ought to be paid or how they should be screen to be fit for work. Since both AIDS and migration can be trans-border, governments should look into providing migrant communities the access to AIDS prevention and treatment programs As for HIV/AIDs programs to be successful, migrants need to be convinced of the relevancy to their well being too.

CARAM Asia initiated participatory action research engaging migrant workers in dialogue regarding their own health and well being. Research outcome is published and made public. It is essential to capture the thoughts, feelings, needs and experience of migrants in order to present a true picture of their state to governments and NGOs for programs and policies to be relevant.

Migrant workers constitute a large and heterogeneous group; there is not one ‘type’ of migrant worker. There is a need to pay attention to cultural diversity, gender based power relations, length of stay and documentation status. After taking into account these factors, then only advocacy and social programs can reach the intended target.

Data from the United Nations report on International Migration in 2006 shows there are about 53 million migrants in Asia. As shown earlier, mobility and AIDS is intersecting along with the advent of globalization. Yet, there had been a shortage of research or programs focusing on mobility and HIV.

Dennis Altman, a member of the Program Committee for the XI International AIDS conference in Vancouver (1996), recalled that only a single extract among the six to seven thousand submitted dealt explicitly with either the political economy or globalization processes. Data on certain vulnerable groups (e.g. displaced groups and migrant workers) remain limited and studies continue to focus on single countries, ignoring international transmission patterns of the disease. This is quoted from HIV/ AIDS Prevention and Care in Resource-Constrained Settings, 2001.

Even statistics of the total number of migrants who acquired HIV/AIDS in Asia is hard to compile as migrants are mobile and receiving countries is only interested to deport HIV positive migrants rather than taking statistics into account. Hence, all stakeholders, be it governmental or non-governmental organizations need to make prompt concerted efforts to provide data and execute relevant programs tailored to the experience of migrants to keep pace with the aggravating HIV/AIDS invasion in Asia, especially amongst the migrant communities.

Vivian Chong is the Information & Communication Officer for Caram Asia. CARAM Asia is a network of NGOs and CBOs, consisting of 23 member partners covering 15 countries in Asia. The CARAM Asia network is involved in action research, advocacy and capacity building with the aim of creating an enabling environment to empower migrants and their communities to reduce HIV vulnerability and to promote and protect the health rights of Asian migrant workers globally. Visit www.caramasia.org for more information on CARAM Asia.