HIV Vulnerabilities of Asian Migrant Workers: Sustaining the Response

1. Action for Health Initiatives (ACHIEVE), Inc. HIV Vulnerabilities of Asian Migrant Workers: Sustaining the Response Malu S. Marin ACHIEVE, Inc./ CARAM-Asia CARAM Asia

2. Action for Health Initiatives (ACHIEVE), Inc. It Figures… • Temporary labor migration towards the Middle East and, in particular, the Arab States, represents the dominant flow (estimated 28.5 million migrants). • There are 13.2 million migrants in South East Asia and East Asia. • 1.2 million are working in Malaysia alone. • The Philippines has an estimated 3.8 million contract workers abroad and majority of these work in Asia and the Gulf States • The total remittance inflow in Asia was USD 162.5 billion in 2009 (39% of total global remittances).

3. Action for Health Initiatives (ACHIEVE), Inc. • In the Philippines, 10% among all registered HIV cases are migrant workers (2012 data). • In Malaysia 0.03% of migrant workers screened, tested HIV positive as of 2004. • Cambodian migrant workers have an HIV prevalence rate of 2.5 %, the highest of any migrant population in Thailand. • In Bangladesh, 47 of the 259 cases of people living with HIV between 2002-2003 were infected as a result of migration. In 2004, 57 of the 102 newly reported HIV cases were among returning migrants.

4. Action for Health Initiatives (ACHIEVE), Inc. HIV Prevalence: Migrant workers in 6 high-prevalence provinces of Thailand, 2010 Source: IBBS, Ministry of Health, Bureau of Epidemiology - Thailand , 2010

5. Action for Health Initiatives (ACHIEVE), Inc. • MIGRATION, in and by itself, is not a risk factor for HIV infection. • Need to look at conditions, in which migrant workers are situated, that predispose or result to ‘risky behaviors’. • Personal factors • Socio-cultural factors • Economic factors • Need to look at impact of HIV infection

6. Initiatives on migration and HIV Pioneered the HIV and migration response in Asia (beginning 2007). • pre-departure • post-arrival • reintegration • policy advocacy (national, regional and international) Placed HIV and AIDS in the map of national and regional responses (18 countries)

7. Migration and HIV response in the Philippines • Began in 1997 • Inclusion of HIV in national AIDS Plans (2000 onwards) • Representation of migration in the National AIDS Body • Integration of HIV in training curriculum of all foreign service personnel • Sporadic funding and support

8. Action for Health Initiatives (ACHIEVE), Inc. • Multisectoral platform for regional advocacy on migration and HIV • Country score card / diagnostics card on access to health for migrant workers in the ASEAN Region • High-level multi-stakeholder dialogues on migration and HIV • Facilitating in-country support

9. Action for Health Initiatives (ACHIEVE), Inc. Challenges • Political issue • issue of rights, citizenship, security, public health • ‘Migration and HIV’ is slipping off in the agenda of country responses and the UN • Evidence-based programming is hampered by ‘absence of epidemiological data’

10. Action for Health Initiatives (ACHIEVE), Inc. • Migrants fall into the cracks of health care systems of their countries of origin and destination • Migrant workers are not a homogeneous group • No interaction with key populations, e.g. sex workers, MSM, IDU, etc.

11. Action for Health Initiatives (ACHIEVE), Inc. Lessons learned • Partnerships across the migration continuum • Community involvement • Address policy barriers • Need to frame migration as a context, rather than a risk factor • Need to look at KPHR in the context of migration or how risky/unsafe behaviors occur in the context of migration • Address gender and sexuality issues in the context of migration.

12. Action for Health Initiatives (ACHIEVE), Inc.