Labour migrants in Russia and their needs

Author: Chamid Sulchan

Labour migrants in Russia unfortunately still have lack of access to health services. They also face a lot of barriers to a normal life from government and society in common.

Daniel Kashnitsky, a junior researcher at the Higher School of Economics on direction on labour migration and HIV positive migrants living in Russia, told AFEW International about migrants’ medical insurance, collaboration with Russian authorities and some hopes for the better future.

Which difficulties do labour migrants from Central Asia face in Russia?

It depends on a country where these migrants come from. People from Kazakhstan and Kyrgyzstan feel a bit better in Russia, because those countries are part of the Eurasian Economic Union. Citizens of those countries do not need to apply for a residence permit nor for the permit to work. They can just come and only need to have an official registration in the place where they live. To get this document might become a barrier for some people, because not all the landlords are ready to provide them with an official registration.

Also, some migrants are eligible to apply for the state medical insurance. Migrants from Belarus, Armenia, Kyrgyzstan and Kazakhstan have been eligible to have one since three years ago, however TB and HIV services are not included in this state medical insurance.

But there are countries, such as Uzbekistan and Tajikistan, who are not part of the Eurasian Economic Union. Migrants from there have to apply for work permits, and they have to reapply every year. They also have to pay a special tax every month, which is a really heavy burden considering the low wages. It’s a large part of their income, so it affects them enormously.

Also, migrants can face some other issues. For example, in the Russian Federal law number 38 there is a paragraph saying that if a foreign citizen is identified with HIV or TB he/she needs to be deported from the country. If one is identified with HIV and it is known by the migration authorities, they will include the migrant’s name in their database. Since deportation is quite expensive, migrants often remain in Russia undocumented. But if once you leave Russia, you will be banned to re-enter. There is a small part of undocumented migrants who had been caught and they are kept in those detention centres. Other migrants live in hiding and keep working, doing black jobs. Some of them get ART in NGOs and private clinics, however a large part of them do not have access to health services, they just keep living as their CD4 level goes down, and some of them they just end up in the emergency care. Unfortunately, we cannot estimate the figures, because the undocumented migrants are not in the state statistics or the patient file data.

What are the factors that influence a lack of access to health services for labour migrants? Probably language barriers, or something else?

Speaking the same language is important of course, because talking about health and body is quite intimate. People prefer to not only speak in their native language, but also to speak to a person who understands them, their social determinants of health, the culture.

Some migrants from Central Asia explained me why they prefer to go to clinics where people of their culture work. One of the reasons was that migrant doctors better understand socio-economic circumstances of migrants’ experiences in Russia. For example, they tend not to prescribe expensive medicines, because they know that migrants cannot afford them. One of the biggest barriers is discrimination in clinics and state institutions. Migrants from Central Asia are often exposed to it.

Unfortunately, migrants can be a reason of rising HIV epidemic in their countries, don’t they?

True. The migration of Central Asia is predominantly male, 80% of the migrants from Central Asia are young males from 20 – 50 years old. They are mostly seasonal migrants. They go to Russia for 10-11 months a year, then they go back to their home country for one or two months. This is the only time when they get to see their wives, children, and other relatives. A lot of them have sexual intercourse in Russia (sometimes not safe), with sex workers, or just with female from their communities.

How do migrants from countries like Tajikistan, Uzbekistan get health insurance in Russia?

They don’t have access to state insurance. But one of the requirements when applying for a work permit, is to have bought a private healthcare insurance. They can buy it from one of the private insurance companies. And it is a very basic insurance scheme, that costs about 50 euros per year. It is meant to show the authorities that one is formally secured, but in fact it does not improve with access to health care. These minimal insurance packages provide almost nothing more than just free emergency care which is still provided free of charge to anyone physically residing in Russia. If you have broken your leg or if you have any other acute situation, you will receive emergency care as it is accessible to anyone in Russia. But if you need any further treatment, then you need to pay. And in most cases the basic private insurance will not help you. Of course, you can buy a more expensive one, that would include everything, but most of migrants cannot afford it.

What have you and your organization done to address the issue of labour migrants having a lack of access to health services?

Firs of all, me and my colleagues created a regional expert group on migration health in our region. It’s an informal network of civil society experts. We are trying to collect arguments and convince policy makers to lift the residence ban for HIV positive foreign migrants in Russia. We are trying to bring evidence to decision-makers that the HIV residence ban only aggravates the epidemiologic situation. It creates negative consequences for the migrants as they can spread the virus even further to the community. It affects a lot of people as they spread it in their home country. We have been in dialogue with the Russian authorities about this, but it is a long process to create this enabling atmosphere and to actually make it happen.

So, it’s hard to collaborate with the Russian authorities, isn’t it?

Yes, because the Russian authorities are little sensitive now to what civil society is claiming. You need to have very strong argument, create a supportive environment and change the public opinion. We are working with the journalists. We helped to create lot of publications on migrants with HIV living in Russia. We work with civil society organizations and we train them. Our partner organizations have direct services for migrants, at least in Moscow, St. Petersburg. Yekaterinburg and Rostov-on-don and some other large Russian cities that attract them labour migrants.

Some limited services for migrants do exist where they can get tested for HIV, where they can have consultations. But it is difficult to provide sustainable provision of ART, and this is a large problem as most of the migrants cannot afford therapy.

Today the Russian government seems reluctant to introduce any serious changes. On one hand, the authorities understand that Russian economy would not survive without migrants. So, they try to keep migrants low profile. They do not encourage migrants to raise their voices, to create trade unions or other grassroots movements. Migrants do not have access to social entitlements, not only healthcare but to pension funds and other security funds.

What do you think should be done by the Russian government to improve the access to health services for migrants from Central Asia?

The first thing Russia needs to do, is to liberalize its HIV legislation. This is very important, because once HIV-positive migrants are not stuck in Russia, then they can travel back and forth, at least they can receive ART from their home country. Secondly, Russia needs to allocate funding for NGOs that work with the migrants, to test them and provide psychosocial support. Third, anyone who resides in Russia and contributes to the Russian economy, should get access to the Russian healthcare, including HIV and TB services. The healthcare needs to change and include all the people who actually live and work in Russia. There is a human right aspect here, but also an epidemiological aspect: if you don’t want the diseases to spread further, you need to provide basic access to services.

Do you see an opportunity that the situation will be changed in the future?

Well, I stay positive because there are some developments in the region of East Europe and Central Asia such as, for example, Kyrgyzstan and Kazakhstan having accessed to the Eurasian Economic Union. It was a major breakthrough, when member countries signed a health insurance agreement to cover their citizens when they migrate within the Union. In terms of access to HIV and TB care, it really has remained unchanged for 25 years, because when they adopted these policies, Russia did not have this severe HIV growth that it has now, it was only starting back then.

Nowadays we try to tell the authorities: it is not that you have to pay for the migrants and their health insurance, but just start with decriminalizing them, liberate migrants from this constant fear of being deported of residing in illegality and being constantly subject to rights violation. This is really important if Russia ultimately wants to be create decent life conditions for all people who live and work in the country.

 

 

AFEW International, AFEW Kyrgyzstan and IOM Tajikistan launched a project for Tajik migrants

Tajikistan is a country marked by a high level of labour migration due to a lack of work in the country. According to official figures, in 2019 more than 500.000 Tajiks left the country for working abroad. The majority works in Russia, where there is a high prevalence of HIV. The proportion of the Tajik migrants among new registered HIV cases in Tajikistan increased  from 10.1 percent in 2014 to 18.8 percent in 2018. Also, little is known about migration of key populations, such as people who use drugs and men who have sex with men (MSM), and their behavior in using health services while working abroad.

To enhance Tajik migrants’ access to HIV services, particularly key populations, IOM Tajikistan together with AFEW International and AFEW Kyrgyzstan launched the project “Improving migrants’ access to HIV services in Tajikistan” in 2019.

What are the goals of this project and how will it change migrants’ lives? Rukhshona Kurbonova, National Professional Officer, Sub-Regional Coordinator on Migration Health for Central Asian countries, talked to AFEW International.

Rukhshona, why it is important to work with migrants?

Migrant workers significantly contribute to the economy of the countries of origin and countries of destination, but are often left out when it comes to health programming. The majority of the Tajik migrants is involved in low skilled jobs, even if they have a good education. The prerequisite for good performance – even for low skilled work – is good health; therefore, both countries of origin and destination benefit from healthy migrants. However, migrants can be stressed by facing a new environment, culture, language, and they are often exposed to poor working and living conditions in the receiving country. This all can put their health at risk. This all circumstances put their health at risk and make migrants vulnerable.

Additionally, since the majority of Tajik migrants are young men from rural areas, where strong social control is part of the traditional patriarchal society, getting into a big metropolis with different norms and morals can impact their sexual behaviour. A difference in social control, little knowledge about prevention of sexually transmitted infections and HIV, alcohol consumption and drug use, and casual sex all play into migrants’ vulnerability to Sexual Transmitted Infections (STIs) and HIV. Therefore, it is important to address their health needs and raise awareness. Integrating migrants into national health programmes and strategies is part of the agenda of the Universal Health Coverage approach promoted by the WHO and other UN organizations including IOM.

The project “Improving migrants’ access to HIV services in Tajikistan” aims to enhance Tajik migrants’ access to HIV services, particularly among key populations. How do you plan to reach this goal and which tools will you use?

The project is composed of two parts: The first part is working in the field with returned migrants in Kulob to raise awareness on safe migration and promoting health seeking behaviour relating STIs and HIV through peer networks. The second part is a regional working meeting with the participation of officials and HIV service NGOs from the Russian Federation, Kazakhstan, Kyrgyzstan and Tajikistan to discuss the essential HIV related package of services for migrants from Central Asia, as recommended by the World Health Organisation.

For the fieldwork in Kulob, IOM will partner with the local NGO “Nakukor”, which has strong experience in working with different groups of migrants. Jointly, they will promote the peer-to-peer approach and hire outreach workers among representatives from the key populations. In addition, within this project supported by AFEW International, IOM will provide free access to HIV tests and survey key populations among migrants to map their sexual behavior and refer them to HIV testing when needed. A legal consultant and venereologists will conduct information sessions for migrants on safe migration and prevention of STIs and HIV. Thanks to the project, two new brochures on safe migration and prevention of STIs and HIV will be developed for migrants. To ensure the sustainability of the project, IOM implements all activities jointly with relevant governments stakeholders – the Tajik Ministry of Labour, Migration and Employment, the Republican Healthy Lifestyle Promotion Center and the Republican AIDS Control Center of the Tajik Ministry of Health and Social Protection.

How long does IOM Tajikistan work with migrants?

IOM Tajikistan has been working on migrants’ health since 2005 and implemented projects on the prevention of STIs, HIV and TB among outbound and inbound migrants. The activities of the Migration Health Unit at IOM Tajikistan are covering the four main pillars needed to ensure the health of migrants holistically: monitoring migrants’ health, advocacy for policy development, provision of migrant sensitive health care services and strengthening inter-country coordination, partnership and networking. IOM Tajikistan has been implementing innovative approaches to reach migrants through peer education, engagement of the diaspora, the creation of multidisciplinary teams in the districts, the publication of communication materials in different languages such as Tajik, Russian, Uzbek, Chinese, Dari, Turkish, and others and by ensuring a multisectoral approach and cross border cooperation. To improve knowledge and skills of the stakeholdres, NGOs and health workers on promoting migrants’ health, a number of educational materials, such as manuals, video clips, and documentaries, were developed and distributed. Additionally, IOM Tajikistan is experienced in providing technical support and promotes the inclusion of migrants’ health issues and concerns into health-related policy documents, such as those developed by the HIV and TB National programmes. Last but not least, we are currently contributing to the development of the National Health Strategy for 2021-2030 and the National Strategy on migration health. IOM Tajikikstan is a member of the Technical Working Group on developing new National AIDS Control Programme and National TB Control Programme for 2021-2025.

Which barriers you might face in Tajikistan and how you are going to overcome them?

Stigma and discrimination are the main barriers faced by migrants and the general population in Tajikistan in accessing HIV services. There is also a high stigma of people who are using drugs, and sexuality is also a taboo topic in society. With our peer-to-peer-approach, we want to reach out to key populations. Through the awareness-raising campaign, working with migration officials and health workers, we want to address and reduce stigma and discrimination of people living with HIV and of key populations. For a better understanding of migrants’ access to HIV services in Tajikistan, the project also has as an operational research component to explore the barriers face by migrants when coming back home.

What do you expect from the project?

The results of the project will improve our understanding of the migrants’ needs concerning HIV services. The project will also help in developing effective communication and health promotion strategies that improve the detection of HIV among the migrant population and refer them for adequate treatment.

Helena Arntz, Junior project officer of AFEW International

Public opinions about migrants, in particular key populations among migrants, are often full of prejudice and stereotyping, which leads to discrimination in the health care system. Migrant workers are in constant movement and often a long time from home, so they can have more difficulties in getting the health care they need. They receive little information about how to be safe abroad, which poses continuous threats to their health and that of their families.

AFEW International has experience with and knowledge on migration in Central Asia and Russia. AFEW International currently also manages two projects in Russian cities Rostov-on-Don and Yekaterinburg to improve healthcare for migrants living with HIV.

In this joint project with IOM Tajikistan we not only want to address the limited information available to key populations among migrants, but also gain better insight in the behavior of this specific group. As the consequences of unsafe migration are not limited to the home country, we will address the needs of migrants at a regional event in Dushanbe. We expect that this will increase cross-border cooperation between Central Asian countries and Russia to improve the needs of key populations among migrants.

 

How to help migrants?

According to UNAIDS (www.unaids.org)[1], Russia has the second highest number of labour migrants in the world after the USA. Rostov region is one of the areas where this number is constantly growing. One of the reasons is its geographical position – Rostov region has the biggest borderline with Ukraine. Due to this fact as well as certain developments related to the armed conflict in Donetsk and Lugansk regions, many migrants from Ukraine with different statuses are coming to Rostov region, in addition to the labour migrants from Central Asia.

Are there any special services for migrants in Rostov-on-Don? How is HIV prevention implemented among migrants? Where can migrants seek help without endangering themselves? AFEW International asked these questions to Vyacheslav Tsunik, President of Rostov-on-Don Regional NGO “KOVCHEG – AntiAIDS” and Manager of the Project “HIV Prevention and HIV Services for Migrants in Rostov-on-Don”.

Significant financial support to carry out surveys and provide services to migrants within this project was provided by AFEW International, which, in particular, facilitated coordination with the Central Asian organisations to provide effective support to migrants when they leave their countries of origin and come to Russia.

For reference

Labour migrants are one of the populations most vulnerable to HIV in the world, which is explained by a number of factors. The data of numerous studies show that people coming from the Central Asia have a very low knowledge of infectious diseases: HIV/AIDS, hepatitis B and C. The situation is further aggravated with the low social and economic status of the migrants from Central Asia and the neighbouring countries, lack of access to health services, low level of social support and high prevalence of depression caused by such people living away from their families. High isolation of this social group often leads to HIV transmission inside this community, in particular through contacts with female sex workers, who come from the same countries.

Vyacheslav, how accessible is health care for the labour migrants in Rostov-on-Don?

Health care is provided to the labour migrants who officially live in Russia, in particular in Rostov region, based on their insurance certificates, which they buy when registering their patents. Without certificates, people can access health care on a paid basis, while emergency care if a person’s life is under threat in cases of heart attacks, strokes, catastrophes or accidents is provided to everyone, even with no documents, free of charge and is covered by the state.

How well informed are labour migrants about the problem of HIV?

Surveys among the labour migrants showed that they are not well informed about HIV. In our opinion, the reason is lack of preventive information provided to them in educational institutions in their home countries and when they come to work in Russia.

Do migrants practice any risky behaviours?

In fact, the prevalence of risky behaviours among migrants is approximately the same as among all young people. If we talk about the migrants who come from Asia, e.g. from Tajikistan and Uzbekistan, they have less risky behaviour due to their national customs and traditions. They mostly socialize with their fellow countrymen and they also have respect to older people and certain traditions, which restrict their risky behaviours. As for people from Ukraine and Moldova, they are closer to us, Russians, in terms of their culture and so the situation among them is similar to ours. There are young people who practice high-risk behaviour in terms of HIV. Mainly, they represent key populations. Their share in the total number of migrants is not so big, but they exist and some of them are clients of our organisation. They are not ready to quit their behaviour models.

Are there any differences in the behaviours of HIV-positive and HIV-negative migrants?

There is really a difference in the behaviours of migrants with HIV and those who do not have HIV.

Migrants living with HIV are a closed group. They are not ready to talk about their disease with their family members or their countrymen. Usually, they seek help in HIV organisations only in life-threatening situations or sometimes when they need to stock up their ARVs if there is a danger of treatment interruption.

In Russia, if migrants test positive for HIV, they cannot access free antiretroviral (ARV) therapy as they are foreign citizens. How is this issue resolved?

The situation with supply of ARVs is regulated by relevant provisions. In Russia, government covers ARV therapy only for the citizens. That is why migrants are not able to access free treatment as they are not Russian citizens. However, our organisation has contacts with community organisations in a number of neighbouring countries. We can help people who come to us and assist them is getting support services and ARVs from the countries of their origin.

Currently you are implementing the project “HIV Prevention and HIV Services for Migrants in Rostov-on-Don”. Please tell us more about it.

The goal of our project is to slow down the transmission of HIV through raising the awareness of HIV among migrants and creating services aimed at HIV prevention in migrant populations.

What do we do? Firstly, we train peer consultants from among migrants. Secondly, we provide medical and social support to HIV-positive migrants, giving them access to health services. Thirdly, we have meetings and negotiations with the representatives of diasporas concerning implementation of the prevention tools among migrants in Rostov region and coordinate service provision with the NGOs in the countries of origin of those people who seek our help.

Our organisation, “KOVCHEG – AntiAIDS”, is a community-based organisation of people living with HIV, representatives of vulnerable populations, PLWH, sex workers, LGBT and migrants. For instance, with our current project we trained a peer consultant from the migrant community. This is a woman from Ukraine living with HIV. Another peer consultant that we have, who works with people who use drugs, is also a citizen of Ukraine. Besides, when we carried out a survey among migrants, we had a volunteer supporting us – Ravshan from Uzbekistan – who is a student of a university in Rostov region.

Within the project for migrants, we organized the process to deliver HIV services. In particular, we have rapid testing, pre- and post-test counselling, if necessary provision of ARVs from our reserve stock, medical assays and support in receiving consultations from infectious disease doctors, tests for immune status and viral load, prescription of medications and treatment monitoring. We also inform migrants about the existing legal opportunities to acquire Russian citizenship with HIV status and facilitate people with HIV in obtaining temporary residence permits and Russian citizenship.

How and where do you share information about the services available?

Migrants can access our informational leaflets in the places, which they visit, such as the migration departments, health institutions, which issue the required health certificates to them, pre-deportation detention centres, and higher educational institutions we cooperate with. We use QR codes, allowing migrants to download any information on their smartphones and use it when necessary. As a result, it brings clients to our consultants, who can provide them with any additional information needed.

Name one of your most important recent activities?

Recently, we appealed to the Public Monitoring Commission and asked it to help us access the migrants in pre-deportation detention centres. The Public Monitoring Commission sent an official request to the Ministry of Internal Affairs. We visited the detention centres, met with the migrants living with HIV who stayed there and agreed with the administration of such centres that we would have further access to such migrants living with HIV. We are planning to seek financial opportunities for people living with HIV to receive consultations from infectious disease doctors, get tested for their immune status and viral load and access ARVs for the period of their stay in such institutions. Besides, we are working on developing an appeal to the government officials about the need to provide this category of people with HIV treatment at the expense of the state.

[1]Migrant populations and HIV/AIDS: the development and implementation of programmes: theory, methodology and practice / UNAIDS, UNESCO.

IT’S TIME

24 of March is a World TB Day 2020.World TB Day is a big moment to sound the alarm, raise attention, and tell world leaders to follow through on their promise to diagnose and treat 40 million people with TB by 2022, as agreed at the UN High-Level Meeting (UNHLM) on TB in September 2018.

We all need to work together now on important activities to make sure that World TB Day 2020 is the biggest and most effective.

What we together can do?

  • REACH OUT
    Reach out to your political leaders (Mayors, Parliamentarians, Ministers of Health, Heads of State) to request their leadership in the fight to END TB, remind them of the commitments and targets that have to be reached by the end of 2022, and request their engagement for World TB Day. This could include making a public statement, supporting an event, introducing a motion in parliament, or committing to achieve the UNHLM country targets.
  • GET SOCIAL 
    The hashtags for this year’s World TB Day are #ItsTimetoEndTB and #WorldTBDay. Start raising awareness through social media. Share your plans with us on Twitter or Facebook.
  • MAKE IT STARRY
    Reach out to celebrities, influencers, TV personalities, and other figures to ask them to join your efforts and raise awareness or wear a red arrow pin ahead of World TB Day. Stop TB partnership has a list of national celebrities, journalists and personalities that we can share with you case by case, so don’t hesitate to get in touch with us to get their contacts.
  • TEAM UP
    Team up with local TB partners to join forces in planning major World TB Day events, public mobilizations, and other activities. Stop TB partnership have a database of partners at country level – so do not hesitate to get in touch with us to be able to identify the partners with whom you want to work for these events.

Text – http://www.stoptb.org/

What is the indicative target of your country?

Nearly one year after the first-ever United Nations High-Level Meeting on Tuberculosis, the Stop TB Partnership, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the World Health Organization, call for immediate action to implement the commitments that were made by Head of States and Governments.

Targets that were agreed in the October 2018 Political Declaration of the High-Level Meeting of the General Assembly on the Fight Against Tuberculosis for 2018-2022 are:

1) to provide appropriate diagnosis and treatment to 40 million people with TB, including 3.5 million children and 1.5 million people with drug-resistant TB;

2) to reach at least 30 million people with preventive treatment, including 4 million children under the age of five, 6 million people living with HIV and 20 million other household contacts of people affected by TB;

3) to mobilize US$13 billion annually needed by 2022 for implementation;

4) to mobilize US$2 billion annually for TB research and innovation.

The Stop TB Partnership, in collaboration with Avenir Health, has produced a  breakdown of what the global 40 million and 30 million treatment targets mean for each country, using the latest estimates of TB disease burden and data on case notifications published by WHO. This country-by-country breakdown (http://www.stoptb.org/resources/countrytargets/) provides indicative targets and benchmarks that could be used to inform country dialogue, further refinement and development of official national and sub-national targets, linked to the development and updating of national strategic plans for TB and associated funding requests, including to the Global Fund.

TB is now the world’s leading infectious killer, surpassing even HIV. In 2017, TB killed 1.6 million people, including 300,000 HIV-positive people.

Several high-TB burden countries have already started to use indicative targets to plan their actions towards ending TB, and others must do so as well if we are to collectively achieve the targets of the High-Level Meeting.

“The UN High-Level Meeting in 2018 demonstrated much greater political commitment to tackling TB, but now we need to deliver. We urgently need increased international funding to fight TB, and increased domestic resource mobilization,” said Peter Sands, Executive Director of the Global Fund. “Together, we must step up the fight to diagnose and cure the millions currently being left untreated and to counter the threat of drug-resistant TB. We can only reach the goal of ending TB as an epidemic by 2030 if we act now.”

Anastasia Pokrovskaya: “Deportation of Migrants with HIV Leads to Criminalization”

Photo: minusvirus.org

Author: Oksana Maklakova, Russia

The government of the Russian Federation is planning to increase the country’s population by 5-10 million people, by attracting migrants from Ukraine, Kazakhstan, Uzbekistan and Moldova. This is what Russian policy-makers say. However, Russia is the only country in the Council of Europe which still deports foreign citizens living with HIV. Anastasia Pokrovskaya, senior research associate of the Federal AIDS Centre, says that introducing amendments to the relevant regulations could protect the health of many people and contribute to their decriminalization. As part of the Partnership Program, she was involved in drafting an expert report for a project to ensure migrant access to HIV treatment and abolish the provision on deportation of foreigners living with HIV who enter the Russian Federation.

How many migrants come to Russia and what is the rate of HIV prevalence among them?

– According to the Ministry of Internal Affairs, in 2018 Russia issued 1,671,706 labour patents to migrants. Those are people who enter the country legally and are officially registered with the relevant authorities. To get a labour patent or a permit to stay in the country for a period exceeding three months, medical examinations, including HIV testing, are mandatory. HIV prevalence is about 100 cases per 100,000 people tested. However, this number does not reflect the real HIV prevalence as some migrants, anticipating possible test results, avoid health check-ups. They come to the country illegally, get short-term visas without getting any patents, buy fake health certificates or send another person to be tested in their place. This law on deportation of foreigners with HIV creates many opportunities for illegal activity, both among migrants and among Russian organizations which offer migrants illegal services to help them get round the law.

Is this typical only for Russia? What’s the situation in other countries?

– Initially about 60 countries applied the rule: if you fall ill or cross the border with HIV, you have to leave the country. However, there are now only nine countries, including Russia, where such regulations still exist. Other countries, such as the United States, Armenia and Ukraine, abolished such legislation in the last 5-10 years.

What is the goal of your project?

– Our goal is to show why this approach should be changed in the first place; to demonstrate the demographic and epidemiological premises for abolishing deportation provisions. We have developed a document providing medical and legal justifications why we need to amend the legislation. We state that this provision should be repealed because it does not bring any benefits. Firstly, it is clear that it will not help us to end the HIV epidemic. In terms of new HIV cases we are ahead of many neighbouring countries from which migrants come to Russia. Secondly, in reality this law does not work anyway. People stay in the country, but go underground and continue living in the ‘grey zone’. As a result, they remain sick and infect others while their disease progresses, as they have no access to treatment. Meanwhile, they cannot go back to their home countries to get treatment because they are afraid they will not be able to return.

Photo: minusvirus.org

What is the current response to such challenges?

– There are some NGOs which help deliver services to such people. According to the law, we are not able to ensure comprehensive medical check-ups or provide relevant health assistance to migrants. The biggest challenge is that we are not able to provide them with antiretroviral therapy (ART). This is the biggest issue. Russian citizens can access ART free of charge. However, our government is not ready to allocate funding to treat foreigners, for obvious reasons.

So there are economic reasons for not abolishing the regulations?

– Probably. There are concerns about financial and administrative consequences. International agreements should be signed between governments. It is difficult for us to use the experience of other countries in addressing the issues of HIV and migrants, as the Global Fund to Fight AIDS, Tuberculosis and Malaria and other international charities which could take over some functions in this regard do not operate in Russia. Even if the country abolishes the regulation on deportation of foreigners living with HIV and such people get the right to stay in our country legally, they could still receive ART at home. All AIDS centres in neighbouring countries accept migrants who are registered for HIV care, and provide them with ART medications for several months. However, to get registered for HIV care, people have to leave Russia and then come back, which is currently not possible due to the travel ban on foreigners living with HIV. Thus, we will have to find our own solutions to this situation. There are some options currently being discussed, but it needs time. The final decision should be made by policy-makers, but unless they are informed about this issue they will not resolve it. We have to speak about it and suggest possible solutions. Only then could the laws be revised. I am sure that in our society there will be people who oppose such amendments, as they think migrants are bad for our country. However, those people often forget that migrants are a unique labour resource and in a way a demographic resource which modern Russia really needs.

Findings from a needs assessment survey of labour migrants among people who use drugs in the pilot regions of Kyrgyzstan and Tajikistan

Findings from a needs assessment survey of labour migrants among people who use drugs in the pilot regions of Kyrgyzstan and Tajikistan

30 November 2017

Financial support for this survey was provided through the budget of the project ‘Bridging the Gaps: Health and rights for key populations 2.0’, funded by the Ministry of Foreign Affairs of the Netherlands. Additional financing agreements with AFEW International as of 1 July 2017 and with the UNAIDS country office in Tajikistan as of 31 July 2017 helped finance the survey.

Our analysis points to a set of problems related to information, as well as social, legal and education issues. People who use drugs face these same problems whilst planning, remaining in and returning from periods of labour migration. A lack of finances and social vulnerability represented key problems faced by migrants when planning their labour migration. A lack of finances hampers access among people who use drugs to complete medical examinations through primary healthcare facilities, HIV testing and TB diagnosis in order to obtain the necessary certificates, including those from HIV centres, drug rehabilitation centres and TB control institutions.

The full version of the report is available here.

AFEW Presents Important Assessments about EECA

AFEW International, together with its network members from Eastern Europe and Central Asia (EECA) is getting ready for AFEW’s Regional autumn school to be held in Almaty, Kazakhstan from October 30 till November 3, 2017. The autumn school will provide the platform for learning, exchange, strategizing and planning for community members and NGO partners from 10 different countries. The regional autumn school is an annual event that takes place as a part of ‘Bridging the Gaps: Health and Rights for Key Populations’ regional approach of AFEW.

One of the highlights of the autumn school’s program will be the presentation of three important assessments that AFEW International recently finalized as a part of the ‘Bridging the Gaps’ program. The final results of all assessments will be available to the general public around December of 2017.

Harm reduction friendly rehabilitation

The assessment on harm reduction friendly rehabilitation in EECA is the study that describes the state of rehabilitation services in Ukraine, Russia, Georgia and Kyrgyzstan. It presents seven international approaches for rehabilitation programs and its activities. The participants of AFEW’s autumn school will discuss the recommendations of what approach is better to adopt for developing stronger work capacity.

Migrant people who use drugs

The assessment on migrant people who use drugs (PUD) is coming from the questionnaire that was disseminated in the EECA region. A survey amongst 600 people who use drugs in Tajikistan and Kyrgyzstan showed that 43% of the respondents have experienced periods of migration to another country in the EECA region, mostly to Russia. From the qualitative interviews with migrant PUD in Russia and Kazakhstan, it is possible to assume that people have very little access to health facilities, legal documents and often little options to return to their native country. The participants of the autumn school will discuss the full assessment and come up with interventions for the coming two years to build good practices and to advocate for the rights and lives of the community members.

Shrinking space for the civil society

The assessment on shrinking space for civil society is the in-depth assessment on the space for the civil society organizations with a special focus on harm reduction and drug policy in NGO’s and community networks. The withdrawing of international funding and shrinking space for the civil society form a real threat for the fight against the further spread of HIV in the region and the rights and lives of communities. During the autumn school, the coping mechanisms will be discussed and further steps will be designed to address the conclusions.

One in Sixth People Infected with HIV in Tajikistan This Year is a Migrant

Author: Nargis Hamrabayeva, Tajikistan

Approximately five thousand citizens of Tajikistan, which were found to be infected with HIV, tuberculosis and hepatitis during their stay in the territory of the Russian Federation, were declared personae non gratae for lifetime by the government of Russia in June this year. How could this expulsion of infected fellow citizens affect the Republic of Tajikistan?

Generally, after returning from Russia, migrant workers, unaware of their status, may unintentionally put the health of the members of their families at risk by spreading and transmitting infectious diseases including HIV/AIDS, believes Takhmina Khaidarova, the head of the Tajik Network of Women (TNW) Living with HIV/AIDS.

“The consequences of transmitting and spreading of infectious diseases depend solely on the will of the state. Providing that a state fully implements their commitments within the framework of the National Strategy for the Response to HIV/AIDS Epidemic for 2017-2020, it would be possible to avoid drastic consequences. If the government of a state cannot conduct awareness-building work about infectious diseases and their transmission amongst their population on adequate level, despite the fact whether or not infected migrants would be deported, the increase of the epidemic will stay high,” she considers.

According to Takhmina Khaidarova, the main problem is the low level of awareness about infectious diseases, including HIV/AIDS, before the migrants leave the country, during their stay in the host country, as well as on their return to their home country. “Migrant workers have little information and preparation, they are not aware about their status before leaving the country and they do not observe any safety measures during their stay in labour migration. After contracting infectious diseases, they return to their home country and, generally, do not undergo medical examinations; so, unaware of this, they transmit infectious diseases to their sexual partners,” says Takhmina Khaidarova.

She believes that another problem lies in the fear of stigma and discrimination, therefore, migrant workers who have returned do not undergo examination until their health deteriorates considerably.

According to figures provided by the Ministry of Health of the Republic of Tajikistan, there have been noted 384 cases of citizens infected with HIV in the first quarter of 2017, whereby one in sixth is a migrant, who had left in search of work outside the country. Presently, the total number of people living with HIV-positive status in Tajikistan is around nine thousand.

It should also be reminded that Eastern Europe and Central Asia will be a prime focus in the 22nd International HIV/AIDS Conference in 2018, which will take place in Amsterdam in July 2018.

Central Asian NGOs Built a Network for Cross-Border Control of Tuberculosis

Author: Marina Maximova, Kazakhstan

During the regional seminar-meeting held on 6-7 June in Almaty, Central Asian nongovernmental organizations established a network of partner organizations to address issues of labour migration and tuberculosis. The participants accepted draft Memorandum of cooperation between non-profit organizations to reduce the prevalence and incidence of tuberculosis among migrant workers in the countries of the region.

“This document was created in response to the need of NGOs consolidation to educate migrant workers about TB symptoms and the opportunities of free treatment and diagnostics in the framework of the project, to promote treatment compliance, to exchange information and to disseminate best practices in the countries of Central Asian region,” says a project manager of the Global Fund, a representative of Project HOPE in the Republic of Kazakhstan Bakhtiyar Babamuratov.

The event was organized by the Project HOPE in the framework of the grant from Global Fund to fight AIDS, tuberculosis and malaria. Representatives of non-governmental organizations from Kazakhstan, Kyrgyzstan, Tajikistan and Uzbekistan attended the seminar .

Migrants do not want to be treated

From all the countries in the Central Asian region, Kazakhstan is accommodating the main stream of migrant workers from neighbouring countries. Migration flow continues to grow. Those who come to find a job often agree to any work, they often live in poor housing conditions and do not eat well. This results in tuberculosis development. In 2016, 753 external migrants addressed the organizations of primary health care and TB facilities of Kazakhstan and were tested for tuberculosis. In 2015, there were only 157 visits. Most migrant workers prefer not to attend medical institutions and refuse to be treated in the TB clinics or to be examined by a doctor. They consider it to be a wasting of working time, i.e. money. They have to support families left at home, therefore money is the main reason to come to a foreign country. For the same reason people do not want to spend money on health, even though a Comprehensive plan to combat tuberculosis in Kazakhstan for 2014-2020 involves activities to improve TB services for migrant workers.

Particularly alarming are the cases when a migrant worker is diagnosed with HIV/TB co-infection, and when such patient needs a serious treatment and social support. This important topic will be discussed in 2018 in the framework of the 22nd international AIDS conference – AIDS 2018 – in Amsterdam. This conference will be very special as for AFEW International and the whole region where the organization works — Eastern Europe and Central Asia.

Work at construction sites and markets

In the situation mentioned above, the participation of the NGOs in addressing of this issue has become very important. Outreach workers and volunteers – people, whom the target group trusts, – are searching for migrant workers on construction sites, at the farms, markets, in the restaurants or cafes. They tell migrants about the disease and the free treatment, convince to pass the examination and to provide social support. The results of such work are impressive.

“Within the project, implemented by Project HOPE in 2016, staff and volunteers of our public Fund helped 898 migrant workers to be tested for tuberculosis. For 25 of them the diagnosis was confirmed, and with our assistance people were able to receive free treatment. Besides, we provided migrant workers with motivational food packages. 8,312 labour migrants received information about the symptoms of tuberculosis, and now they know where to go if they are sick,” says the Director of the Public Fund Taldykorgan regional Foundation of employment promotion Svetlana Saduakasova.

These are the results of the activity of only one non-governmental organization in Kazakhstan. Nowadays, social activists are effectively working in eight regions of the country. Such results are possible to achieve only thanks to active collaboration with the non-governmental organizations from those countries where work migrants come from. The community members actively communicate with each other and exchange useful information to be aware of whether the diagnosed person came back to his home city, got registered in the TB clinic, continued to receive treatment, and so on. Only under these conditions we can achieve a complete recovery from TB for each individual and finally stop the growth of morbidity in the region.