More funds are required to promote migrants’ health

In December 2019, IOM Tajikistan together with AFEW International and AFEW Kyrgyzstan launched the project “Improving migrants’ access to HIV services in Tajikistan”. Aim of this project is to raise awareness among outgoing migrants on safe migration and to promote health seeking behaviour relating Sexually transmitted infections (STIs) and HIV through peer networks.

Rukhshona Kurbonova, National Professional Officer, Sub-Regional Coordinator on Migration Health for Central Asian countries, talked to AFEW International about the outcome of the project, the challenges that the project faced during its 1-year implementation, and the important role of community representatives in the process.

Rukhshona, 2020 was not the easiest year, because of the Covid-19 pandemic. How has this affected the project “Improving migrants’ access to HIV services in Tajikistan”?

Indeed, 2020 became quite a difficult year for the world, also for us. We have managed to implement key activities, and tried our best to fully roll out the project, but have not had the reach that we hoped for, due to COVID-19. The main activity of the project was outreach work among outgoing migrants to raise awareness on prevention STIs and HIV and promoting health seeking behaviour. As a result of the project, the number of the migrants covered by HIV testing in Kulob increased 4 times. Although we referred less migrants for HIV testing than was planned, the results of the project demonstrated a positive impact on health seeking behaviour. The COVID19 situation hindered reaching the initial target of 1000. We have adapted to this situation by setting up a testing program at the Kulob AIDS Control Center, which will continue to provide free testing among migrants.

Talking more about COVID19, I would like to say that the pandemic also drew our attention to the needs of the migrants’ families. Many migrants abroad lost their jobs and could not send money to their families at home. This led to some precarious situation with the families left behind. IOM and AFEW responded to this by allocating funds for the support packages. As a result, 50 vulnerable migrants’ households received food packages and hygiene kits, including protective materials for COVID-19.

Did IOM Tajikistan or partner organizations face any other challenges?

One of the challenges was a process of implementing a new approach where we tried to identify high-risk behaviour among migrants during outreach work. This included asking them questions on drug use and sexual practice. This was a very sensitive issue, and particularly the questions about men having sex with men were met with a very negative response. It was very difficult to discuss these topics.

When we were organising safe migration training among migrants who use drugs, it became clear that active drug users need psychosocial support, rather than information on migration legislation. It means that safe migration training sessions need to be organized among people who use drugs in remission phase and in case they intend to go abroad for work.

 What is the main outcome of the project, from your point of view?

The main outcome of the project is that we piloted successfully our new approach on reaching key population among migrants and migrants with risk behaviour. Although we could not implement all activities in the way we would have wanted, it is clear that the suggested approach needs to be extended and applied in other projects.

Within the project, the IOM conducted operational research. What was the goal of this research and do you plan to use its results in the future?

The goal of the operational research was to measure the effectiveness and impact of the suggested project activities on the knowledge, attitude and practice relating STIs and HIV of migrants, including key populations. Due to COVID19, we could not conduct all sessions that were foreseen, but nonetheless we collected valuable data about attitude and behaviour among migrants through base line survey and focus group discussions. This information gave us more understanding of the vulnerability among migrants, including a lack of knowledge and healthy practices among women in comparison with men and high stigma and discrimination toward men who have sex with men. Based on the received data, we plan to extend our research and develop scientific article next year.

Did you involve community representatives into the project?

Community representatives played a key role in the project implementation. The outreach work was led by NGO “Nakukor”, who involved leaders of key population groups, including people living with HIV. A “peer to peer” approach was used, and community leaders and local migration and health authorities also helped in identifying the vulnerable migrants’ families and distributing food and hygiene packages.

In the end of November the online regional dialogue “Migrants’ Access To Essential HIV Services: Progress And Opportunities Amid COVID-19” was organized. What are the main insights of the event?

The event was organized jointly with WHO office in Europe and WHO Tajikistan. WHO colleagues helped us to bring Russian health authorities- representatives of Rospotrebnadzor – into this dialogue. As a result, the event gathered key stakeholders from the country of destination and countries of origin of migrants. Participation of the HIV service organizations extended the dialogue and gave opportunity to ask questions directly to each other. NGOs raised the issue of the lack of access of migrants with HIV to ART: Russian legislation prohibits residency of foreigners with HIV, and this means that ART is not available for migrants with HIV. The Healthcare Committee of the CIS is now developing a model HIV legislation which might change the situation in the future. The event demonstrated that regional meetings need to be organized on a regular basis to share updates and developments on migration and HIV.

Which results are you personally proud of?

Despite the limitations because of COVID19, the IOM, with AFEW and national partners, was able to conduct a number of activities reaching key populations among migrants, providing free HIV tests, collect data, organize a regional on-line event, develop two new brochures: on safe migration, the first brochure in Tajikistan that targets migrants who use drugs, and a brochure on prevention of sexually transmitted infection and HIV among migrants. The achievements and lessons learnt gave us the basis for the developing other new projects that will target key population among migrants.

Do you see any challenges in the future for your projects and your help to migrants?

Unfortunately, there is lack of recognition of the contributions that migrants make both to the economics of the countries of origin and destination. It also needs to be recognised that the health of migrants is a key point for their performance. More funds are required to promote migrants’ health and advocate migrants’ rights to health. Inclusive policies, as part of the framework of universal access to health, are of great importance. More efforts need to be applied to extend cross-border cooperation between countries of origin, transit and destination.

In some countries of the EECA region, HIV and TB national programmes heavily depend on the support of international donors. AFEW International is one of the few organizations that specifically target migrants in their programmes in Eastern Europe and Central Asia. Labour migration is a long-term trend in the EECA region that significantly contributes to economics of the countries. In this regard, health of migrants is a fundamental condition for productive work and the social and economic development of the countries of origin and destination. Joint efforts and international support are highly required to address migrants’ needs in health.

A roundtable “Migration and HIV in EECA”

On December 17th, the Regional Expert Group on Migration and Health will hold a roundtable “Migration and HIV in EECA region” that will take place on the eve of International Migrants Day. The event will be held in Moscow from 11:00 to 13:30 Moscow time (9:00 to 11:30 CET) and will be broadcast online.

The purpose of the Roundtable is to discuss the most challenging issues in the intersection of HIV/AIDS, tuberculosis and migration in Russia. The report “Legalizing HIV-positive migrants in Russia” will be presented and discussed.

International migrants living with HIV will tell their stories at the roundtable. This is going to happen for the first time in Russia.

The event will gather representatives of Russian Federal Service for Surveillance of Consumer Rights and Human Wellbeing, Ministry of Health of Russia, WHO Europe, UNAIDS, as well as experts from civil society organizations and international NGOs, such as Eastern Europe and Central Asia Union of People living with HIV, International Federation of Red Cross and Red Crescent Societies, Oxfam.

The roundtable is supported by the Oxfam in the Russian Federation and AFEW International. 

To participate, please fill in a registration form.

The final program 

Report – Legalizing HIV-positive migrants in Russia

Regional dialogue on HIV and Migration from Central Asia

Dear partners, colleagues and friends,

IOM jointly with the Ministry of Health and Social Protection of the Republic of Tajikistan, AFEW International and WHO invites you to the online regional dialogue ​“Migrants’ Access To Essential HIV Services: Progress And Opportunities Amid COVID-19 ” .

Date: 12 November 2020

Time:  9.00 CET/13.00 MSK +2

Speakers:

– IOM Regional Office for East Europe and Central Asia

– WHO Regional Office for Europe

– Expert Council on Healthcare at the Interparliamentary Assembly of CIS

– Federal Service for Supervision of Consumer Rights, Protection and Human Welfare (Russian Federation)

– Global Health Research Center of Central Asia

– Republican Center on Prevention and AIDS Control (Republic of Tajikistan)

HIV service organizations:
AFEW Kyrgyzstan, «Nakukor» (Republic of Tajikistan), «LUNA», «Shagi» (Russian Federation)

To join this event as VIEWER (BROADCAST MEETING): https://live.kudoway.eu/br/110219086128

To take part at the discussion, please join as PARTICIPANT: https://live.kudoway.eu/ad/220215000515

Working languages: English and Russian

Roles and perspectives of key stakeholders on access to health services for labour migrants from Central Asia to Russia

The migration flow between Russia and Central Asia represents one of the world’s largest labour migration routes. Labour migrants from Central Asia significantly contribute to the economies of both Russia and their country of origin, however they do not have complete access to health services. Due to the growing number of new HIV cases in Eastern Europe and Central Asia, this is a particular public health concern.

The roles and perspectives of key stakeholders on access to health services for labour migrants in Russia have not been studied extensively. Chamid Sulchan, a student of Vrije Universiteit Amsterdam and intern of AFEW International, during his internship made a research “Roles and perspectives of key stakeholders on access to health services for labour migrants from Central Asia to Russia”.

Chamid, why the topic of labour migrancy is so interesting for you?

First of all, it’s a very important topic. Labour migrants from Central Asia are heavily stigmatised in Russian society and have a lack of access to health services. I firmly believe that every human being has the right to healthcare, and that migrants should have the same rights as Russian citizens. They contribute to the economy of both Russia and the Central Asian countries, supporting their families by sending remittances home. They fill in jobs in the service and construction sector that many Russians do not want. Migrants should be seen as heroes, hard-working people and as equal human beings. Together with AFEW International I had the great opportunity to do research on such an important topic.

What was the aim of your study?

The aim of my study was to explore the role and perspectives of key stakeholders on access to health services for labour migrants from Central to Russia. In addition, recommendations were formulated on further research needed to gain a complete understanding of the challenges and health needs of labour migrants.

What is the fact in the research that impressed you the most?

It was a fact that although many migrants from Central Asia prefer to visit “Kyrgyz clinics”, which are clinics found by Kyrgyz migrants, an opposite trend is also seen. Tajiks and other migrants said they preferred to approach Russian doctors if they have money, rather than go to these Kyrgyz clinics. This could imply that there may also be intercultural issues between people from various Central Asian countries.

Did you meet any limitations during your work?

Limitations of my work included language barriers, as some of the stakeholders could not speak English. Luckily, my colleagues at AFEW helped me with interpreting. Furthermore, due to coronavirus all interviews were conducted through Skype and Zoom. This made it hard to build rapport with the participants. It was also hard to reach policy-makers and healthcare professionals, which I think are also very important stakeholders in the field of migration health.

What is the biggest barrier for labour migrants in Russia?

The biggest barrier for labour migrants to access health services is the lack of documents (to obtain for Russian citizenship, work and residence permit). This is also in line with the lack of medical insurance. Migrants have to show a negative HIV-status result in order to receive a work and residence permit, or else they are banned from Russian territory. This can lead to many migrants refusing to get tested and working illegally in Russia, leaving them completely out of the legal framework.

What are the solutions to improve the situation with migrants?

More research should be done on the roles of other key stakeholders, on the mental health of migrants and on returned migrants. More (epidemiological) data should be available on migrants (both documented and undocumented). The Russian government should research and develop a programmatic response to integrate migrants from Central Asia into Russian society and into the national health policy. Civil society organizations, researchers and international organizations should continue to organize awareness-raising events and joint events focused on migrants to evaluate impact, and adapt legislation for migrants from Central Asia. Lastly, stigma and discrimination should be reduced by educating Russian healthcare providers and providing real stories of migrants in the media.

 

Please, find the full research here. 

Migrants in need. COVID-19 and the impact on labor migrants’ health, income, food and travel

Authors – Olga Shelevakho and Helena Arntz

“I lost my job in Russia due to the COVID-19 pandemic and I didn’t have any money to send back to my mother in Tajikistan who is taking care of my children. I don’t know how to help them”

This is one of many stories from Tajik migrants who have lost their job in Russia in the last months and can’t go back to their families. Some of them have to stay in Russia in poverty and some are stranded at the borders or are staying in unsanitary conditions with hundreds of other people without food, money or shelter. Government help is not enough in this situation, which is why NGOs in Russia and Kazakhstan have taken on the responsibility of helping migrants.

For reference

Russia alone hosted around 12 million labor migrants in 2019, which include an estimated 3 million migrants from Uzbekistan and 1.2 million from Tajikistan. Hoping for better chances of finding a job, migrants from Central Asia migrate mostly to Russia and Kazakhstan. Labor migrants from Central Asia significantly contribute to the economies of these two countries, as well as to the economy of their country of origin. That makes migrants an important part of the international economy, however society’s attitude towards migrants still remains bad.

Lockdown in Russia

At the end of March 2020, the Russian government announced that all non-essential businesses would be closed and suspended all international civil aviation travel. These travel restrictions, put in place to stop the spread of COVID-19, have a severe impact on migrants’ lives. Due to the pandemic regulations, an estimated 83% of the migrants lost their jobs and many of them were not able to return home. In March, 200 Central Asian migrants were stuck at Moscow Domodedovo airport for two weeks and 300 Kyrgyz nationals stuck at the Novosibirsk airport went on hunger strike. Hundreds of people who were trying to go home to Uzbekistan, Tajikistan or Kyrgyzstan by car got stranded at the border.

As many factories and companies stopped working, a lot of migrants lost their jobs and had no money for basic items. When big cities such as Moscow closed down as a result of the COVID-19 pandemic, a pass system was introduced to stop people from going outside. Labor migrants had great difficulty obtaining these passes, as migrants needed to have an officially registered job to be able to receive them. This means that undocumented migrants weren’t able to go out, which caused great difficulties in accessing social and health services. This has serious implications for migrants living with HIV, who cannot get their ARV therapy.

With regards to COVID-19 care, the Russian government announced that it’s free for everyone, even if a person is undocumented. During quarantine there was a moratorium on eviction from Russia, even for people without documents.

Liudmila Vins, the director of NGO “Luna” (Yekaterinburg):

“A migrant who owns a small bakery fell ill with coronavirus. His entire family and workers, also migrants, including illegal immigrants, were tested for free. They started a period of self-isolation, and the bakery was temporarily shut down. The owner of the bakery received all the benefits that were due to him as a small business owner”.

Families in need

The travel restrictions have not only impacted the lives of migrants, but also their families back in their home countries, who depend on incomes from seasonal labor. Especially for a country such as Tajikistan, where remittances made up 32% of Tajikistan’s GDP in 2018, this is a massive blow to its economy. Numbers from the International Organization for Migration show that 51% of Central Asian migrants make regular money transfers to their homeland. Of these, an estimated 80% were unable to transfer any money at the end of April 2020. The lockdown in the host countries thus also places a heavy burden on the families back in the home country.[1] The main problems Central Asian migrants face is not being able to pay their rent (64%), not being able to find a job (45%) and not being able to pay for food (43%).[2] The Russian government decided to compensate migrants for their loss of income, without much success, firstly because the vast majority of labor migrants work in the informal sector, which makes them ineligible for compensation or unemployment benefits. Secondly, the maximum payment by the Russian government to compensate for loss of income of officially registered migrants is 12,130 rubles a month (less than 160 euros), which is not enough not for the migrants themselves to survive, and definitely not enough for them to send money back to their families at home.

Children

Children of “unwanted” migrants are another big problem, according to human rights activists. When undocumented migrants are arrested by the police, they are taken to temporary detention centers. In some regions children of migrants are placed in a shelter for this time, while in Yekaterinburg they are taken to the Detention Center together with their parents. In these centers migrants are kept in separate locked cells. Each cell has several rooms of different sizes, which can accommodate from 4 to 12 people, and sometimes more. One person should have at least 4.5 square meters, but the centers are often overcrowded, especially after police raids.

Who can help migrants?

Despite many restrictions, several civil society organisations have mobilized their resources to help migrants during this difficult time. Kazakh NGO “Zabota”, managed to provide migrants information and recommendations by phone. Some NGOs received small grants from EFCA (Eurasia Fund of Central Asia) for the emergency project “Qolda”. In the framework of this initiative packages with food, hygiene and protection items such as masks were delivered to families of migrants residing abroad. Local ethno-cultural associations and diasporas also didn’t leave their nationals without help. In Russia, NGO “KOVCHEG Anti-AIDS” helps migrants such as Anna who live with HIV receive their medication from its reserve cabinet. They created a mobile point called “trust” so they could continue to meet migrants during the lockdown.

Anna (32 years old) from Ukraine: “I’ve had HIV since 2017. I went to Krasnodar, Russia, with my husband in 2014 where I worked as a housekeeper and my husband at a construction company. Every six months we went to Donetsk to get therapy and take tests. In December 2019, I got pregnant and in March after the borders were closed, we could not go back for the treatment. It was impossible to leave Russia, and I couldn’t interrupt treatment because of the risk of HIV transmission to my child. As a result of the pandemic, the organization where I worked was closed, and my husband and me were told to stay home.  I applied to the Krasnodar AIDS Center for therapy, but they couldn’t help me. Then I found the contact of NGO “KOVCHEG Anti-AIDS” in Rostov on Don, which helped with the therapy”.

In Tajikistan, people are starting to feel the consequences of the lack of remittances normally sent back by their relatives. Since the start of the pandemic, the costs of basic food items have been rising and many families cannot cover basic needs such as food. Thanks to NGOs, people got some supplies. NGO “Nakukor”, with the help of IOM Tajikistan and AFEW International, have distributed food packages to 500 migrant households in the Kulob region, providing families with basic supplies.

NGO “Luna” in Yekaterinburg mobilized resources to provide migrants with masks and hygiene kits. “Luna” has also helped several migrants to obtain residence permits and to register for an apartment. Recently, after borders reopened, some labor migrants left Russia and flew back home, primarily due to fear of infection.

Support NGOs

In April, President of Russia Vladimir Putin announced a support package for socially oriented NGOs and volunteers. The support package consists of seven items such as additional payments to employees of social institutions, grant support for volunteers as well as direct support for NGOs to help them pay salaries. Some NGOs have been exempted from taxes for the quarantine period.  Obviously, NGOs are playing a very important role in helping migrants during this pandemic. They should also be prepared for the reduction in remittances to the poorest Central Asian states to have implications on society and poverty in the long term. This will become clear in the coming months and years. The work of NGOs should not be underestimated and these organisations should continuously receive support to help people in need.

 

[1] IOM Central Asian and Russian Federation strategic preparedness and response plan: Coronavirus disease 2019, February – December 2020, updated on 27 April 2020.

[2] “Influence of the COVID-19 Pandemic on the Position of Migrants and Remittances in Central Asia” by Sergey Ryazantsev and Marina Khramova. Institute for Socio-Political Research of the Russian Academy of Sciences, Department of Demographic and Migration Policy at MGIMO University.

Labor migration: awareness and access

There are currently about a million citizens of the Republic of Kyrgyzstan working in the Russian Federation. Key groups of the population are also migrating to different countries seeking a better life. Because of this, the AFEW partnership conducted a study called “Assessment of Labor Migration Among Drug Users in Kyrgyzstan and Tajikistan”, which ultimately led to the development and implementation of the “Labor Migration: Awareness and Access” project in 2018. This partnership was created in the framework of the “Bridging the Gaps” project and was financed by the Ministry of Foreign Affairs of the Netherlands.

The main objectives of the project were to make people who use drugs more aware of their legal rights, and increase their awareness of organizations that provide social services to Kyrgyz citizens located in the neighbouring countries.

The project was implemented in two Kyrgyz cities- Bishkek and Osh – for 15 months, starting in October 2018. During this period, AFEW-Kyrgyzstan created a database of organizations in Kyrgyzstan and the Russian Federation that provide social support to people from key populations, including migrants. From the number of potential migrants, more than five thousand people who use drugs (PWID) received advice on planning their trips and were made aware of possible difficulties they could face.

Migrants face constant obstacles

Within the framework of this project, AFEW Kyrgyzstan held a series of meetings with migrants who shared with us their feelings, experiences and thoughts. As practice has shown, the most common problem that labor migrants encounter upon arrival in Russia is registration.

It’s common for migrants to turn to fellow countrymen who can provide documents illegally, but these services often cost a lot of money.

 “The employer was a Moscow resident, our former compatriot, he did both registration and documents for us. I had registration, but we lived on the territory of the houses that served. It was a basement and there was a room in which we slept. I tried not to go further than this territory – it was dangerous” – Sergey, 36 years old.

Another problem often encountered by migrants from Kyrgyzstan is the attitude of law enforcement officials, who often exceed their authority. Often police detain migrants without any evidence of a violation, simply because there is no one to intervene on behalf of them, and migrants themselves do not have sufficient legal knowledge to defend themselves.

“I remember sitting in a cell for a long time and waiting for a Muscovite acquaintance to come, who might be able to negotiate for me.” – Sergei, 36 years old.

Despite all the difficulties migrants face, they are still going to work abroad due to economic necessity. There are frequent cases where labor migrants fall into slavery. Employers take their documents from them, and then stop paying them correctly, promising that in the future they will definitely give them their salary.

In this way, people worried about their income are often afraid to leave and change their job. They can’t go to the embassy or the migration service, because without documents they will, at best, be sent back home without any money.

Step-by-step instructions for migrants – booklets

Thanks to the project, for the first time, printed information booklets were prepared in Kyrgyzstan in 2019 for people who migrate to Russia to earn money. In these booklets potential migrants can find answers to important questions, as well as explanations for the most common problems that migrant workers face. The booklets also provide detailed guides to pre-migration procedures, including how to correctly prepare documents, as well as consultations with social workers and additional consultations for people with higher status.

A distinctive feature of the booklets is that all the information provided in them is official and reliable. Any prospective migrant who receives the booklet can travel and avoid most illegal situations by following the recommendations.

“This booklet is very important for us migrants. Migrant workers often travel to Russia, not understanding what they will face. This manual should make people think twice before they cross the border and face all the challenges.” – Victor, 49 years old.

“Migrating is scary. Even if you have friends there or you are traveling with someone. First of all, you don’t know where you will live, you don’t know whether there will actually be work. You do not know who you can trust and where you can get help, or what documents you need to take. The booklet can be considered a little lifeline that you always keep close. Many migrants don’t even think about compulsory health insurance, and in the handout, they immediately warn that it is needed. ”- Victor, 49 years old

Far-reaching plans

In the future, AFEW-Kyrgyzstan will continue to support migrants from socially vulnerable groups and provide them with important information. To this end, the organization plans to conduct a study, “The Experience of Labor Migration Among People Who Use Drugs” to study the experience of labor migration in the Russian Federation over the past 3 years among migrants who use drugs. It will also analyze the socio-legal and medical needs of the selected group while planning and returning from labor migration, and while finding work.

The COVID-19 Pandemic and Central Asian Migrants in Russia

On the 16 July the Central Asia Program of the Institute for European, Russian and Eurasian Studies (IERES) will organize a webinar “The COVID-19 Pandemic and Central Asian Migrants in Russia”.

The Covid-19 pandemic revealed how Central Asian migrants in Russia are vulnerable to both the spread of the virus and the impact it causes on their livelihoods. Its effects are particularly visible in the everyday living and working conditions of migrants, including for those migrants who are currently serving prison sentences in Russian penal institutions and those who had to bury their relatives/friends/compatriots. On the event speakers will discuss the impact of the Covid-19 pandemic on vulnerable communities of Central Asians in Russia and their remittance-dependent home countries.

Speakers

Sherzod Eraliev is a postdoctoral researcher at Aleksanteri Institute for Russian, East European and Eurasian Studies, the University of Helsinki. He holds a doctoral degree from the University of Tsukuba, Japan (2018) and a master’s degree from the University of Manchester, the UK (2009). Sherzod Eraliev was a visiting fellow at the Central Asia Program of the Institute for European, Russian and Eurasian Studies (IERES), the George Washington University in 2019.

Juliette Cleuziou is an assistant professor in anthropology at the University Lumière-Lyon 2 (France). Her work in Tajikistan has been focusing on kinship, marriage and the impact of migration on family life and reproduction, while her fieldwork in Russia has been focusing on diasporic networks of mutual help among Tajikistani migrants, and transnational relations between Russia and Tajikistan. She is currently coordinating a collective research project (REFPoM) on migrants' access to the health care system in Russia and their attitude towards the risk of death, which also addresses the care collectively provided to bodies of migrants who have died in Russia (burial on the spot, repatriation, mutual aid funds, etc.).

Rustam Urinboyev, Associate Professor in the Department of Sociology of Law at Lund University and Senior Researcher within the ERC-funded “GulagEchoes” project in the Aleksanteri Institute, University of Helsinki. Rustam works at the intersection of sociology of law and ethnography, studying migration, corruption, governance and penal institutions in the context of Russia and Central Asia. His current research focuses on (1) migration, shadow economy and informal legal orders in hybrid political regimes, (2) corruption, informality and legal pluralism in Uzbekistan, and (c) informal hierarchies, religious orders and ethnic identities in Russian penal institutions. He is the author of Migration and Hybrid Political Regimes: Navigating the Legal Landscape in Russia (2020), published by the University of California Press.

When  Thursday, July 16, 2020, 10:00 AM – 11:30 AM (New York Time)

Safe migration

In 2019, IOM Tajikistan in cooperation with AFEW International and AFEW Kyrgyzstan in the framework of Bridging the Gaps launched the project “Improving migrants’ access to HIV services in Tajikistan” to scale up the access of Tajik migrants, in particular from the key populations, to HIV services.

Kulob-based NGO Nakukor, which is IOM’s partner, became a part of this project. Nakukor has many years of experience in working with different groups of migrants. The head of this NGO, Bakhodur Khaitov, told AFEW International about safe migration, which challenges migrants face when they come to a foreign country and how Nakukor helps migrants to find the best solution to overcome existing barriers.

Bakhodur, what does the term “safe migration” mean?

Safe migration means that the migrants are protected from any risks related to their health, legal status or life at all the stages of the migration process (in the countries of origin, transit and destination). Creating conditions to enable safe migration, first of all, means advocating for the rights of migrants to have decent work and living conditions. It also means migrants have access to social and health services. Taking into account today’s global migration trend, a safe migration process is vital for migrants.

It is the task of the government to help create civilized and safe migration conditions and equip people with the required knowledge, so they can mitigate their risks of falling in the hands of human traffickers or finding themselves in other difficult situations.

What are the vulnerabilities of migrants and especially the migrants who use drugs?

Mainly, they are related to poor working and living conditions, lack of legal protection, limited access to social services, feeling of isolation, stigma and discrimination, language barrier, and cultural differences.

As for the migrants who use drugs, they face double stigma due to their use of psychoactive substances. In the general population, both in their countries of origin and countries of destination, there is a widespread opinion that drug use is not a disease but a sin and that it is not possible to re-integrate a person who uses drugs into the society. Such things as lack of substitution treatment programs in many countries, language barriers, fear of deportation and other problems contribute to the vulnerability of migrants who use drugs. Migrants do not receive the help they need to break the circle of drug use, find a job, and support a family due to social and economic challenges as well as lack of government-funded rehabilitation and reintegration programs for drug users. People who used to be participants in subscribed opioid substitution treatment programmes in their countries of origin, have to interrupt their treatment when they become labour migrants abroad. This increases their risks and often makes them go back to illegal drugs from unsupervised sources. The situation is aggravated because of the lack of prevention and support programmes for migrants in the host countries: such as needle and syringe exchange programmes, voluntary counselling and testing, legal aid, residential projects. Special attention should be paid to the issue of migrants’ referral between NGOs in the countries of origin and destination.

What do migrants often forget about during their migration?

Usually, Tajik migrants find jobs using informal networks of their acquaintances and neighbours. When they are still in their homeland, migrants often do not properly prepare themselves for going abroad. This means that they do not check the migration laws of the country of destination, they do not undergo the required medical check and often do not collect information about the organizations offering services to migrants both in their own country and abroad. As a result, when migrants face some problems in a foreign country, they do not know what to do and where to go for help.

Working with migrants within this project, we found out that many of them faced deportation or administrative expulsion for 3 to 5 years or even longer due to various reasons. As a rule, migrants are the only breadwinners in their families, while their wives, children, parents and sometimes even brothers and sisters live as one household. Currently, because of Covid-19, the situation of deported labour migrants and their family members has worsened because of the high unemployment rate in their home country. The returning migrants are desperately looking for jobs, and if they can find part-time jobs in local businesses or at local construction sites, they get very small salaries. These salaries often do not allow them to cover the basic needs of their families related to food and health.

Nakukor’s experience shows that migrants are really interested to learn more about the Russian migration laws, about the history and the culture of their country of destination. Also, they are eager to receive information about organizations and projects, that can help them with their legal, educational and health-related issues.

Are your training sessions popular among migrants?

Yes, participants with migration background are usually looking forward to our workshops and actively participate in our training sessions. The workshops organized for them demonstrates that in recent years, the labour migrants from the region of Kulob did not have enough opportunities to receive accurate information and qualified consultations on migration. It makes such people vulnerable as they have a greater risk to fall victim of human trafficking and experience difficulties accessing health services abroad. The training sessions offered within the AFEW-supported project “Improving migrants’ access to HIV services in Tajikistan” allowed migrants to meet the lawyers from the IOM Tajikistan and Nakukor NGO as well as representatives of the Tajik Ministry of Labour, Migration and Employment. During the training sessions, migrants could not only ask their questions, but also share their stories with the international organizations and governmental agencies. On top of that, participants were able to find out how laws and regulations apply in practice and learn about the services offered by different organisations both in Tajikistan and abroad. Participants were also interested in this project as it offered free access to HIV testing and free consultations with an STI treatment doctor.

It should be noted that in our training sessions we use a special approach. We use interactive training methods for adults. The project lawyers offer real life case studies, ask questions to migrants, encourage the participants to engage in the discussions, give feedback on their actions while being abroad, and answer any questions that the participants might have.

Within the project, you also implement outreach activities. What do they include?

Our outreach activities are aimed to reach migrants that have returned from a period abroad. We try to increase their awareness on safe migration and motivate them to seek HIV and STI services.

We are very happy that we were able to engage members of the key populations, including people living with HIV, to join our outreach team. We implement targeted activities for migrants based on their needs and raise their awareness on STI and HIV prevention. Thus, our focus lies on the key populations with migration experience: people who inject drugs, men who have sex with men, and sex workers. Besides, within our outreach activities beneficiaries receive referrals for free HIV testing and STI diagnostics.

It should be mentioned that until now migrants did not have access to free HIV testing. Within the AFEW-supported project, 1,000 HIV tests were procured by IOM to offer free testing services to migrants.

Has the COVID-19 pandemic influenced your activities?

Yes, based on the WHO recommendations to ensure 1.5-meter distance between people, starting from April we reduced the number of training participants to 8-10 people. We really hope that our trained beneficiaries will share their knowledge with other migrants following the “peer-to-peer” principle.

Recently we received information from IOM that our request on social support for the vulnerable migrants and their families was supported by the AFEW International and we will be able to distribute food packages and hygiene kits among the most vulnerable migrants and migrant’s households as well as conduct informational sessions on prevention COVID19.

 

 

 

 

 

 

 

 

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.