Series of webinars on TB and migrant health

TB Europe Coalition (TBEC) and the Regional Expert Group on Migration and Health (REG) are coordinating a series of 3 webinars on TB and migrant health. The webinars will address the barriers migrants face when accessing TB and healthcare services across the WHO Europe region and the challenges for service delivery.

In Europe and Central Asia migrants represent one of the key groups vulnerable to TB, as well as other infectious diseases such as HIV and hepatitis. Migrants face many barriers to accessing adequate healthcare services, both during migration and once they have arrived in a host country. This includes, but is not limited to, language barriers, cultural barriers, stigma and discrimination as well as poverty, which can have a significant impact of their physical and mental health and wellbeing. Female migrants are particularly vulnerable to specific health challenges such as gender-based violence and reproductive and sexual health issues.

Promoting the rights of migrants is key to achieving the sustainable development goals, and ensuring that “no one is left behind” irrespective of their migration status. Migration issues are cross-cutting; economic and social policies, human rights and equity issues, development agendas, and social norms are all relevant to migration health. Therefore, it is essential that any policies aimed at addressing the needs of migrant communities are multisectoral.

The webinars will take place in Russian and English with simultaneous translation.

 

The first webinar on Wednesday 3rd March 2021, 12pm – 13:30 EET (11 pm – 12.30 CET) will focus on TB and migrant health within an Eastern European and Central Asian (EECA) context, the second will focus on a Western European and EU Member State context, and the third will focus on service delivery.

Agenda of the first webinar:
1. Introduction (Paul Sommerfeld, TBEC Chair)
2. Overview of barriers and coping strategies in EECA, (Daniel Kashnitsky, Regional
Expert Group on Migration and Health)
3. TB and Migration in EECA – online course (Mari Chokheli, TB People)
4. Essential package of TB services among migrants in EECA: Policy framework and its
implementation in the practice (Masoud Dara, WHO Regional Office for Europe)
5. Transborder cooperation between sending and receiving countries to provide
migrants access to TB care (Rukhshona Qurbonova, IOM Tajikistan)
6. Questions & Answers.

Register for the first webinar via this link.

If you have any questions please contact:  coordinator@tbcoalition.eu

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.

Barriers for migrants

Author – Chamid Sulchan

The main reason why labour migrants from Tajikistan, Moldova, Belarus and Uzbekistan come to Russia is that there is no work for them in their home countries. Often labour migrants have big families; parents, brothers, sisters, wives and children, and they have to take care of them. Working in Russia is often the only way for them to help their families to survive.

Margarita Abramyan, manager at KOVCHEG Anti-AIDS in Rostov-on-Don, a partner of AFEW International in Russia, has been implementing a project called ”HIV and migrant workers in southern districts” in the framework of the regional approach of the “Bridging the Gaps: health and right for key populations” program. She told us what influences migrants’ access to health services in Russia and how to improve this difficult situation.

How would you describe the access to health services for labour migrants in Russia?

So it really depends on whether you are in Russia legally or illegally. If a migrant comes to Russia legally, he/she receives a residence and work permit with medical insurance. If the migrant is in Russia illegally, this person can stay here up to 90 days. They don´t need to undertake all the documentation procedures and therefore don´t have a medical insurance. To get a legal residence permit or a medical card in Russia, you need to be tested for HIV, viral hepatitis and TB. But the thing is that you have to pay for all these tests yourself, and many migrants cannot afford this.

Under the migrant medical policy, emergency ambulance assistance and emergency operations are free. If you need an operation that is not absolutely necessary, then you need to pay for this operation yourself.

What are the consequences if labour migrants do not have access to health services?

There are a lot of consequences of the lack of access to health services for labour migrants in Russia. Migrants who come to Russia often work at construction sites, the kind of jobs that are really dangerous and where it´s common to have serious accidents. When a migrant has a serious accident at a construction site and they do not have access to healthcare, they can become an invalid for life.

The big problem is that migrants are actually afraid to get medical help, because medical workers ask for their documents and check if their papers are valid. If medical workers find out that migrants are illegal, then basically they can be thrown out of the country. Another big problem is that HIV positive migrants who come to Russia cannot get Russian citizenship. However, many of those HIV positive migrants come to Russia anyway. They stay in the country illegally and do not have access to healthcare. They often don´t know the condition of their health and cannot get any ART.

What these migrants sometimes do is that they connect or communicate with the non-profit-organizations from Ukraine or Uzbekistan, with countries that have borders with Russia, and then they can get therapy from there. So they could register in Ukraine, for example, and get therapy there and then go back to Russia. We are in contact with these organizations to support migrants. Of course, now with the coronavirus situation it´s a lot more difficult because the borders are closed. So the migrants can´t go back to their own countries and get treatment there.

What are other factors that influence migrants’ access to health services, besides their legal or illegal status?

So other factors include societal denial and ignorance . Russian people and people who come from post-Soviet countries have a very particular mentality – they believe that HIV will never touch them. They think they will never get sick and if they get something, like a flu, then they just drink some herbs, and everything will be fine.

The other thing is that there is a widespread belief left over from the 90s that only sex workers, LGBTQ+ people and drug users can get HIV, so if you don´t live a “wild life”, you live a so-called a ´normal life´ that is not connected to drugs or sex work, then you definitely will never get HIV. Another thing is that people still have a lot of unprotected sex. Moreover, most of the migrants that come to Russia send their money to their families back home. All the money that migrants earn is sent back to their home countries and they do not want to spend this money on healthcare.

Are culture and language also a barrier for migrants to access health services?

Yes, it’s a very big barrier. Together with my organization we went to one of the detention centres for illegal migrants in February and there is no official interpreter for them there. Migrants are communicating with through signs. Even though there is a lot of medical information about HIV and how to access medical services, there are no interpreters for migrants. For example, of the four people who came from Uzbekistan, only one spoke Russian. The people who cannot speak Russian are trying to figure it out for themselves.

 Is there a governmental programme that tries to help migrants integrate into Russian society?

There is no governmental programme like this, these kinds of activities are mostly done by NGOs. These activities include language training, consultations, cultural trainings and workshops, and it´s mostly just NGOs doing that, as volunteers.

Which services does your organization provide for labour migrants?

We provide peer-to-peer consultations for migrants. We also have lawyers, virologists, and psychologists who support migrants. We are also supporting migrants in getting their Russian citizenship and filling out the documents for work and residence permits. If there are funds, we also try to support migrants financially. We also have rehabilitation centres for drug HIV positive users. Also, we often organize information events for labour migrants where we tell them about access to health services and about treatment and testing for HIV. We also have a lot of contact with local organizations and job centres. If a migrant is looking for a job, we can refer them to our other contacts.

What do you think should be done to improve the access to health services?

On the governmental level, first of all the medical insurance for labour migrants should cover all the medical services that are also available for Russian citizens. On the local level it would be great if NGOs get financial support from the government to pay for HIV treatment and testing for migrants.

There is always hope that things will change. If the government provides enough support, treatment and care to migrants then communicable diseases will not be transmitted. There are migrants who take their health and the health of their families very seriously, but they do not have the same access to health services as Russian citizens.

 

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.