|Population Mobility and AIDS (UNAIDS, 2001, 16 p.)|
Being mobile in and of itself is not a risk factor for HIV/AIDS; it is the situations encountered and the behaviours possibly engaged in during mobility or migration that increase vulnerability and risk regarding HIV/AIDS.
Migrants and mobile people may be highly marginalized while in transit, at destination, or on their return home. They may be subject to discrimination, xenophobia, exploitation and harassment, and have little or no legal or social protection in the host community. Such marginalisation increases vulnerability to HIV infection and also the difficulties of living with HIV/AIDS13.
13 For a discussion of the link between marginalized populations, vulnerability and HIV, see Report on the Global HIV/AIDS epidemic, June, 2000, UNAIDS, Geneva.
Migrants and mobile people may have little or no access to HIV information, health services, and means of AIDS prevention (condoms, treatment for sexually transmitted infections [STIs]). Cultural and linguistic barriers heighten their lack of access, as do unfamiliarity with the community, and the instability of mobility.
Migrants and mobile people may avoid attention from authorities, even if that attention is meant to provide health services, or to help improve their living conditions. They may also be uncomfortable and inexperienced in relating to the nongovernmental or community- based organizations that might be there to help them.
Poverty and lack of resources may force those moving from one place to another to increase their risk of HIV by trading or selling unprotected sex for goods, services and cash in order to survive and/or continue their travel.
Migrants in some countries face the possibility of involuntary testing for HIV, and deportation, if found to be positive14. Their HIV status may be revealed to authorities in their destination or source countries, or to their communities and families. Such breaches of confidentiality give rise to stigma, discrimination and rejection. Deportation from a country in which advanced HIV care is available to one in which such care is not available may mean greater suffering and an earlier death.
14 c.f. Verghis S. Promoting and protecting human rights to reduce the HIV vulnerability of migrant workers. UNDP (Editor). Population mobility in Asia: Implications for HIV/AIDS action programmes. Bangkok: UNDP, 2000, p. 87-103.
The most vulnerable
The most vulnerable mobile people are refugees, those without legal status in the country in which they are living, and women.
Refugees and internally displaced people - People displaced by conflict and other emergencies live through chaotic conditions, during which HIV/AIDS is not likely to be seen as a priority. Yet HIV spreads fastest in conditions of poverty, powerlessness and social instability, the conditions that are at their extreme in complex emergencies. Physical, financial and social insecurity erode the caring and coping strategies of individuals and households. This often results in forced high-risk sexual behaviour and sexual abuse. Women and girls find themselves coerced into sex to gain access to basic needs such as food, shelter, and security, and are also especially vulnerable to rape15.
15 Piot P. HIV/AIDS in complex emergencies - a call for action. World Health Organization, Health in Emergencies, 7 (September 2000).
Legal status - Whether a person is in a country legally or illegally has a powerful influence on his or her vulnerability to HIV/AIDS. Undocumented migrants live on the margin, trying to avoid contacts with authorities that may result in imprisonment and deportation. They have virtually no rights in the place where they live, including no legal access to social and health care services and to prevention and care for STIs and HIV/AIDS. They may be forced by their precarious circumstances into unsafe working conditions and accommodations, and be exploited for meagre wages. Women and children may also be subject to sexual violence, thereby increasing their risk of HIV and other STIs.
Women and girls - Employment opportunities are usually more limited for women migrants, who may find themselves confined to a parallel economy, working under inferior conditions, subject to discrimination both as women and as migrants, and unable to claim the rights that are their due. They may have very little or no access to reproductive health services. They may also have little or no bargaining power to prevent unwanted and unsafe sex during travel and at destination. Large numbers of women move to take up work as domestic employees. Often their rights are not respected, nor are they protected by local laws or customs. They may be sexually exploited by their employers. Some women migrate to take up occupations that involve increased risk of encountering HIV, such as sex work16. Other women and girls (and boys as well) are deceived, coerced or trafficked into sex work17. Still other women end up in precarious and vulnerable situations after they have entered countries clandestinely to join husbands or partners who had migrated. Finally, some women become vulnerable without ever having left their homes when their partner has gone abroad to work, and comes home with HIV18.
16 For more information on sex work see UNAIDS Technical Update on sex work.
17 For examples of work being done with trafficked women and girls, see IOM website http://www.iom.int
18 c.f. Salgado de Snyder V, Perez M and Maldonado M. AIDS - risk behaviors among rural Mexican women married to migrant workers in the United States, AIDS Education & Prevention, 8, 1996, 134-142.
Migrants and mobile people are exposed to unique pressures, constraints, and living environments. Many are separated from their families and spouses or regular partners. They may feel anonymous. They may also feel freed from the social norms that guided their behaviour in their family, community and culture. Lonely people away from home may be especially susceptible to peer pressure. These factors may provoke people to take risks and engage in behaviours they would not have engaged in at home.
In some settings, living and recreational environments for migrants and mobile workers are almost exclusively male. This leads to the development of commercial sex services and the pressure to use them. It may also lead to increased sex among men.
'If you wanted to spread a sexually transmitted disease, you'd take thousands of young men away from their families, isolate them in single-sex hostels, and give them easy access to alcohol and commercial sex. Then, to spread the disease around the country, you'd send them home every once in a while to their wives and girlfriends.'19
19 Quote by Mark Lurie, South Africa Medical Research Council, speaking about mines in South Africa, in Schoofs M. All the Glitters: How HIV Caught Fire in South Africa, The Village Voice, 28 April-4 May, 1999.
Lack of attention and resources
Financial, human and institutional resources in many countries are extremely limited for HIV/AIDS prevention and care programs. The resources that are available are most often targeted to local populations, with little or no resources going to the needs of migrants and people moving through the community.
The projects on HIV/AIDS and mobility established in some developing countries by international agencies and nongovernmental organizations (NGOs) have generally been limited in social and geographical coverage, and also in time.
Few national AIDS plans deal with population mobility in ways that take into account its importance to the epidemic. The challenge is thus for governments to acknowledge the need to address HIV/AIDS among migrants and mobile people.