1. The 8th International Congress on AIDS in Asia and the Pacific (8th ICAAP), Colombo, 19-23 August 2007 MIGRANT-FRIENDLY TESTING: VOICES FROM THE DESTINATION COUNTRY CARAM Asia Satellite session 21 August 2007 Speaker: Elijah FUNG St. John’s Cathedral HIV Education Centre, Hong Kong

2. INTERNATIONAL GUIDELINES/RECOMMENDATIONS ⇨ The International Labour Organization states that HIV testing should not be required at the time of recruitment or as a condition of continued employment. ⇨ “Any restrictions on these rights based on suspected or real HIV status alone, including HIV screening of international travellers are discriminatory and cannot be justified by public health concerns”. (20) International Guidelines on HIV/AIDS And Human Rights, drafted in 2006 By UNAIDS and the PHCHR

3. - continued “mandatory and other coercive forms of HIV testing do not serve a legitimate public health goal, jeopardises access to health services, reduces health seeking behaviours an enhances stigma and discrimination”. (17) A JOINT WHO/UNICEF/UNAIDS TECHNICAL CONSULTATION ON SCALING UP HIV TESTING AND COUNSELLING IN ASIA AND THE PACIFIC IN JUNE 2007

4. GOVERNMENT RESPONSES ⇨ approximately 60 governments around the world have established health screening procedures. e.g. The United States and New Zealand require negative HIV tests from non-nationals who wish to apply for residence or a work permit. ⇨ migrants are being screened for up to 22 diseases and conditions, including TB, HIV and pregnancy.

5. GOVERNMENTS USE VARIOUS ARGUMENTS TO JUSTIFY MANDATORY HEALTH SCREENING POLICIES ⇘ economic reasoning ⇘ public health (e.g. In 2006, Korean government has adopted a strict policy and implemented restrictive regulations against migrant workers with HIV to prevent them from entering or staying in Korea.) ⇘ security concerns (protection of a state’s territory, population and interests against external threats)

6. Testing on arrival ⇨ Bahrain and Dubai request migrant workers to be tested. ⇨ Malaysia adopts policy of mandatory testing for migrant workers to protect the country free from identified communicable diseases and to make sure that national public health facilities are not overburdened by unhealthy foreign workers. ⇨ Korean government adopts strict policy to prevent migrant workers with HIV to enter or stay in the country. ⇨ Even when testing is not legally required, requirement for testing might come from agents other than the State, as is evident in the example of Hong Kong. ⇨ Mandatory testing in Japan is officially non-existent and HIV status is not regarded as a condition of entry. However, there have been cases of migrant workers being tested without notification and /or informed consent.

7. 1. TESTING ON ARRIVAL – LACK OF 3 C’s (Confidentiality, Counselling & informed Consent) “They gave us a paper but everything was written in Korean so we didn’t know what it was about. They just make us sign it… no one explained about the test. They just said that they are busy.” (said a group of migrants in Korea) “No … there was nothing like that (consent)”. (Male Bangladeshi construction worker in Bahrain)

8. - In Korea, migrant workers are tested in large groups, ranging from 50 upwards to as many as 500 people in a big hall. There is no pre-test or post-test counselling provided. “For foreigners, they usually come as a big group so we are not offering any specific pre-test or post-test counselling. But when they have some questions I do answer before or after the test. That’s about it.”. 2. OBSTACLES TO PROVIDING PROPER COUNSELING

9. 3. LANGUAGE BARRIER “Actually, it was in Korean. We just make a guess. This is my weight, blood pressure, etc.” (Filipino worker) “It will be helpful if some leaflets are in Indonesian language.” (Indonesian domestic worker”

10. 4. THE POWER OF THE SPONSOR When employers come to the testing centres with workers as the attendant and act as interpreter, they will also know the results, which could lead to the migrant worker being fired. “ Sometimes south-eastern Asian women visit this centre with Japanese men. There are many cases of a Japanese man and woman of South- eastern Asia coming here as a pair. Because there are Japanese men who want to know the result of the woman, the Japanese man often listens to the explanation together. It is difficult to confirm the consent of the women due to her language. We cannot confirm if the woman really wants the Japanese man to listen to the result or not”. (Staff, Voluntary Testing Centre)

11. 5. RESULTS OF TESTING “The results go directly to the hotel. You only know that you passed when the Hotel releases your medical card, and you are told to go to the Labour Office”. (Filipina waiter working in Dubai) “We do not get the medical test result. Company collects the result. We only get the ID card.” (Bangladeshi salesman) “The check up service was poor in Hong Kong. No result was given to me. I have the right to know the result of my testing.” (Filipino domestic worker)

12. 6. LACK OF REFERRAL In Hong Kong, a number of non-government organizations (NGOs) help those workers who fail the health test. Unfortunately, only about 20% of those interviewed in the survey were aware of the existence of NOGs that provide these services.

13. 7. DEPORTATION ⇨ “Unfit people sent back to home but they are healthy and can work. New (coming to Dubai first time) people if unfit should give them ticket and some money. They spent lots money 1 lakh rupee to come to Dubai. If unfit lose all money.” (Indian construction worker)

14. CONCLUSION Mandatory testing does little to stop the spread of HIV. Instead, testing reinforces the stigmatization, discrimination and segregation of infected individuals and migrants. It is necessary to emphasize human rights in the development of laws and policies to cover the health of migrant workers.

15. Thank you!