Symposium: Global Perspective on Migration and HIV/AIDS: Sharing Best Evidences and Practices in Policy and Research Migration: the global picture Migrants as a vulnerable population Rosilyne Borland International Organization for Migration

Definitions Health is “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” - World Health Organization Migration health “addresses the physical, mental and social needs of migrants, and the public health needs of hosting communities” - IOM / WHO

Which migrants?

Migrants can be –Internal or international –Forcibly displaced (natural disaster / conflict) IDPs, refugees, asylum-seekers –Workers formal / informal / seasonal / sector specific –Regular and irregular Legal migration status, identity documents Within a formal system (e.g. detained, deported)

Migrants can be –At any phase of the migration process Preparing to move, in transit, in destination, returnees –Victims of sexual violence / exploitation Trafficked persons, exploited labour migrants, SGBV survivors –Members of key populations IDU, SW, MSM –A population vulnerable to HIV –A population which faces barriers in accessing health services

Global Statistics Source: UNDP;ILO;UNHCR;UNDESA;British council; US State Dep

National AIDS Policy IOM-UNAIDS Review of National Strategic AIDS Plans 84 National Strategic Plans (NSP) reviewed to date 92% of those reviewed refer to migration / migrants Extremely wide range of terminology Migrant Mobile Population Illegal Migrant Internally Displaced Person Foreign Businessmen Trafficked Person Seasonal Migrant Roma Labour Migrant Returnee

Migration Health: Changing Paradigm Link between population mobility and spread of disease: one of oldest public health concerns Migration health ≠ border health: health of migrants and their communities Stigma and myths about HIV and migration health result in discriminatory policies: HIV entry, stay and residence restrictions (see hivtravel.org)

Migration as a Process Transit Destination country or community Return Origin country or community Migrant health profile: Disease prevalence Living, working conditions Access / barriers to health services Violence, exploitation Mobility factors (separation from partner) Actions, attitudes throughout the cycle

Migration as a Social Determinant of Health Positive or negative impact on migrant’s health depending on the conditions throughout the process

Responses Environmental Structural Individual Combination prevention Universal access strategies which recognize structural and environmental factors faced by migrants Multi-sectoral strategies, multi-country strategies along the route of migration Migrant community health workers / HIV peer educators

Responses IOM spaces of vulnerability approach (e.g. ports and transport corridors) Migrants’ sexual networks cross regions – varying HIV epidemics, HIV knowledge, risk factors Barriers to access health services are key – ensure access to health (HIV within other services)

Global Policy Framework 2009 World Health Resolution Health of Migrants –Monitor Migrant Health –Migrant-sensitive Health Systems –Policy and Legal Frameworks –Partnerships, Networks, Multi-country Frameworks 2011 Political Declaration on HIV/AIDS –Explicitly recognizes vulnerability of migrants