Migrant Population and HIV: Supporting HIV Prevention, Care and Treatment towards Migrants in Thailand

1INTERNATIONAL ORGANIZATION FOR MIGRATION

Migrant Population and HIV: Supporting HIV Prevention, Care and Treatment towards Migrants

in Thailand Consultation Workshop on Situation Review on the Current HIV/AIDS

Prevention and Care Service to Migrant Populations International Organization for Migration

16 August 2013Bangkok, Thailand


Current Situation and Issues of Concerns


Migration and Vulnerability to HIV

Migration cuts across the social determinants of health

• Separation from family; new found freedom, loneliness, Level of social exclusion

• Existence of xenophobia, discrimination, stigma in host community

• Availability of migrant friendly services

• Exclusion from HIV programmes and services

• Limited/lack of access to clean water and sanitation

• Availability or lack of safe, clean housing

• Often poor working conditions and lack of occupational health schemes

• Access to / existence of jobs that provide a living wage; disposable income• Educational attainment

• Economic status• Legal status • Lack of knowledge and

skills on how to protect oneself and others

• Lack of awareness of services and rights available

• Exploitation or abuse may expose them to risky behavior – unprotected sex or drug use.

• Lack of legislation ensuring migrants’ access to health regardless of status

• Existence and effectiveness of labour policies to protect workers’ rights

• Policies prohibiting discriminatory practices

• Policies in other domains affecting the health of migrants

Adapted from: Commission on Social Determinants of Health. Closing the gap in a generation: health equity through action on the social determinants of health. Final report of the Commission on Social Determinants of Health. Geneva, World Health Organization, 2008.


HIV Prevalence in the Greater Mekong Sub-Region

Thailand Myanmar Cambodia Viet Nam Lao PDR China0100200300400500600700800900

HIV Prevalence per 100,000 population in Countries of the GMS in 2009

Num

ber

per

100,

000

pop

Reference: World Health Statistics 2012. WHO 2012. Accessed online at http://www.who.int/gho/publications/world_health_statistics/EN_WHS2012_Full.pdf

No Data

http://www.who.int/gho/publications/world_health_statistics/EN_WHS2012_Full.pdf


Barriers to Improving Access to Health in Border Areas

Thailand

Myanmar

Cambodia

Lao PDR

Viet Nam

Poor migrant monitoring systems Complex migration practices Limited surveillance systems ?Under resourced health system especially in border areas

No cross border referral system Limited migration sensitive health system Migration Policies/frameworks ineffective for border areas

Medicine shortages Key areas and hard to reach pop Disease specific multi country partnerships Ineffective border collaborations

Barriers to Improving Access to Health in Border Areas


Migrant’s access to ARTs in Thailand - current situation

• Thailand’s National Strategy for 2012-2016 aims to provide access to quality HIV treatment and care for any person living with HIV in Thailand, regardless of their nationality.

• Health care security:– Registered migrants –1,300 baht (abt. USD 43) for health insurance. Includes ART to

prevent mother to fetus infection but not ARV for people living with HIV. 600 baht /check up (USD) (MoPH).

– Undocumented migrants – 1,300 baht/year (USD 43), health promotion and disease prevention. Includes ART to prevent mother to fetus infection. Out/inpatient (30 Baht/visit (USD 1) at contracted hospital). Work related disability (employers, work related fund). A&E (any hospital).

• There is provision of ARVs for certain categories of low skilled migrants but demand is higher than provision.

• Cambodian migrants can return home to obtain a 3 month supply of ARVs. A scheme developed by the Thai and Cambodian authorities.

• Challenges among Cambodian mobile workers living with HIV – lack of adherence, late appointments, no information before travelling to Thailand.


Thailand: Strengthening Health Service Provision and Policy Development

• Registration of migrant workers; health assessment and enrolment to health insurance scheme

• Establishment of networks of paid, full-time migrant community health workers (CHWs) and volunteers (CHVs)

• Introduction of the concept of “migrant-friendly” or “migrant-sensitive” health services delivery to improve accessibility of service

• Investing on health promotion and awareness raising interventions to improve knowledge of migrants on health

• Promoting multi-sectoral collaboration including non-health stakeholders

• Research on Health Financing Schemes• Border Health Development Master Plan and Health Policy

Development


Regional Commitments on Migrant HealthJAN 2007 ASEAN Declaration on the Protection of the Right’s of Migrant Workers, 12th

ASEAN Summit, Cebu, Philippines

JUL 2010 Joint Recommendations from the Regional Dialogue on the Health Challenges for Asian Labour Migrants, Bangkok, Thailand

SEP 2010Bangkok Statement on Migration and Development, from the Asia Pacific Regional Preparatory Meeting for the Global Forum on Migration and Development 2010, Bangkok, Thailand

APR 2011 Dhaka Declaration of Colombo Process Member Countries from the Ministerial Consultation of Labour Migrant Sending Countries in Asia, Dhaka, Bangladesh

OCT 2011 Joint Recommendation from the 4th ASEAN Forum on Migrant Labour, Bali Indonesia

NOV 2011Regional Priorities from High Level Multi-stakeholder Dialogue on Migrant Workers’ Health and Access to HIV services in the ASEAN Region, Bangkok, Thailand

JAN 2012Joint Statement of the Asia-Pacific High Level Intergovernmental Meeting on the Assessment of Progress Against Commitments in the Political Declaration on HIV/AIDS and the Millennium Development Goals, Bangkok, Thailand


Regional Networks to HIV/AIDS and Migrant Health

1997 (UNRTF)

The Joint United Nations Initiative on Migration Health and HIV/AIDS (JUNIMA) in South East Asia brings together governments (including ASEAN Secretariat), leading Civil Society Organization networks, and the United Nations family, to promote universal access to HIV prevention, treatment, care and support for mobile and migrant populations in South East Asia and southern China.

Political Declarations on HIV/AIDS to achieve the Millennium Development Goals

2001 Declaration of Commitment on HIV/AIDS - Heads of State and Representatives of Governments issued the Declaration which sets out a series of national targets and global actions to reverse the epidemic of HIV/AIDS.

2006 Political Declaration on HIV/AIDS - adopted by UN Member States, reaffirms the 2001 Declaration of Commitment on HIV/AIDS and in particular the Millennium Development Goal to halt and begin to reverse the spread of AIDS by 2015.

2011 Political Declaration on HIV/AIDS – UN member states adapted the new Political Declaration that includes new commitments and bold new targets to create momentum in the AIDS response.


Regional Frameworks Addressing Migrant Health and HIV/AIDS

1993 ASEAN Task Force on AIDS (ATFOA) for universal access to HIV prevention, treatment, care and support, providing the focus for a coordinated regional response to HIV.

2001 ILO Code of Practice on HIV/AIDS and the World of Work providing guidance to policy-makers, employers’ and workers’ organizations and other social partners for implementing appropriate workplace policy, prevention and care programmes, and for establishing strategies to address workers in the informal sector.

Adopted 2004,

Renewed 2011

MOU for Joint Action to Reduce HIV Vulnerability related to Population Movement in the GMS to reduce HIV vulnerability and promote access to prevention, treatment, care and support among migrants, mobile populations and affected communities in GMS countries.

2008 World Health Assembly 2008 (WHA 61.17) adopted the resolution on the health of migrants calling on Member States “to promote migrant-sensitive health policies” and “to promote equitable access to health promotion and care for migrants […]”

2010 Recommendation concerning HIV and AIDS and the World of Work, 2010 (No. 200) - The first international labour standard on HIV and AIDS in the world of work, was adopted by governments, employers’ and workers’ representatives from ILO member States.


Strategic Approaches to Support HIV Prevention, Treatment and Care for

Migrants in Thailand


World Health Assembly Resolution on Health of Migrants (WHA 61.17)

Calls upon Member States:

“to promote equitable access to health promotion and care for migrants”

“to promote bilateral and multilateral cooperation on migrants’ health among countries involved in the whole

migration process”


Global Operational Framework• Research and

Information system

• Advocacy for policy development

• Health service delivery and capacity building

• Strengthening inter-country coordination and partnership

Monitoring

Migrants Health

Policy and Legal Framewo

rks

Migrant sensitive health systems

Partnership, Networks and Multi-country

Frameworks


Pillar 1: Monitoring of Migrant Health

• Include migrants in HIV national data collection systems

• Identify key indicators on HIV and Migration that can be used across the GMS

• Promote data collection and analysis of key populations across border areas; including the identification of “spaces of vulnerability” where migrants interact with local community and engage in high-risk behaviour

• Monitor migrants’ health seeking behaviour especially those in trans-border movements

• Analyze available data for evidenced based policy and programme formulation


Pillar 2 : Promote conducive policies and legal frameworks on the health of

migrants• Harmonize national HIV, public health and migration policies and encourage inter-sectoral collaboration

• Enforce regulations to protect migrants from mandatory HIV testing and adherence to generally accepted testing standards

• Establish minimum labour standards and health rights for migrant workers, access to health and insurance schemes

• Adopt international standards on right to migrants’ health

• Develop and implement national and multi-sectoral policies including monitoring frameworks to improve standard of health for migrants livings with HIV

• Standardize pre-departure training on HIV vulnerability and prevention in coordination with migrant sending countries

• Promote extending social protection based on good migrant health programming


Pillar 3: Migrant Sensitive Health Systems

• Facilitate, provide and promote equitable access to comprehensive HIV services for migrants and mobile population throughout the migration process

• Ensure that programmes are targeted to address “spaces of vulnerability” for migrants

• Develop frameworks for monitoring migrant sensitive health service performance

• Improve quality of services for migrant focused programmes and mainstreaming migrant friendly services

• Assign focal points in government for migrant health

• Advocate multi-stakeholder approach towards health and migration


Pillar 4: partnerships, networks and multi-country frameworks in

migrant health• Involve various actors in the countries of origin and destination to protect migrants’ rights and health

• Create multi-stakeholder working groups and develop resource mobilization plan for increasing programmes on HIV and migration

• Engage with all stakeholders to assist in HIV policy and programme development for migrant populations

• Work towards harmonization of treatment protocols, procurement and interventions with neighbouring countries

• Promote inclusion of migrant health needs in existing regional and global funding mechanisms


Thank youDr. Montira Inkochasan, [email protected]

Dr. Jaime Calderon, [email protected]

mailto:[email protected]

mailto:[email protected]

Documents

Migrant Population and HIV: Supporting HIV Prevention, Care and Treatment towards Migrants in Thailand