US: City initiative aims to combat rising STIs rates among vulnerable populations

NYC to launch STD outreach program for uninsured New Yorkers, migrants

The city is launching a new outreach program to try to curb sexually transmitted diseases among uninsured New Yorkers, including migrants, The Post has learned.

Health Department officials reported a significant 36% spike in syphilis cases among women and an 11% jump in the gonorrhea rate among men in the city in 2022 — when a tidal wave of migrants began flooding the Big Apple, according to the most recent data available.

For both sexes combined, the city saw a 3% increase in syphilis cases that year compared to 2021, a 3% increase in chlamydia cases and 10% increase in gonorrhea cases.

“Assuring comprehensive and timely screening and treatment for STIs [Sexually Transmitted Infections], including chlamydia, gonorrhea, and syphilis, is critical for preventing … infertility, increased susceptibility to HIV, and congenital syphilis—as well as preventing onward spread to sex partners,” the department said in a pitch to potential bidders to run the program.

“Those who have immigrated to the US face barriers including insurance ineligibility (for undocumented and DACA recipients), delays in eligibility to access public health insurance programs (for documented immigrants), and barriers in understanding eligibility standards,” it added.

More than 212,000 migrants have sought assistance since arriving in the city starting in mid-2022, with 63,000 currently in the Big Apple’s shelter system, Mayor Eric Adams said Tuesday.

Last year, Health Commissioner Ashwin Vasan raised the alarm that half the migrants entering the city had not been tested for the contagious and potentially deadly polio virus.

Most low-income citizens have access to health insurance such as Medicaid to be screened and treated for sexually transmitted infections including chlamydia, gonorrhea, syphilis and HIV.

But the department said it’s more difficult to reach the hundreds of thousands of uninsured New Yorkers, including asylum-seekers, undocumented migrants here illegally and other young people.

Residents who lack insurance are unlikely or unable to self-pay for treatment out of pocket or may resist testing on their own, too, officials said.

“Lack of insurance and financial instability are among the frequently noted barriers to STI care, and they are often correlated,” the department said in its “concept paper” explaining the outreach.

Younger residents, LGBT individuals, blacks and Latinos and the unemployed who are uninsured or underinsured are also less likely to get screening, officials added.

Reported STI cases in the city have risen steadily since 2018, the department said.

But officials said the increase may partially reflect the resumption of STI screening services that were suspended or postponed during the COVID-19 pandemic.

Such services were impacted by lockdown protocols and restrictions and nationwide shortages in testing supplies.

The department said it is seeking up to three contractors to provide STI-related services to uninsured New Yorkers in neighborhoods with the highest rates of chlamydia, gonorrhea, and syphilis.

The services would include screening and treatment as well as providing vaccines for hepatitis A, hepatitis B, HPV, and mpox.

“The purpose of this RFP [request for proposals] is to ensure that these individuals have equitable access to STI services,” the proposal said.

The Health Department had no immediate comment on how much the initiative would cost or how much each contractor would be paid and over how many years.

Tajikistan: Migrants can get tested and access treatment for HIV anonymously and free of charge

Where to get an anonymous HIV / TB test and free treatment in Tajikistan

HIV and tuberculosis are two complex diseases that require a multi-faceted approach that includes medical, social and educational interventions. It’s crucial to tackle these diseases not only to reduce the number of infections but also to improve the quality of life of people living with them.

The number of people living with HIV among migrants is increasing

In Tajikistan, one in three people with HIV is a labour migrant. Over the past five years, 5,463 cases of HIV infection have been identified, according to data from the Republican Centre for Prevention and Control of HIV/AIDS. Migrants make up 22% of the infected. While in 2019 migrants accounted for only 17% of those infected, by 2023 this figure had increased to 32.5%.

Balajon Davlatov, a specialist in the dispensary department of the Republican HIV Centre, strongly recommends taking a free test at one of Tajikistan’s HIV prevention and control centres immediately after arrival.

“If migrants have doubts about their HIV status, they should be tested when they back home,” Balajon Davlatov said.

According to his words, more than 300 migrants are already on the dispensary registration of the Republican HIV Center. The identity and test results are not disclosed to third parties.

“Any information about each individual should be confidential. You can obtain rapid tests that report a patient’s HIV status within 15 minutes by analyzing saliva – completely anonymously,” says Balajon Davlatov.

HIV tests are available free of charge at one of the 67 state HIV prevention and control centres in all regions of Tajikistan.

In addition to blood testing at AIDS Centres, self-testing using near-blood fluid is now available. Self-testing kits are available in Dushanbe, Rudaki, Khujand and B.Gafurov via online ordering at hivtest.tj.

The order process involves filling out a simple form with a few questions. The platform helps people confidentially know their HIV status and provides up-to-date information on protection and prevention methods.

Those who tested positive for HIV can learn more about their result and get a second confirmatory test at the AIDS Centre.

In Tajikistan, there is an example of an HIV-positive mother who gave birth to two healthy children by stopping the virus from growing in her organism:

“We had a case of an HIV-positive woman. After she was treated with antiretrovirals, she gave birth to two healthy children who were HIV-negative. She’s now based in the Russian Federation and we send her the necessary medication and support. This shows that people infected with HIV can have children who are healthy and lead a full life”, says Balajon.

HIV is a human immunodeficiency virus that attacks the immune system. Most people do not experience any symptoms when they are infected. Sometimes a flu-like condition develops a few weeks after infection. But if abandoned and left untreated, HIV can develop into the final stage, AIDS, when the body is so weak it cannot protect the body from various infections and diseases.

Infecting another person with HIV is a Crime

However, a positive HIV status can bring certain risks, not only related to the state of health, if a person knows that he/she has a positive HIV status, but hides it from his/her sexual partner, within the framework of article 120 of the Code of Administrative Offenses of the RT, he or she may be fined from 720 to 1440 somonis.

Avoiding treatment for HIV or other infectious diseases is also subject to a fine from 1440 to 2160 somoni. This responsibility is stipulated in Article 119 of the Administrative Offenses Code of the RT.

If an individual intentionally infects another person with HIV, he or she can be punished by up to 3 years’ restriction of freedom or up to 2 years’ imprisonment. When a person infects another person with HIV knowing their HIV status, they can face 2 to 5 years in prison. The prison term can be longer – from 5 to 10 years in case more than one person was infected or the victim was a minor. This punishment is stipulated in Article 125 of the Criminal Code of Tajikistan, which characterises these actions not as an ordinary offence, but as a criminal act.

Therefore, it is crucial to have regular tests and status checks, especially if a person is at risk of infection.

How to recognise TB in the early stages

Having an HIV diagnosis, however, a person is not only at risk of committing offences but is also at risk of contracting serious infectious diseases, such as tuberculosis. We should also talk about this disease in more detail since the working conditions of many labour migrants can contribute to the infection of tuberculosis and its progression to more severe stages. Moreover, TB infection may have no connection with the presence or absence of HIV in a person. It is a separate disease that is also prevalent among different population groups, including labour migrants. In 2023, 4,048 TB patients were registered in Tajikistan.

In its initial stages, TB can easily be mistaken for the common flu, making it difficult to diagnose. However, several symptoms may indicate the presence of the disease:

Cough that lasts for more than 3 weeks.
The cough may be dry or with sputum that may contain blood.
Feeling tired for no apparent reason, even a rest.
Appetite loss and weight loss for no apparent reason.
Slight fever (up to 37-38°C), in the evening or at night.
Heavy sweating during sleep, even in a cool room.
Chest pain, which may increase with coughing or deep breathing.
Decrease in performance and shortness of breath with minor physical exertion.

Farkhod Dzhumayev, a phthisiologist, said the flu is not as exhausting: symptoms last 1-2 weeks, while TB is treated for 6 months to 2 years. Tuberculosis is treated with TB drugs, but without treatment, it can lead to death. Discontinuing medication prematurely or without consulting a doctor is dangerous, as it can lead to drug resistance of the pathogen.

To keep your family safe, if you suspect you are at risk of TB, you can contact one of the 69 public TB diagnostic and treatment centres. This service is provided free of charge by the state in Dushanbe, DRS, Sughd, Khatlon and GBAO.

“A patient who lives in a large family of 8 people in a 3-room apartment approached us,” says the doctor. “He went to hospitals, where he was prescribed treatment for flu, which did not relieve the patient from high fever, cough, exhaustion and headache. Fortunately, on the recommendation of the family doctor, he had a sputum test, which enabled us to detect tuberculosis in time and prescribe effective treatment.”

As Farhod Dzhumayev recalls, during the 2 months when the patient didn’t know his true diagnosis, his family also managed to get infected with TB:

“We checked his family, tested their sputum, conducted chest X-rays, and took a Mantoux immunologic test, and those who had active TB were prescribed TB treatment,” says the phthisiologist.

It’s easier to prevent the disease

HIV and tuberculosis are not a verdict. You can live a normal life with proper treatment like others.

In addition, advances in modern medicine make it possible to hope for a complete recovery from tuberculosis in a relatively short time. Scientists are also close to obtaining a cure for HIV. They are still at the testing stage, and it takes time to study their actions and potential risks. However, likely, HIV will soon move from being an “incurable” disease to a treatable one.

At this point, despite the availability of current or potential treatment, it is important to make efforts to prevent infection with serious diseases such as HIV and tuberculosis, because in any case, it is easier to prevent the disease than to spend energy, time and resources on recovering health.

Read more for addresses of treatment and testing centres in Tajikistan: https://asiaplustj.info/en/node/339434

Interview: Musarrat Perveen from CARAM Asia on the urgent need for migrant HIV policy changes

Addressing Migrant Workers’ Vulnerability to HIV

We spoke with Musarrat Perveen, regional coordinator at Coordination of Action Research on AIDS and Mobility in Asia (CARAM Asia), who advocates at regional and global levels for policy reform of discriminatory practices that put migrant workers at risk of HIV and AIDS.

Continuing our coverage of AIDS 2024, the 25th International AIDS Conference, we spoke with Musarrat Perveen, regional coordinator at Coordination of Action Research on AIDS and Mobility in Asia (CARAM Asia), who advocates at regional and global levels for policy reform of discriminatory practices that put migrant workers at risk of HIV and AIDS, sexually transmittable infections (STIs), and other health conditions, as well prevent them from accessing health care services.

CARAM Asia, established in 1997, is a regional network of 42 migrant and migrant support organizations across 18 countries in Asia that focuses on coordinating research on AIDS and mobility. It helps to target the important challenges individuals face throughout the migration process and support community-based organizations in their efforts to both promote and protect migrant workers’ health rights, including sexual and reproductive health rights. These efforts aim to empower migrant communities by developing research, awareness publications, campaigns, and policy recommendations to protect migrant workers’ rights and address their health and welfare at national and regional levels.

The American Journal of Managed Care^® (AJMC^®): Can you explain the research you presented at the International AIDS Conference and what motivated you to undertake this study?

Perveen: Migration is a historical and global phenomenon driven by disparities in income and quality of life. Economic migration is driven by various factors. There are push factors that include inadequate labor standards, high unemployment rates, poverty, political instability, and weak economies, and there are pull factors such as higher wages, improved job prospects, and increased demand for labor. Migrant workers boost economic development by addressing workforce shortages in such sectors as construction, agriculture, services, and domestic work in receiving countries and by increasing the gross domestic product in sending countries through their remittances. For example, in 2015, the Philippines, Pakistan, and Bangladesh received $29.7 billion, $20.1 billion, and $15.8 billion, respectively.

Despite these contributions, migrant workers are still treated as commodities by the governments of sending and receiving countries, which neglect their human, labor, and health rights, resulting in their exploitation and abuse, and putting them at risk of HIV/AIDS, STIs, and other health conditions. Social, economic, and political factors further influence HIV risk among migrant workers, due to their separation from families, poor living conditions, and exploitative working conditions; they go abroad alone and experience cultural shocks, stigma, discrimination, and isolation. The resulting isolation and stress, combined with these policy restrictions, often leads to risky behaviors—migrant workers belong to sexually active and reproductive age groups—while seeking intimacy in a foreign country. Additionally, policies in receiving countries frequently prioritize short-term labor needs while overlooking the essential human needs and health rights of migrants. This results in limited access to crucial HIV prevention information and health care services, which, in turn, increases their vulnerability to HIV/AIDS, STIs, and other health conditions. Further restrictive in-migration policies dehumanize migrant workers by limiting their ability to bring spouses, get married, or become pregnant in receiving countries.

In 2005 and 2007, CARAM Asia conducted 2 regional research studies under the main title, “State of Health of Migrants.” The 2005 study focused on migrant workers’ access to health information and services in sending and receiving countries,² and the regional research in 2007 focused on migrant workers’ mandatory health testing across various countries in Asia.³ These studies in Asia were groundbreaking, identifying numerous policy barriers and challenges experienced by migrant workers at every stage of the migration process, and highlighting that governments in the region generally failed to reform and implement policies protecting migrant workers’ health and rights despite international guidance on health provision for all. As a result, there has been limited policy and program work focusing on HIV/AIDS prevention, treatment, and care for migrant workers.

The purpose of our research presented at AIDS 2024 was to gather current information and monitor the development of policies and programs concerning migrant workers’ health rights over the years. Our principal research objective was to evaluate the current status of health rights for migrants in 5 Asian sending countries: Cambodia, the Philippines, Bangladesh, Sri Lanka, and Pakistan. The research looked at how HIV- and AIDS-related policies and practices have changed over time and identified any positive changes in protecting migrants workers’ health rights, especially regarding HIV. It also identified remaining obstacles in this area. HIV is an important indicator because it is a sensitive health condition with wider social consequences of stigma and discrimination.

AJMC: What criteria guided your selection of Bangladesh, Cambodia, Pakistan, the Philippines, and Sri Lanka for this research?

Perveen: The selected countries for the study in South and Southeast Asia are some of the major migrant-sending countries. These countries are experiencing an increase in the working-age population entering the workforce while facing limited opportunities within their local job markets. Labor-exporting countries rely on policies that promote out-migration to relieve the pressure of underemployment. Simultaneously, exporting the surplus workforce provides considerable income to the countries’ coffers through foreign exchange generated by migrants’ remittances.

Many countries are willing to compromise their citizens’ rights by allowing or even helping them to move to countries that lack proper protections for migrants’ rights. Migration policies often prioritize securing macro benefits, leading them to neglect upholding migrants’ rights. Migrants’ health rights are quietly violated regularly, with the most dramatic incidents being labor exploitation, physical abuse, and trafficking.

We selected the 5 countries for our study for several reasons. First, Bangladesh, Cambodia, Pakistan, the Philippines, and Sri Lanka were recognized as some of the major sending countries in Asia, with a significant number of migrant workers moving abroad in search of employment opportunities. These countries were important for studying changes in HIV/AIDS policies and obstacles in protecting migrant health rights, and they were previously included in CARAM Asia’s “State of Health of Migrants” reports.

Second, these countries had migrant workers who returned from various receiving countries, including the Middle East and the Gulf Cooperation Council countries of United Arab Emirates and Saudi Arabia, and the Southeast Asian countries of Malaysia, Thailand, and Singapore. These returning migrant workers brought valuable experiences and insights into the barriers they faced in accessing health services in different receiving countries, particularly concerning HIV/AIDS. Due to the lack of resources to conduct the study in the above-mentioned receiving countries, we analyzed the migrants’ self-reports and reviewed the sending countries’ policies.

Third, some of these sending countries were known for practicing strict policies that criminalized the transmission, disclosure, and nondisclosure of HIV. For example, in Bangladesh, Cambodia, Sri Lanka, and Pakistan, mandatory policies dictate HIV testing for employment abroad and disclosure of HIV-positive status to their families and prospective sexual partners. However, we belive that mandatory HIV testing violates human rights by infringing upon personal rights to privacy and confidentiality. No one should have the authority to demand an HIV test from any other individual, thus undermining their fundamental rights.

These policies say that informing partners and families about HIV is important to prevent its spread, but doing so can also cause stigma, discrimination, and treatment delays. Disclosing HIV status should be done in a way that reduces risks to individuals, such as through voluntary disclosure with informed consent and by providing psychosocial support to help them cope with partners’ and families’ reactions. Considering this illustration of criminalization policies, a comprehensive investigation was indispensable to examine the evolution of the reform of the aforementioned policies, and others, about safeguarding migrants’ rights, particularly their health rights concerning HIV/AIDS.

AJMC: What are some examples of discriminatory health practices and policies that migrants face, particularly concerning health screenings?

Perveen: First, mandatory health screening as a prerequisite for migrant workers entering destination countries is discriminatory and dehumanizing; it violates such basic rights as the right to employment and to access health services. Most receiving countries in Asia enforce strict health policies that discriminate against migrant workers based on their HIV status.

Before their work permit applications are accepted, migrant workers must undergo mandatory medical testing at the predeparture stage; their employment documents will only be processed if the test results show they are fit to work. Second, they have to undergo mandatory testing upon arrival in receiving countries, and if they test positive for conditions such as HIV, tuberculosis, or pregnancy, they are immediately subjected to criminalization, arrest, detention, and deportation by those governments—who also do not cover the cost of their return to the sending country. If they pass, they receive a 1-year work permit. This process repeats every year.

Failure to pass these tests results in arrest, detention, and deportation. Migrant workers filling unskilled or semiskilled jobs are specifically targeted for these examinations. Consequently, they are treated differently from locals and are excluded from the protection offered by existing laws and policies on HIV in both sending and receiving countries.

Second, HIV testing standards are often disregarded, including confidentiality and informed consent. Migrant workers often do not receive detailed information about the testing procedures or the conditions being tested for. They do not fully understand the consequences of a positive result and often feel pressured to sign documents without understanding them. Health officials frequently assume implicit consent or accept consent from recruiters, which is very problematic. The testing procedures can be invasive and may cause embarrassment, as they may require migrants to be completely unclothed or examined by health care providers of the opposite gender. Confidentiality is often breached, as test results are sent directly to recruiters, sometimes before the migrant is informed. Also, migrants are often not given their reports and are only told if they are eligible to work abroad or not, with little explanation if they are considered unsuitable.

Third, in some of the receiving countries, migrant workers are required to pay very high costs for public health care services compared with the locals, but their minimal salaries often place these costs far beyond their means. And if they try to access public health services, undocumented migrant workers who do not possess legal documents in receiving countries also face the risks of arrest, detention, and deportation. CARAM Asia advocates for universal health coverage for all regardless of their legal documentation status or if someone is living with HIV.

Fourth, there is a marked lack of awareness programs to prevent HIV among potential migrants who are in the process of leaving a country and there are no specific health services for returnee or deported migrant workers based on if they are living with HIV. Therefore, they may go back to their communities without even knowing the reason for deportation and transfer infections. There also are no data to identify these returnees, nor are there government programs to help locate and provide them with health services.

AJMC: Can you provide examples of health and migration policies reviewed in your study that discriminate against migrant workers?

Perveen: There are several examples of these policies:

Bangladesh: The National Strategic Plan for HIV/AIDS (2011-2015) introduced strategies for combating HIV/AIDS among migrant workers, such as predeparture preparation; distribution of information, education, and communication materials; airport advertisements, and establishing voluntary counseling and testing centers. However, implementation of these strategies remains unclear, suggesting inconsistent access to health care services for migrant workers. This indicates that the policy inadequately addresses their health needs, particularly regarding HIV/AIDS.
The Philippines: The Republic Act 8504 (1998) and other laws on HIV-related support and insurance have helped to improve HIV-related services. However, implementation and program sustainability remain challenges, especially in HIV testing and treatment for overseas Filipino workers, and there are persistent gaps in service coverage.
Pakistan: The National AIDS Control Program (1986-1987)provided health access for migrant workers. However, treatment centers are more concentrated in major cities, making access to and awareness of these centers difficult for migrant workers who largely hail from rural areas.
Cambodia: The National Plan of Action of the National Committee for Counter Trafficking (2014-2018) and National AIDS Authority’s 7-point Policy Directives do not specifically address migration health issues.
Sri Lanka: Migrant workers receiving care throughGulf Approved Medical Centers Association–certified centers face mandatory HIV testing, but the centers do not ask for their consent for testing. If a migrant receives a positive results, they are immediately deported and blacklisted from employment in any Gulf country through a shared database.

The American Journal of Managed Care^®(AJMC^®): Why have migrants historically been excluded from national AIDS programs in the regions you studied?

Perveen: Migrants have been excluded from the national AIDS program in Bangladesh, Cambodia, Pakistan, the Philippines, and Sri Lanka due to the governments’ lack of recognition of the workers’ vulnerability to HIV/AIDS and sexually transmitted infections (STIs) in their national AIDS plans. Instead of being labeled as most at risk for contracting HIV, they are often only considered vulnerable populations. However, in the past, they also were not always considered vulnerable. Although these policies and perceptions have changed due to intense advocacy by CARAM Asia and other stakeholders in the region, the governments still are not recognizing the risk factors migrant workers face, highlighting the ongoing discriminatory treatment they face through the health policies of sending and receiving countries.

Annually Reported HIV diagnoses by Age and Sex

From 2013 to 2022 in Sri Lanka

For example, the countries studied categorize men who have sex with men, persons who inject drugs, sex workers and their clients, and Hijras as most at risk. Migrant workers are excluded from this classification despite data showing an annual increase in cases of HIV and a significant number of returnee migrants now living with HIV. In Sri Lanka, for example, 187 of 607 (30.8%) reported HIV cases in 2022 had a history of external migration, as shown in the figure.

AJMC: How are migrant workers more vulnerable to HIV vs nonmigrant populations, and what unique risk factors do they face in the receiving countries you studied?

Perveen: Migrant workers are more vulnerable to HIV compared with local nonmigrant populations because sending and receiving countries often treat migrant workers as commodities, neglecting their fundamental human, labor, and health rights. Their young ages when going abroad for employment also predisposes them to culture shock due to unfamiliar policies and conflicting cultural norms. This can lead to stress and anxiety, and neglect that make them more susceptible to rights violations, violence, abuse, and exploitation. Other unique risk factors for migrant workers in receiving countries include the following:

Single-entry visas
Prohibitions on marriage with locals
Restrictions on bringing spouses
Isolation in a foreign country
Neglect of their human need of intimacy

The stress and anxiety also can result in behavioral changes that include unprotected sexual behavior, which raises the risk of contracting HIV. A lack of awareness about HIV prevention measures further increases their vulnerability to HIV and other sexual and reproductive health rights issues due to limited access to health information and services. Women also may experience sexual abuse and exploitation, particularly those working in the entertainment sector or as domestic workers, who often live in their employers’ private homes with no access to social support. In many cases, women are forced into the sex industry, which also increases their risk of contracting HIV and where they encounter many other health problems.

AJMC: What were the top health priorities identified by migrants in your focus group discussions, and what challenges did they highlight as barriers to equitable HIV/AIDS health care in the countries studied?

Perveen: Among the top health priorities identified by migrant workers during the research was HIV/AIDS, STIs, tuberculosis, and mental health. Challenges they highlighted as barriers to equitable HIV/AIDS health care include the following:

Stigma and discrimination: People living with HIV/AIDS often face considerable stigma and discrimination from their families and society. This stigma leads many to conceal their HIV status, resulting in isolation and a lack of support.
Financial burden: Migrant workers are required to undergo regular annual health checks, including tests for HIV and sexual health. These expenses are typically paid out of pocket by the workers, either directly or through salary deductions. This financial strain is particularly challenging for those with low incomes.
Lack of health care coverage for undocumented migrants: In some receiving countries, registered migrants must undergo tests to qualify for health insurance coverage. However, undocumented migrants also often lack health care coverage, leaving them without access to essential medical services.
Lack of access to embassy and consulate services: There are significant gaps in accessing embassy, consulate, and Philippine Overseas Labor Office services for overseas Filipino workers living with HIV. Reports from these migrant workers who were deported between 2012 and 2016 indicate they were quarantined without access to their embassies. Furthermore, receiving country health ministries or immigration offices are not obligated to notify embassies about workers’ health issues, resulting in a lack of connection to repatriation and reintegration services. Most embassies and consulates also lack funds and facilities to help migrant workers, and some even don’t even answer phone calls.
Immediate deportation and blacklisting: Migrants who receive a positive result following an HIV test are often deported immediately and blacklisted from migrating to any Gulf country via the shared database. This deportation frequently occurs without providing information or referral services, leaving migrants unaware of their HIV status and its implications.

AJMC: Based on your research findings, what specific recommendations do you have for improving health policies for migrant workers in these countries?

Perveen: Sending and receiving countries should invest sufficient funds in HIV education for migrant workers to provide awareness about HIV/AIDS and STI prevention, and provide access to health services at all stages of the migration cycle. Also, most receiving countries should eliminate discrimination against labor migrants by reforming health policies that criminalize—via arrest, detention, and deportation—migrant workers based on HIV status, and ensure unrestricted access to health services for documented and undocumented migrant workers.

Governments of receiving countries also should ensure migrant workers get proper days off and, when possible, provide affordable, accessible, and healthy recreational activities as alternatives to risky behaviors for relaxation and holidays, including those that permit spouses. In addition, national AIDS strategies, strategic frameworks, and programs need to include migrants, migrant workers, and families and partners of migrants more prominently and address their specific needs with comprehensive services that are supported by appropriate levels of funding and interagency coordination.

It is also important to standardize laws and policies on HIV testing to ensure that any testing migrants must undergo adheres to internationally accepted standards that include informed consent, confidentiality, pre- and posttest counseling, and proper referral to treatment, care, and support services. The goal of testing also should become to prevent HIV infection, not to criminalize migrant workers.

Sending and receiving countries also should work to eliminate stigma and discrimination against people living with HIV and respect gender and sexual orientation among migrant workers, and receiving countries especially should provide employment access returning migrant workers.

AJMC: What final thoughts or messages would you like to share for future advocacy and policy change?

Perveen: Readers of CARAM Asia’s research might include important stakeholders in both receiving and sending countries, such as government agencies, politicians, policymakers, migrant nongovernmental organization, journalists, and other influential groups. We hope that our research on discriminatory policies and obstacles in protecting migrants’ health rights, along with our recommendations for improved health policies for migrants, reach this audience and they are able to highlight the necessity in addressing these ongoing issues. Through this research, we also strive for a deeper understanding of the impacts of discriminatory policies in receiving and sending countries on marginalized populations like migrant workers, in term of their health.

Prioritizing the voices and experiences of migrant workers in the fight against HIV is crucial, and we advocate for this through participatory action research and other means. Effective advocacy for the health rights of migrant workers requires active collaboration with various stakeholders, including migrant nongovernmental, civil society, community-based, and government organizations. This approach ensures that evidence-based knowledge is grounded in the lived realities of migrant workers.

For future advocacy and policy changes to be effective, it is essential to develop inclusive policies with active participation from migrant workers, enhance access to legal and health services, decriminalize and protect labor migrants, and foster ongoing collaboration among researchers, activists, health care professionals, and policymakers. This strategy underscores the transformative power of research-informed advocacy in creating equitable HIV/AIDS health care, particularly for vulnerable populations like migrant workers.

Reference

Perveen M. Lack of access to treatment and criminalization of labor migrants based on HIV-positive status: a review of HIV policy progression and migrant’s health rights in five origin countries in Asia. Presented at: AIDS 2024, July 22-26, 2024; Munich, Germany. Poster EPF198. https://aids2024.iasociety.org/cmVirtualPortal/_iasociety/aids2024/eposters#/PosterDetail/774

Canada: Migrants face significant healthcare gaps despite universal coverage promises

Op-ed: Failing Migrant Rights, Failing Public Health

Janet Butler-McPhee, Anne-Rachelle Boulanger, and Nadia Fyfe

Canada prides itself on being a welcoming country with a universal healthcare system — and is lauded for both around the world. But for people without citizenship, significant healthcare gaps exist and access is often barred. This is true for many people living with HIV who require antiretroviral therapy to treat the condition and ensure that it can’t be transmitted. Having marked World Hepatitis Day this month, we also know that many people living with hepatitis C (HCV) in Canada cannot access healthcare and face the needless prospect of liver damage, cancer, and even death without treatment. The status quo is unacceptable for those who wish to call Canada home, and for Canadians who understand the critical importance of public health and human rights.

Accurately determining the number of people without citizenship in Canada who are living with HIV, HCV, and other sexually transmitted and blood-borne infections is challenging. However, it is well-recognized that migrants are disproportionately affected by some of these conditions but may never have had access to treatment. Migrants account for roughly 30% of people living with HCV in Canada and 70% of those living with hepatitis B. In 2017, it was estimated that up to 500,000 people in Canada were living without health insurance, primarily due to their lack of citizenship. And with more and more people immigrating since then, we can assume that these numbers have now increased.

Accessing healthcare is a complicated ordeal for newcomers, as all provinces and territories have their own healthcare insurance plans. Most require people to have lived in their jurisdiction for six months to be eligible for healthcare, and then impose another three-month waiting period before coverage kicks in. In some jurisdictions, access is even further limited for people living with HIV, as antiretroviral therapy is only available at specific pharmacies, or coverage is only available with a specialist’s recommendation, even though those specialists already have lengthy waiting lists. These requirements delay access to essential healthcare and worsen outcomes.

Newcomers to Canada will, in most cases, pay out of pocket during these long waiting periods. In a 2023 study that looked at the impact of waiting periods in Ontario, 32% of participants reported delaying necessary healthcare for themselves or immediate family members due to lack of coverage. Media outlets have regularly reported on harms (both financial and otherwise) caused by such delays. One individual avoided getting gender-affirmative care. Another woman was charged $35,000 for a life-saving hospitalization. A couple was also denied an appointment with an obstetrician unless they paid $10,000 upfront. None of this bodes well for public health.

Access to healthcare is even more restricted for people without immigration status — a situation in which people often become trapped because of legal technicalities. People in this position cannot obtain status in Canada, nor are they afforded their basic human right to healthcare, as immigration status is required to access any public healthcare plan. We know that people living with HIV and HCV can be — and are — caught in this position, unable to access care critical to their well-being and survival. The United Nations has frequently called on Canada to ensure that our public healthcare is accessible to all people, regardless of their immigration status; the world may soon realize how “un-Canadian” some of our policies really are.

The Interim Federal Health Program (IFHP) attempts to fill some of these gaps by providing temporary healthcare coverage to refugee claimants, recognized refugees, and other protected persons in Canada. Through IFHP, these individuals should have access to the same coverage provided by the province or territory in which they live. But the program often fails to provide consistent access to essential healthcare to those in need, as noted by service providers. Following extensive cuts to the program in 2012, the Federal Court confirmed that the cuts put “lives at risk and… serve to perpetuate the historical disadvantage suffered by members of an admittedly vulnerable, poor and disadvantaged group.” Today, a change in political will could threaten its very existence. If we are really committed to protecting people in need, as we claim on the world stage, their access to healthcare should be a no-brainer.

Addressing the barriers non-citizens face in accessing treatment for HIV, HCV, and other health conditions isn’t just a matter of fairness — it’s a public health necessity. Canada must eliminate wait times for health insurance, increase funding for temporary healthcare coverage, and ensure provincial requirements do not hinder access to life-saving care. Only then will Canada have any hope of a truly universal healthcare system where no one is left behind.

Janet Butler-McPhee is a Co-Executive Director of the HIV Legal Network and a member of the steering committee of Action Hepatitis Canada.

Anne-Rachelle Boulanger is a Policy Analyst with the HIV Legal Network.

Nadia Fyfe is a law student at the University of Western Ontario.

New Zealand’s healthcare system difficult to navigate for migrant mothers

Migrant moms return home due to New Zealand health system struggles

Migrant mothers face a confusing and frustrating time when it comes to navigating New Zealand’s healthcare system, new research has found. But there are ways to make the process easier.

The Asian population is the fastest growing ethnic group in New Zealand, currently making up 15% of the total population. Three-quarters are migrants.

And yet, research has found Asian women have poorer maternal and perinatal outcomes when compared with New Zealand Europeans.

One recent study found that while pregnant Asian mothers were more likely to see a doctor than New Zealand European mothers, they were less likely to have their first-choice lead maternity caregiver (LMC).

Speaking with migrant mothers from China and India, our research identified overarching themes describing their experiences with healthcare in New Zealand. The interviewees also outlined ways their needs could be better integrated into the health system.

A lack of understanding

New Zealand’s maternal healthcare is considered relatively unique. Midwives are the lead maternity carer for more than 90% of women.

But that uniqueness can cause problems for migrant mothers. Most of the research participants said they were not aware of the different health services available to them and their children.

As one Indian mother said:

[I had] a pretty hard time to find a good midwife because when I was pregnant for the first time, I didn’t know anything, and New Zealand is a new country. And I didn’t have anyone, didn’t know anyone, and had no family and no friends.

Having to manage a language barrier was another challenge. At times, this prevented the mothers from accessing the care they needed.

As one Chinese mother explained:

For any kind of appointment including GP and doctor, the first thing is to make an appointment. No matter how much time it takes, I have to use translation. And I need to ask others to help make the call every time… Sometimes I don’t want to bother others, so I would rather not see the doctor.

Another barrier mentioned by the mothers we spoke to was that their child’s access to some services – such as Plunket – depended on their visa status.

One mother we spoke with sent their young toddler back to India to live with family when the cost of care became too much:

[W]e were spending a lot of money for [my daughter’s] daycare because she was under three years, so she wasn’t getting any free hours for daycare. So, we were spending more than $60 per day for her daycare, so it was quite expensive for us. So that’s why me and my husband decided to leave her with my mum and dad [in India].

Going home rather than waiting

Many of the mothers we spoke with said doctors in New Zealand were friendly. But the research participants also expressed a general lack of trust of the GPs.

One mother spoke of how a New Zealand doctor used the internet to search for information regarding their symptoms. This undermined her trust and confidence in the doctor.

Many of the research participants were also frustrated by the lack of diagnostic tests. They reported feeling dismissed when they asked for them.

These factors contributed to them travelling back to their home country to receive care. As a Chinese mother recounted:

My kid had an extra teeth [sic] when she was three-years-old and we have been waiting for the dentist. Now two years have gone, and we are still in the line … When we went back to China, we paid ourselves and extracted the tooth.

The migrant mothers also spoke about a lack of support systems. In India, new mothers and their child were cared for by their family members. That support structure, however, was absent in New Zealand.

As one Indian mother explained:

when I got home, I was on borderline depression, so postpartum depression, and when I asked my midwife… I really didn’t receive any like, ‘Oh, you’ve got this, you can ask your GP to assess you, and then we can give you some mental wellbeing support’. It just seemed very difficult to ask for help in terms of postpartum.

Improving care

The responses from the migrant mothers highlighted the importance of a system that is inclusive of migrants’ needs. This includes wider access to translation and orientation services that help migrants navigate the different facets of life in New Zealand.

It’s not out of the realm of possibility. One Chinese mother explained how she had seen this model of migrant care while working in Japan:

In the first week when we arrived in Japan, they provided a whole week training including the national system, rubbish recycling, and medical system… Some basic trainings, for example, how and where to register GP, the process for seeing a doctor when you are sick, the emergency number, etc. These would be valuable for people that are new to New Zealand, especially those that cannot speak English.

New initiatives, such as the Healthy Mother Healthy Future, have been implemented to help Asian mothers during pregnancy.

But New Zealand also needs to address issues of access to childhood services, particularly for children whose parents are on work visas.

New Zealand’s healthcare system is built on the idea of universal access and fairness. Our research shows that, for many migrant mothers and their children, this is not the case.

This research was completed with the assistance of Dr. Hongxia Qi. This research was funded by a grant from the Health Research Council (19/263).

Turkey: HIV-Positive Syrian refugee fights for access to treatment in Istanbul detention centre

HIV positive Syrian refugee ‘left for dead’ in İstanbul removal center

Ahmed Aaabo’s treatment has been disrupted by bureaucratic hurdles after his temporary protection status was removed, says his lawyer.

Ahmed Aabo was only 10 years old when his family left him at the Turkish border in 2011, seeking a safer life amidst the Syrian civil war.

Granted Temporary Protection Status upon entering Turkey, Ahmed’s life took a dramatic turn about eight months ago after he donated blood to the Turkish Red Crescent, which revealed he was HIV positive.

Ahmed began receiving treatment at Haseki Training and Research Hospital in Fatih, İstanbul, where he regularly took his medication. However, his situation worsened due to administrative decisions and bureaucratic barriers.

Losing protection status

His temporary protection status was deactivated under the G-78 restriction code, which is used for foreigners who are deemed to pose a public health threat due to infectious diseases. This deactivation prevented him from accessing his medications.

In an attempt to understand his situation and secure his medication, Ahmed visited the Kumkapı Foreigners’ Branch Directorate. There, he was detained and handcuffed for allegedly residing illegally and transferred to the Hadımköy Removal Center.

His lawyer, Hasan Kocapınar, filed a lawsuit to halt the deportation process. While awaiting the court’s decision, Ahmed was moved to the Adana Removal Center, where he could not access his medication, further deteriorating his health.

Kocapınar managed to get Ahmed transferred back to İstanbul, where he finally received his medication, but the interruption in his treatment had already severely affected his health.

Appeal to authorities

Kocapınar emphasized that denying Ahmed his right to treatment is a human rights violation. “Ahmed’s health has severely deteriorated due to the deprivation of his right to treatment and erroneous administrative actions. We will pursue all necessary legal avenues to restore his treatment rights,” he said.

He urged the authorities to honor international agreements and provide Ahmed with the care he needs, highlighting that sending Ahmed back to Syria would endanger his life, especially given his HIV status, which would make him a target for extremist groups.

Kocapınar also noted that Ahmed only has a three-month supply of medication left and emphasized the need for the Directorate General of Migration Management and the Directorate of Migration Affairs to resolve the issue. “Ahmed is currently held at the Arnavutköy Removal Center, where he does not have adequate access to his treatment. This is a human rights violation, and Ahmed’s right to health and life must be protected,” Kocapınar asserted.

G-78 Restriction Code

This code is applied to foreigners who carry infectious diseases that could threaten public health and safety, resulting in an indefinite ban on their entry to Turkey.

Peru: Venezuelan migrants in Peru face severe challenges in HIV care and basic services, report finds

Biobehavioral Survey (BBS) in Venezuelan Migrants living in Lima/Callao and Trujillo – Final report

Translated with Google translate – Scroll down for article in Spanish

The persistent and serious economic and social crisis that Venezuela is experiencing has led more than 5.5 million Venezuelans to leave their country in search of guaranteeing the right to health and life, access to basic services and job opportunities. Peru, with more than 1.57 million Venezuelan migrants, is the second country in Latin America with the most reception. This situation represents one of the largest migratory movements, comparable to that seen in war situations, such as in Syria or Afghanistan. From 2018 to date, changes have been observed in migratory dynamics, which could result in the modification of the conditions faced by migrants, and have an impact on their access to basic services.

Faced with this situation, different government bodies and some NGOs have created different channels to offer support to Venezuelan migrants in Peru. Despite the commitment and effort of the Peruvian government to support the refugee and migrant population, 91.5% of the Venezuelan population residing in the country does not have health insurance.[ 1] Many of them do not have the necessary legal and economic means to access these services and not having legal identification in the country, they do not have the national health insurance or Comprehensive Health Insurance (SIS).

The number of Venezuelan migrants living with HIV and residing in Peru has been increasing. In 2021, according to USAID figures through the LHSS (Sustainability of Local Health Systems Project) project, more than 8,000 migrants living with HIV were estimated, of which less than 50% received antiretroviral treatment. Worrying is the large percentage of migrants who stopped receiving treatment when leaving their country or during their journey to Peru, and who have encountered significant barriers to access to comprehensive HIV services during their stay.

National regulations ensure universal access to antiretroviral treatment to all people with HIV in the national territory, regardless of the country of origin, but research carried out by cooperation agencies reports that only 2% of migrants with HIV have Comprehensive Health Insurance (SIS) and that 23% of them arrive with or develop advanced stages of HIV or AIDS.

This document reports a prevalence of HIV of 1.01% in the Venezuelan migrant population in Lima/Callao and Trujillo, which is higher than the prevalence of 0.4% in the Peruvian adult population (15-49 years) [UNAIDS] and the prevalence of 0.5% in the adult population in Venezuela (15-49 years) [UNAIDS]. As in Peru, the HIV epidemic in the Venezuelan migrant population is concentrated in key population (gay men and men who have sex with other men-MSM, transgender women-MT, sex workers-TS and intravenous drug users), as well as in the young population. However, higher prevalence of HIV was found in the MSM population of Venezuelan migrants (15.6%) than the Peruvian MSM population (10%) [UNAIDS] and higher prevalence in Venezuelan male STs (43.39%) than Peruvians (3%) [10].

The findings of the cascade of the care continuum of migrants with confirmed HIV diagnosis that showed low levels of treatment initiation, continuation of care and virological suppression are worrying: 25% had started antiretroviral treatment, 20.6% reported receiving HIV care at the time of the study and 38.8% were on virological suppression. Virological suppression was higher among those with old diagnosis (85.7%) than in those with new diagnosis (17.4%). Figures well below the 95-95-95 targets of the Global AIDS Strategy 2021-2026.

The migrant population with HIV has multiple basic needs, and confronts different forms of discrimination based on their origin (xenophobia), gender expression and identity (transphobia), sexual diversity (homophobia or lesbophobia), age, or living with HIV (serophobia), which, when superimposed, determine an intersectional discrimination that, together with other social determinants, are barriers to access to health services, decent work, food and housing, and also present great difficulties in regularizing their migratory status and accessing a foreign identity card that would enable them to process the SIS. The main difficulties faced by the Venezuelan migrant population are financial (52.6%), food (21.6%) and housing (17.3%).

70.7% of migrants participating in this study report having had an experience of stigma or discrimination. With regard to the experiences of violence in the last 12 months during their stay in Peru, a total of 45.5% reported psychological violence, 47.7% physical violence, 48.7% reported having suffered forced sex and 44.2% reported having been sexually exploited in exchange for resources.

It is necessary to address these barriers through responses focused on and directed by the affected communities such as expanding the supply of diagnostic services and combined HIV prevention in the primary health care sector, which includes pre-exposure prophylaxis (PrEP) and self-testing in health services free of discrimination and with a gender equality approach.

The findings of this report provide solid evidence on the vulnerability factors and social and health determinants of the Venezuelan migrant community in Peru. It portrays the health situation of migrants in general and migrants living with HIV and identifies gaps in access to education, work, health, justice and equality for all. It is a resource for the generation of focused and differentiated policies for combined prevention, early diagnosis and timely treatment of HIV, the elimination of discrimination, the efficiency of investments in HIV, and the strengthening of other programs aimed at social welfare, food security and the elimination of poverty.

From UNAIDS we welcome the findings of this work that describes the HIV epidemic in this population in two of the Peruvian regions with the largest number of migrants and provides government decision-makers with the necessary evidence to sustain inclusive public policies aimed at eliminating the barriers to access to services, generated by the inequalities faced by the migrant population, with HIV and belonging to the key populations in Peru.

Joint United Nations Programme on HIV/AIDS (UNAIDS) – Equipo Peru

[1] [Proposal for Increasing Health Care Coverage for Venezuelan Refugees and Migrants Living with HIV. Update in Response to the COVID-19 Pandemic. PAHO/UNAIDS/CDE/COVID-19/21-0013 © PAHO/WHO and UNAIDS, 2021].
[10] Degtyar A, George PE, Mallma P, Diaz DA, Cárcamo C, Garcia PJ, Gorbach PM, Bayer AM. Sexual Risk, Behavior, and HIV Testing and Status among Male and Transgender Women Sex Workers and their Clients in Lima, Peru. Int J Sex Health. 2018;30(1):81-91. doi: 10.1080/19317611.2018.1429514. Epub 2018 Mar 27. PMID: 30224942; PMCID: PMC6138045.

The report in Spanish can be downloaded here: https://peru.iom.int/sites/g/files/tmzbdl951/files/documents/2024-01/oimreportefinal_es.pdf

Encuesta Bioconductual (BBS) en Migrantes Venezolanos que viven en Lima/Callao y Trujillo – Reporte final

La persistente y grave crisis económica y social que vive Venezuela ha llevado a más de 5.5 millones de venezolanos a abandonar su país en búsqueda de garantía al derecho a la salud y a la vida, acceso a servicios básicos y oportunidades laborales. Perú, con más de 1.57 millones de migrantes venezolanos, es el segundo país de Latinoamérica con mayor acogida. Esta situación representa uno de los mayores movimientos migratorios, comparable con el visto en situaciones de guerra, como en Siria o Afganistán. De 2018 a la fecha, se han observado cambios en la dinámica migratoria, que podrían traducirse en la modificación de las condiciones que afrontan los migrantes, y repercutir en su acceso a servicios básicos.

Ante esta situación, diferentes instancias gubernamentales y algunas ONG han creado distintos canales para ofrecer apoyo a los migrantes venezolanos en el Perú. A pesar del compromiso y el esfuerzo del gobierno peruano en apoyar a la población refugiada y migrante, el 91,5 % de la población venezolana residente en el país no cuenta con seguro de salud.[1] Muchos de ellos no cuentan con los medios legales y económicos necesarios para acceder a estos servicios y al no disponer de identificación legal en el país, no les corresponde el seguro nacional de salud o Seguro Integral de Salud (SIS).

El número de migrantes venezolanos que viven con VIH y reside en el Perú ha ido en aumento. En el 2021, según cifras de USAID a través del proyecto LHSS (Proyecto de Sostenibilidad de los Sistemas Locales de Salud) se estimaron más de 8,000 migrantes viviendo con VIH, de los cuales menos del 50% recibían tratamiento antirretroviral. Es preocupante el gran porcentaje de migrantes que dejaron de recibir el tratamiento al abandonar su país o durante su trayecto al Perú, y que han encontrado importantes barreras para el acceso a los servicios integrales de VIH durante su estancia.

La normativa nacional asegura acceso universal al tratamiento antirretroviral a toda persona con VIH en el territorio nacional, independientemente al país de origen, pero investigaciones realizadas por las agencias de cooperación informan que solo el 2% de los migrantes con VIH disponen de Seguro Integral de Salud (SIS) y que el 23% de ellos llegan con o desarrollan etapas avanzadas de VIH o SIDA.

El presente documento reporta una prevalencia del VIH de 1.01% en la población migrante venezolana en Lima/Callao y Trujillo, la cual es más alta que la prevalencia de 0.4% en población adulta peruana (15-49 años) [ONUSIDA] y que la prevalencia de 0.5% en la población adulta en Venezuela (15-49 años) [ONUSIDA]. Al igual que Perú, la epidemia de VIH en la población venezolana migrante está concentrada en población clave (hombres gay y hombres que tienen sexo con otros hombres-HSH, las mujeres transgénero-MT, las trabajadoras sexuales-TS y usuarios de drogas intravenoso), así como en población joven. Sin embargo se encontró mayor prevalencia de VIH en la población HSH de migrantes venezolanos (15.6%) que la población HSH peruana (10%) [ONUSIDA] y mayor prevalencia en TS masculinos venezolanos (43.39%) que peruanos (3%) [10].

Son preocupantes los hallazgos de la cascada del continuo de atención de las personas migrantes con diagnóstico de VIH confirmado que mostro niveles bajos de inicio de tratamiento, continuación de cuidado y de supresión virológica: 25% había iniciado tratamiento antirretroviral, 20.6% reportó encontrarse recibiendo atención en VIH al momento del estudio y el 38.8% se encontraba en supresión virológica. La supresión virológica fue mayor entre aquellos con diagnóstico antiguo (85.7%) que en aquellos con diagnóstico nuevo (17.4%). Cifras muy por debajo de las metas 95-95-95 de la Estrategia Global de Sida 2021-2026.

La población migrante con VIH presenta múltiples necesidades básicas, y confronta distintas formas de discriminación por su origen (xenofobia), expresión e identidad de género (transfobia), diversidad sexual (homofobia o lesbofobia), edad, o vivir con el VIH (serofobia), que al superponerse determinan una discriminación interseccional que junto con otras determinantes sociales, son barreras de acceso a servicios de salud, al trabajo digno, a alimentación y vivienda, y presentan además, grandes dificultades para regularizar su estatus migratorio y acceder a un carnet de extranjería que les habilitaría a tramitar el SIS. Las principales dificultades a las que se enfrenta la población migrante venezolana son financieras (52.6%), de alimentación (21.6%) y de vivienda (17.3%).

El 70.7% de los migrantes participantes en este estudio refiere haber tenido una experiencia de estigma o discriminación. Con respecto a las experiencias de violencia en los últimos 12 meses durante su estadía en el Perú, un total de 45.5% reportó violencia de tipo psicológica, 47.7% violencia física, 48.7% reportó haber sufrido sexo forzado y 44.2% reportó haber sido explotado sexualmente a cambio de recursos.

Es necesario abordar estas barreras a través de respuestas enfocadas en y dirigidas por las comunidades afectadas como son ampliar la oferta de servicios de diagnóstico y la prevención combinada del VIH en el sector primario de atención a la salud, que incluya la profilaxis preexposición (PrEP) y el auto testeo en servicios de salud libres de discriminación y con enfoque de igualdad de género.

Los hallazgos de este informe aportan evidencia sólida sobre los factores de vulnerabilidad y determinantes sociales y de salud de la comunidad migrante venezolana en el Perú. Retrata la situación de salud de las personas migrantes en general y de los migrantes viviendo con VIH e identifica brechas en el acceso a educación, trabajo, salud, justicia e igualdad para todos. Es un recurso para la generación de políticas enfocadas y diferenciadas de prevención combinada, diagnóstico temprano y tratamiento oportuno del VIH, la eliminación de la discriminación, la eficiencia de las inversiones en VIH, y el fortalecimiento de otros programas que apunten al bienestar social, la seguridad alimentaria y la eliminación de la pobreza.

Desde ONUSIDA saludamos los hallazgos de este trabajo que describe la epidemia del VIH en esta población en dos de las regiones peruanas con mayor número de migrantes y brinda a los tomadores de decisión del gobierno, la evidencia necesaria para el sustento de políticas públicas inclusivas y orientadas a la eliminación de las barreras al acceso a servicios, generadas por las desigualdades que enfrenta la población migrante, con VIH y pertenecientes a las poblaciones clave en el Peru.

Programa Conjunto de las Naciones Unidas sobre el VIH/SIDA (ONUSIDA) – Equipo Perú

https://peru.iom.int/sites/g/files/tmzbdl951/files/documents/2024-01/oimreportefinal_es.pdf

HIV services expanded for displaced migrants in wake of Ukraine war and regional turmoil

Navigating HIV services during migration crisis in Eastern Europe and Central Asia

Countries affected by the migration crisis in Eastern Europe and Central Asia, prompted by the war in Ukraine and other turmoil in the region, have had to put in place measures so that all displaced people have access to essential HIV services.

Key Figures:

In 2022, Europe was confronted by the largest refugee crisis since World War II.
As of February 2024, nearly one-third of Ukraine’s population remains displaced, with 6.3 million Ukrainian refugees globally, primarily concentrated in Europe, 62% of them are women.
In 2022, around one million Russian citizens emigrated, with many choosing prolonged stays abroad.
Central Asian countries witnessed the biggest influx of international migrants since their independence.
Up to 300,000 Belarusians left their country since May 2020.
Migration from Central Asia to Russia surged in 2023, with notable increases in Uzbek, Kyrgyz, and Tajik nationals entering for work purposes. (ICMPD Migration Outlook Eastern Europe and Central Asia 2024)
The HIV epidemic is growing in Eastern Europe and Central Asia, with Russia, Ukraine, Uzbekistan, and Kazakhstan accounting for 93% of new infections in the region combined.

Surviving the devastating events of March 2022 in Mariupol, Ukraine, uncertain of what the future held, Svetlana fled her hometown.

“Mariupol was a scene of utter destruction. I had a packed suitcase, but I left it behind, only taking with me a dog and a cat,” recalls Svetlana. “With assistance, we managed to reach the Polish border, eventually finding refuge in Lithuania.”

Living with HIV since 2000, Svetlana relies on anti-retroviral treatment (ARV) to keep the virus at bay by taking a tablet a day. In haste, she had only taken one pill box.

Upon her arrival in Lithuania, she connected with an online organization that within days helped her to obtain her life-saving medicine from a doctor.

Svetlana is one of 70 participants in 6 countries in the Regional Expert Group on Migration and Health (REG) study that assessed the healthcare access for Ukrainian refugees using qualitative methods. According to Daniel Kashnitsky, the lead REG expert, “insights from specialists and service recipients revealed that all HIV-positive refugees had access to treatment across EU host countries.”

After recovering from the initial shock, the European Union activated the Temporary Protection Directive, establishing legal guidelines for managing mass arrivals, offering humanitarian aid, and ensuring access to life-saving antiretroviral treatment and basic HIV services to those in need.

Outside the EU, in countries like Moldova and Georgia, special regulations ensure free access to HIV services. Moldova’s National AIDS Coordinator, Yuri Klimaszewski, underscored that Moldova provided HIV services to refugees like it does for its citizens.

The study also revealed that some refugees struggled in host countries, leading to challenges maintaining treatment adherence. Tatyana (name changed) left Odessa along the Black Sea in April 2022.

But she returned home because she could not find adequate support under the opioid maintenance therapy program in Poland. She found it complicated to reach the service point, the language barriers prevented her from communicating her needs with medical staff, and she lacked community support.

“Despite the unprecedented support shown by European countries to Ukrainian refugees, systemic issues, particularly bureaucratic complexities, require proactive intervention by social workers, community organisations and volunteers to effectively address these challenges,” said Mr Kashnitsky. Additionally, he added, “there is a pressing need to tackle the stigma faced by people living with HIV and other key populations, such as people who use drugs.”

Uladzimir, who left Belarus for Poland in the first days of the war in Ukraine, needed about a month to start receiving ARV treatment. First, he had to obtain “international protection”, then confirm his HIV status and wait for an appointment with a doctor. But once all that was cleared, he had access to all the necessary services. For many accessing services is not as straightforward as it is for Ukrainian refugees, according to the REG study “Forced migrants with HIV status: social psychological and medical aspects of adaptation”

Legislation in some countries makes accessing HIV prevention and treatment for migrants challenging. And in some cases, national healthcare systems may lack resources to meet the influx of people and their needs.

As the Russian Federation continues to deport migrants living with HIV, those who remain in Russia due to the inability to return home or for family reasons are compelled to stay in the country illegally. They are deprived of HIV treatment and health services. Some have succeeded by receiving treatment remotely (ARVs sent to them with the help of countries of origin).

Recommended strategies, as outlined by the REG study, include improving the system of informing people about potential risks and available HIV services abroad, establishing health insurance protocols, and supporting community organizations that provide HIV services.

Removing legal provisions that discriminate against migrants living with HIV will also reduce barriers to accessing antiretroviral therapy, resulting in significant improvements for public health in the region.

Eamonn Murphy, UNAIDS Regional Director for Asia Pacific and EECA regions, praises the collaborative efforts involving various stakeholders, including governments of countries of origin and host countries, community organizations, the Joint UN Programme on AIDS, and donors.

However, he says more needs to be done. “There is an urgent need to work on the legalization and standardization of such approaches to ensure all people on the move can access essential services and remain on treatment wherever they are.”

The Golondrinas strategy connects HIV positive migrants to medical care in LAC region

Golondrinas’ project seeks to guarantee care for migrants with HIV

Translated with Deepl.com; For original article in Spanish, please scroll down.

It is a strategy for people arriving in another country to continue with the necessary treatment.

A person with HIV who leaves his or her country may experience difficulties with treatment or care elsewhere. While anyone can access the Universal Health Insurance (SUS) in Bolivia, the issue is made difficult due to forms and other issues; however, access to medicines for migrants carrying the virus has been achieved, according to the head of Health and Human Rights Projects at the Institute for Human Development (IpDH) in Cochabamba, Karina Rojas.

The ‘Golondrinas’ strategy seeks to ensure health care for migrants with HIV in the countries through which they pass or stay.

The Americas and Caribbean Platform of Coalition Plus held its annual meeting earlier this year in Cochabamba. The director of the Institute for Human Development (IpDH), Edgar Valdez, explained that the Platform’s members are Colombia, Guatemala, Argentina, Dominican Republic, Canada, Ecuador and Bolivia.

The meeting is a space to address issues such as policies, human rights in each country, budgets and how to work together on this issue, as each country has differences and similarities regarding access to treatment, the vulnerability of people with HIV, stigma and discrimination.

Another issue that stands out is related to migration and the ‘Golondrinas’ strategy.

The head of IpDH’s Health and Human Rights Projects explained that the ‘Golondrinas’ project was born in one of the meetings of the Platform of the Americas and the Caribbean, because it is a necessity for this vulnerable population; migrants with HIV.
‘People who migrate, sometimes do so irregularly and, therefore, it is very easy to violate their rights’.
She said that, in response to this situation, they submitted a project to the French Development Agency, which is currently providing funding. It consists of providing sexual health services along the route taken, in the case of Bolivia, by people arriving from Venezuela, as well as Haiti, Peru, Colombia and other countries.
Valdez explained that the project is integrated between French Guiana, Ecuador, Guatemala, Colombia, Bolivia and Argentina.

‘In other words, we want to provide health care and their rights as immigrants. It is a health support to all people with HIV, to all migrants of sexual diversity and to all women who also come here to Bolivia. In general, they are in transit, but some of them also stay. So there is legal support.

She added that there are organisations, such as Caritas and the government, which also work on other aspects.
‘We are seeing how we can articulate how to respond to this population that is extremely vulnerable because of their migrant status, because of the discrimination they may suffer and the stigma. So it is a space for them to consult, receive care and, of course, medicines.

Rojas described how they have seen cases where it has been possible for people with HIV from other countries to access treatment.

‘By advocating and explaining that health comes before the legal situation, people with HIV who need treatment have been able to access and collect from Cdevir (Centro Departamental de Vigilancia y Referencia para casos de VIH), for example.
In Cochabamba, Bolivia, there is still not much progress. But there is a need.
‘We are contacted by people who migrate, who have HIV; they have contacted us because they want to pick up their retroviral treatment or they don’t want to stop taking their medication.

He stressed that the right to health comes before documents.

The director of the Red Somos de Colombia Community Medical Unit, Jhon Ramirez, said that his country receives Venezuelan migrants who are in transit through Colombia to South or Central America.

‘The project consists of being able to approach migrants, identify their HIV status, get them into treatment and, if they are passing through, refer them to the organisations that are part of the Americas and Caribbean Platform of Coalition Plus, which have resources from the Golondrinas strategy.

The risk in ‘survival sex’ practices
For a migrant person, in their need to move from one place to another, to have sex with a trailer driver, as an example, is a survival sex practice.

The director of the Red Somos de Colombia Community Medical Unit, Jhon Ramirez, explained that there are also known cases of migrants agreeing to sex in exchange for food or a room with a bathroom or other basic necessities.
Valdez described that countries such as Colombia and the Dominican Republic receive migrants from Haiti; in addition, people from Venezuela also arrive in Colombia and Ecuador. However, in most cases they are in transit to Chile, Argentina and others.

‘We are also trying to see if there are people who want to stay in Bolivia; we protect their rights to see how they can be legal, what Bolivian laws protect these people.

Karina Rojas, head of IpDH’s Health and Human Rights Projects, stressed the importance of offering sexual health services, that is, that they can access HIV testing, ‘women can access family planning’, and treatment for sexually transmitted infections.
‘As they are a vulnerable population, sometimes they do sex work. We want to partner with other organisations that work on migration from another point of view; for example, Caritas here in Cochabamba has a shelter, so we can refer them to the shelter and they can refer us to the health services.

The IpDH director explained that ‘Golondrinas’ is related to access, above all, to universal health care.
‘We focus specifically on people with HIV, sexual diversity and, of course, sex workers as well, so everything related to sexuality, violence (…). We are always reflecting on these issues, the issue of migration.
For Ramírez, there are complex issues.

‘But the most complex part of the situation is that people do not have access to condoms, access to antiretrovirals, access to combined prevention strategies, such as access to PREP (pre-exposure prophylaxis), access to post-exposure therapy, and this is closely linked to issues of survival sex practices,’ he said.

Aiming for a single international code for patient access to treatment
The director of the Red Somos de Colombia Community Medical Unit, Jhon Ramirez, said that the ‘Golondrinas’ strategy aims to ensure that migrants with HIV have access to a single code that allows them access to treatment in other countries, if they leave their own.

‘The strategy is to let the migrant population know that in Bolivia there is the IpDH, that here they can access prevention services, that they can access medical treatment, counselling; this is the most important thing we have to do (…), so that the person knows that on the route to South America they will find Kímirina in Ecuador, the IpDH in Bolivia and the Fundación Huésped in Argentina’.
These organisations will be able to guarantee some kind of medical support in their migratory transit, in order to be able to successfully refer people.
‘The idea is to have a referral and counter-referral system so that, if I give a doctor in Colombia, in Ecuador they can see what medication this person has and there are no barriers to access.
The aim is to have a system at international level, and that each person has a unique code to be used at the time of the interview with the doctor or nurse in the programmes.
‘The code will be for the professional to access their medical history, so that the doctor in Colombia can see the treatment in Bolivia, to continue the same treatment, because they can sometimes open the entire clinic; and also so that the person has a reference code so that they can access this information.

DATA IN COLOMBIA Ramírez explained that in his country there are 7 million Venezuelan migrants. Of these, according to Colombian immigration data, two million have a vocation to stay, and the rest are migrants who are passing through to other countries in the region.

‘We seek to address 3,700 migrants and refer them to sexual health, reproductive health and HIV prevention services, as a strategy to control indicators of public health interest in our countries. An important part of the Golondrinas strategy is to establish the needs of the migrant population in terms of sexual health, reproductive health and other pathologies.
He added that it is estimated that in Colombia there are around 22,000 Venezuelan migrants who could be living with HIV.
‘We have identified 4,500, who are in the health system in Colombia. We still need to look for another 18,000 people who may be living with HIV and do not know it at the moment.

She added that a study carried out with George Hawkins University showed an HIV prevalence rate of 0.9% and 5% for syphilis.
The head of IpDH’s Health and Human Rights Projects explained that in Cochabamba there are still no statistics available.
‘We have also tried to incorporate this nationality data, for example, into the Simone (Computer System for Monitoring and Evaluation of the National HIV Programme), which is the monitoring system of the Ministry of Health, but there is still no data that we can reflect,’ said Rojas.

However, he assured that the doors of the IpDH are open for those who need antiretroviral treatment if they have HIV; for those who had risk situations, sexual violence; for testing and others referred to sexually transmitted infections.
‘What we want is that they don’t cut off the health services they need along the way.

Proyecto ‘Golondrinas’ busca garantía de atención a migrantes con VIH

Se trata de una estrategia para que las personas que llegan a otro país puedan continuar con los tratamientos necesarios.

Una persona con VIH que deja su país puede atravesar dificultades en torno a su tratamiento o atención de salud en otros lugares. Si bien, cualquier persona puede acceder al Seguro Universal de Salud (SUS) en Bolivia, el tema se dificulta debido a los formularios y otros; sin embargo, se ha conseguido el acceso a medicamentos para migrantes que portan el virus, según describió la responsable de Proyectos de Salud y Derechos Humanos del Instituto para el Desarrollo Humano (IpDH) en Cochabamba, Karina Rojas.
La estrategia ‘Golondrinas’ busca que se garantice la atención en cuanto a salud a personas migrantes con VIH en los países por donde pase o permanezca.

La Plataforma de las Américas y el Caribe de Coalition Plus realizó su reunión anual en días anteriores, en Cochabamba. El director del instituto para el desarrollo Humano (IpDH), Edgar Valdez, detalló que son miembros de la Plataforma los países de Colombia, Guatemala, Argentina, República Dominicana, Canadá, Ecuador y Bolivia.
El encuentro es un espacio para abordar temas como las políticas, los derechos humanos en cada país, los presupuestos y cómo trabajar de manera conjunta frente a esta problemática, ya que cada país tiene diferencias y semejanzas respecto al acceso al tratamiento, a la vulnerabilidad de las personas con VIH, al estigma y discriminación.
Otro de los temas que resalta es el relacionado con la migración y la estrategia denominada ‘Golondrinas’.
La responsable de Proyectos de Salud y Derechos Humanos del IpDH expuso que el proyecto ‘Golondrinas’ nació en una de las reuniones de la Plataforma de las Américas y el Caribe, porque es una necesidad para esta población vulnerable; los migrantes con VIH.
“Las personas que migran, lo hacen, a veces, irregularmente y, por lo tanto, es muy fácil vulnerar sus derechos”.
Dijo que, ante esa situación, presentaron un proyecto a la Agencia Francesa de Desarrollo y, en la actualidad, otorga financiamiento. Consiste en dar servicios de salud sexual a lo largo del recorrido que hacen, en el caso de Bolivia, personas que llegan de Venezuela, además de Haití, Perú, Colombia y otros países.
Valdez detalló que el proyecto está integrado entre Guyana Francesa, Ecuador, Guatemala, Colombia, Bolivia y Argentina.

“Es decir que, queremos brindar atención de salud y sus derechos como inmigrantes. Es un apoyo de salud a todas las personas con VIH, a todas las personas migrantes de diversidad sexuales y a todas las mujeres que vienen también aquí a Bolivia. En general, son en tránsito; pero, algunas se quedan también. Entonces hay un apoyo jurídico”.

Agregó que existen organizaciones, como Cáritas y la Gobernación, que también trabajan en otros aspectos.
“Estamos viendo cómo articulamos para responder a esta población que es extremadamente vulnerable por su condición migrante, por la discriminación que pueden sufrir y el estigma. Entonces, es un espacio para que ellos puedan consultar, recibir atención y, por supuesto, los medicamentos”.
Rojas describió que atendieron casos en los que fue posible que personas con VIH de otros países accedan a sus tratamientos.
“Haciendo incidencia y explicando que antes que la situación legal está la salud, las personas con VIH que necesitaban tratamiento, han podido acceder y recoger del Cdevir (Centro Departamental de Vigilancia y Referencia para casos de VIH), por ejemplo”.
En Cochabamba, Bolivia, todavía no existen muchos avances. Pero, hay necesidad.
“Nos contactan personas que migran, que tienen VIH; nos han contactado porque quieren recoger su tratamiento retroviral o no quieren dejar de tomar sus medicamentos”.
Remarcó que por encima de los documentos está el derecho a la salud.
El director de la Unidad Médica Comunitaria Red Somos de Colombia, Jhon Ramírez, expresó que su país recibe migrantes venezolanos, que van de tránsito por Colombia hacia Suramérica o Centroamérica.
“El proyecto consiste en poder abordar a las personas migrantes, identificar su estatus serológico a VIH, entrarlos en tratamiento y, si van de paso, poderles referenciar a las organizaciones que hacen parte de la Plataforma de las Américas y el Caribe de Coalition Plus, que cuentan con recursos de la estrategia Golondrinas”.

El riesgo en las “prácticas de sexo por supervivencia”
Que una persona migrante, en su necesidad de traslado de un lugar a otro, tenga relaciones sexuales con un conductor de un trailer, como ejemplo, es una práctica de sexo por supervivencia.

El director de la Unidad Médica Comunitaria Red Somos de Colombia, Jhon Ramírez, explicó que también se conocen de casos de personas migrantes que acceden a relaciones sexuales a cambio de comida o de una habitación con baño u otros enseres o elementos básicos.
Valdez describió que países como Colombia y República Dominicana reciben migrantes de Haití; además a Colombia y Ecuador también llega gente de Venezuela. Aunque, en la mayoría de los casos son de tránsito a Chile, Argentina y otros.

“Nosotros estamos también tratando de ver si hay alguna persona que quiere quedarse en Bolivia; le protegemos sus derechos para ver cómo puede ser legal, cuáles son las leyes bolivianas que le protegen a esas personas”.
La responsable de Proyectos de Salud y Derechos Humanos del IpDH, Karina Rojas, remarcó la importancia de ofrecer servicios de salud sexual, es decir, que puedan acceder a pruebas de VIH, “las mujeres a planificación familiar”, tratamiento de infecciones de transmisión sexual.
“Como es una población vulnerable, a veces, hacen trabajo sexual. Entonces, es un riesgo también de violencia sexual en ese trayecto (…). Queremos asociarnos a otras organizaciones que trabajan la migración desde otro el punto de vista; por ejemplo, Cáritas de aquí de Cochabamba tiene un albergue; entonces, nosotros podemos referir al albergue y ellos pueden referirnos a los servicios de salud”.
El director del IpDH explicó que ‘Golondrinas’ tiene relación con el acceso, sobre todo, a salud a nivel universal.
“Nosotros nos concretizamos de manera específica en las personas con VIH, en las diversidades sexuales y, por supuesto, las trabajadoras sexuales también; entonces, todo lo relacionado a la sexualidad, la violencia (…). Siempre estamos reflexionando en esas temáticas, el tema de migración”.
Para Ramírez, existen temáticas complejas.
“Pero, lo más complejo de la situación es que las personas no tienen en su tránsito migratorio acceso a condones, acceso a antirretrovirales, acceso a estrategias de prevención combinada, como el acceso a la PREP (profilaxis previa a la exposición), el acceso a la terapia postexposición, y esto va ligado mucho a temas de prácticas de sexo por supervivencia”, sostuvo.

Apuntan al código único internacional para acceso al tratamiento de pacientes
El director de la Unidad Médica Comunitaria Red Somos de Colombia, Jhon Ramírez, expresó que la estrategia ‘Golondrinas’ apunta a que las personas migrantes con VIH tengan acceso a un código único que les permita el acceso a tratamiento en otros países, si es que sale del suyo.

“La estrategia es poder que la población migrante sepa que en Bolivia está el IpDH, que aquí pueden acceder a servicios de prevención, que pueden acceder a tratamientos médicos, a orientaciones; es lo más importante que tenemos que hacer (…), para que la persona sepa que dentro de la ruta hacia Suramérica va a encontrar en Ecuador a Kímirina, en Bolivia al IpDH y en Argentina a la Fundación Huésped”.
Estas organizaciones en su tránsito migratorio podrán garantizar algún tipo de soporte médico, para poder referenciar de manera exitosa a las personas.
“Se trata de tener un sistema de referencia y contrarreferencia que, si yo lo medico en Colombia, en Ecuador puedan ver qué medicación tiene esta persona y no tenga barreras de acceso”.
El objetivo es contar con un sistema a nivel internacional, y que cada persona tenga un código único para ser utilizado al momento de la entrevista con el médico o enfermero en los programas.
“El código será de acceso del profesional a su historia clínica, para que pueda ver el doctor de Colombia el tratamiento en Bolivia, para continuar el mismo tratamiento, porque pueden hacer apertura, a veces, de toda la clínica; y también que la persona tenga a la mano un código de referencia para que puedan acceder a esa información”.
DATOS EN COLOMBIA Ramírez detalló que en su país hay 7 millones de personas venezolanas migrantes. De ellos, según datos de inmigración Colombia, 2 millones tienen vocación de permanencia, y el restante son migrantes que van de paso hacia otros países de la región.
“Buscamos poder abordar 3.700 migrantes y poder referenciarlos hacia servicios en salud sexual, salud reproductiva, prevención del VIH, como una estrategia de control de los indicadores de cifras de interés en salud pública en nuestros países. Algo importante que tiene la estrategia Golondrinas es poder establecer las necesidades de la población migrante en cuanto a salud sexual, salud reproductiva y también en otras patologías”.
Agregó que se estima que en Colombia hay alrededor de 22 mil personas migrantes venezolanas podrían estar viviendo como VIH.
“Tenemos identificadas 4.500, que están ingresadas al sistema de salud en Colombia. Nos falta buscar esas otras como 18 mil personas que pueden vivir con VIH y en el momento no lo saben”.
Acotó que un estudio realizado con la Universidad de George Hawkins mostró una prevalencia para VIH en el 0.9%, para sífilis, un 5%.
La responsable de Proyectos de Salud y Derechos Humanos del IpDH explicó que en Cochabamba todavía no se cuenta con estadísticas.
“Hemos tratado también de incorporar este dato de nacionalidad, por ejemplo, al Simone (Sistema Informático de Monitoreo y Evaluación del Programa Nacional de VIH), que es el sistema de monitoreo del del Ministerio de Salud, pero todavía no hay datos que podamos reflejar”, expresó Rojas.
Sin embargo, aseguró que las puertas del IpDH están abiertas para quienes necesiten el tratamiento antirretroviral si tienen VIH; para quienes tuvieron situaciones de riesgo, violencia sexual; para hacerse pruebas y otros referidos a infecciones de transmisión sexual.
“Lo que queremos es que no corten los servicios de salud que necesitan en el trayecto”.

Poland: Ukrainian refugees struggle with stigma and treatment gaps

Ukrainian refugees with HIV adjust to care abroad

On top of housing, work and schooling, Ukrainian refugees with HIV face an additional, urgent difficulty: how to access the antiretroviral medicines they need to suppress the virus. In Poland, they face a particular stigma, causing many HIV positive refugees to conceal their health status.

When Anna Aryabinska fled from Kyiv in March 2022 with her ex-partner’s children, she had little idea that she would end up supporting not only his family, but many HIV-positive Ukrainians in Poland. Until Russia’s full-scale invasion, Aryabinska had been an activist for the Ukrainian organisation Positive Women, supporting women with HIV. Now she is one of a group of volunteers assisting fellow Ukrainian refugees to keep taking medication for HIV, as well as integrate into healthcare systems in European countries which have very different epidemic profiles and standards of treatment.

Ukraine has the second-largest HIV epidemic in Europe after Russia, with an estimated 260,000 people living with the disease. Over six million Ukrainians are now refugees from Russia’s full-scale invasion, according to the UNHCR. In Poland, the top destination, 1.6 million Ukrainians have applied for temporary protection schemes (the vast majority are women and children as martial law bans most men aged 18 to 60 – like Aryabinska’s ex-partner – from leaving Ukraine). On top of issues around housing, work and schooling, people with HIV face an additional, urgent difficulty: how to access the antiretroviral (ARV) medicines they need to take every day to suppress the virus.

Difficult adjustment

Anna Aryabinska left Kyiv in March 2022, when Russian forces were just a few kilometres from the city. Better prepared than many, she took a three-month supply of ARVs and a medical note from Kyiv doctors with her. When she reached Poland she registered right away at the local AIDS centre. Since then, she has been guiding others through a similar process as part of an online service, HelpNow, supported by the Ukrainian NGO Alliance for Public Health.

‘People are in such a panic,’ she says. ‘And they have no one else to ask.’ HelpNow has set up hubs in Poland, Germany and the Baltic states, and has helped Ukrainian refugees in 47 countries with online support, as well as in-person assistance in major refugee hubs like Warsaw. HelpNow volunteers teamed up with local NGOs to help refugees baffled by practical issues like finding translators for medical records or doctor’s appointments, receiving necessary documentation, or simply reaching the nearest AIDS clinic – there are only 16 in Poland, compared to 300 in Ukraine.