Colombia: Constitutional Court affirms right to continuous HIV care for vulnerable migrants

Translated with Google translate – Scroll down for original article in Spanish

Court demands comprehensive and barrier-free care for migrants on the street with HIV

2025 Ruling T-415 requires the elimination of barriers and guaranteeing health care for homeless migrants with HIV and comorbidities.

The Constitutional Court ordered to guarantee comprehensive, continuous and unadministrative care to homeless migrants who face HIV, associated diseases, mental health and drug dependence. In Judgment T-415 of 2025, the Third Review Chamber concluded that responsible authorities violated fundamental rights by not managing in a timely manner the services ordered by specialists for a Venezuelan citizen in a situation of extreme vulnerability. The ruling establishes a reinforced standard of protection and details immediate obligations for the competent entities.

Constitutional Court sets a reinforced standard of health protection

The sentence originates from the guardianship presented by “Manuela” in favor of Josué, a homeless Venezuelan migrant diagnosed with HIV, tuberculosis, hepatitis C, seborrheic dermatitis, severe mental health effects and drug addiction problems.

The Third Review Chamber, composed of Magistrate Lina Marcela Escobar Martínez (rapporteur), and Magistrates Vladimir Fernández Andrade and Jorge Enrique Ibáñez Najar, determined that the entities involved violated the patient’s rights to life, equality, human dignity, health and social security.

The ruling recalls that article 100 of the Constitution guarantees foreign people the same civil rights as Colombian citizens, while article 4 establishes their duty to comply with the Constitution and the laws. In the face of extreme vulnerability scenarios, state attention must be guided by the principles of human rights, intersectional approach, pro persona, solidarity and human dignity.

Diagnosis and therapeutic continuity: essential pillars of the right to health

The Court reiterated that the right to diagnosis is an integral part of the fundamental right to health. For this right to be guaranteed, three essential components must be met:

  1. Adequate identification of the patient’s condition,
  2. Evaluation and follow-up by the specialist,
  3. Prescription and continuity of treatment.

In the case analyzed, the lack of timely authorizations prevented the continuity of specialized services ordered by treating doctors, which deepened the vulnerability of the patient. The corporation recalled that opportunity and continuity are mandatory principles of the health service, and that administrative barriers cannot be interposed when the life or integrity of the patient is compromised.

Mental health and drug dependence: non-negotiable components of care

The Court pointed out that mental health is an integral part of the fundamental right to health, so Josué had the right to access the psychiatric and toxicology care ordered by his attending physician.

Likewise, he specified that people in a street situation, due to low therapeutic adherence and the complexity of their needs, must receive a’rmative actions that facilitate access to rehabilitation treatments, with or without hospitalization, according to the medical order.

These a’rmative actions as indicated in the legal glossary included in the bulletin – exist to level the conditions of those who have faced historical barriers that prevent them from exercising their rights on equal terms.

Institutional shortcomings: violation of rights due to lack of timely management

The Third Chamber concluded that the entities responsible for the case were unaware of the condition of subject of special constitutional protection of the patient by not managing in a timely manner all the services ordered by the specialists.

The Court stressed that Joshua’s situation represented exceptional and borderline circumstances, requiring an intersectional approach and a comprehensive understanding based on the pro-person, solidarity and human dignity principles.

Denying or delaying services prescribed by dealing professionals, the corporation said, contradicts the constitutional jurisprudence that protects people with multiple conditions of vulnerability.

Orders and measures of immediate compliance

Judgment T-415 of 2025 establishes precise orders to ensure the patient’s effective access to services:

1. Entities responsible for social care

The Court ordered a new classification interview, ensuring that the patient is not excluded from the “street dweller” category, a condition that determines reinforced protection measures and guarantees access to differentiated care routes.

2. Territorial health authorities

The ruling instructed the competent entity to immediately and comprehensively authorize all the services ordered by the specialists regarding their diagnoses related to mental health and drug dependence.
This includes evaluations, therapeutic interventions, prescriptions and follow-ups defined by the treating clinical team.

All these procedures must be carried out without administrative barriers, in accordance with the principles of opportunity and continuity that govern the fundamental right to health.

New obligations for health authorities after Judgment T-415

The ruling of the Constitutional Court, sets guidelines that must be observed by the entities in charge of caring for people in extreme vulnerability:

  • Express recognition of homeless migrants as a population of special constitutional protection.
  • Effective guarantee of the right to diagnosis, specialized assessment and continuity of treatment.
  • Elimination of administrative barriers that prevent the attention ordered by specialists.
  • Application of affirmative actions to facilitate therapeutic adherence and access to comprehensive treatment in mental health and drug dependence.
  • Institutional responses articulated between social and health sectors to avoid interruptions in care.

This precedent reinforces the State’s responsibilities regarding the protection of people with multiple vulnerabilities, especially when they are at risk of life and require urgent intervention.

Corte exige atención integral y sin barreras para migrantes en calle con VIH

Fallo T-415 de 2025 obliga a eliminar barreras y garantizar atención en salud para migrantes habitantes de calle con VIH y comorbilidades.

La Corte Constitucional ordenó garantizar atención integral, continua y sin barreras administrativas a personas migrantes en habitanza de calle que enfrentan VIH, enfermedades asociadas, afectaciones en su salud mental y farmacodependencia. En la Sentencia T-415 de 2025, la Sala Tercera de Revisión concluyó que autoridades responsables vulneraron derechos fundamentales al no gestionar de manera oportuna los servicios ordenados por especialistas para un ciudadano venezolano en situación de extrema vulnerabilidad. El fallo fija un estándar reforzado de protección y detalla obligaciones inmediatas para las entidades competentes.

Corte Constitucional fija un estándar reforzado de protección sanitaria

La sentencia se origina en la tutela presentada por “Manuela” en favor de Josué, un migrante venezolano habitante de calle diagnosticado con VIH, tuberculosis, hepatitis C, dermatitis seborreica, afectaciones severas en su salud mental y problemas de farmacodependencia.

La Sala Tercera de Revisión, integrada por la magistrada Lina Marcela Escobar Martínez (ponente), y los magistrados Vladimir Fernández Andrade y Jorge Enrique Ibáñez Najar, determinó que las entidades involucradas vulneraron los derechos a la vida, igualdad, dignidad humana, salud y seguridad social del paciente.

El fallo recuerda que el artículo 100 de la Constitución garantiza a las personas extranjeras los mismos derechos civiles que a los ciudadanos colombianos, mientras que el artículo 4 establece su deber de acatar la Constitución y las leyes. Ante escenarios de vulnerabilidad extrema, la atención estatal debe guiarse por los principios de derechos humanos, enfoque interseccional, pro persona, solidaridad y dignidad humana.

Diagnóstico y continuidad terapéutica: pilares esenciales del derecho a la salud

La Corte reiteró que el derecho al diagnóstico es parte integral del derecho fundamental a la salud. Para que este derecho sea garantizado, deben cumplirse tres componentes esenciales:

1. Identificación adecuada de la condición del paciente,

2. Valoración y seguimiento por parte del especialista,

3. Prescripción y continuidad del tratamiento.

En el caso analizado, la falta de autorizaciones oportunas impidió la continuidad de servicios especializados ordenados por médicos tratantes, lo que profundizó la vulnerabilidad del paciente. La corporación recordó que la oportunidad y la continuidad son principios obligatorios del servicio de salud, y que las barreras administrativas no pueden interponerse cuando está comprometida la vida o la integridad del paciente.

Salud mental y farmacodependencia: componentes innegociables de la atención

La Corte señaló que la salud mental es una parte integrante del derecho fundamental a la salud, por lo que Josué tenía derecho a acceder a las atenciones por psiquiatría y toxicología ordenadas por su médico tratante.

Así mismo, precisó que las personas en situación de calle, debido a la baja adherencia terapéutica y a la complejidad de sus necesidades, deben recibir acciones afirmativas que faciliten el acceso a tratamientos de rehabilitación, con o sin internado, según la orden médica.

Estas acciones afirmativas según lo indicado en el glosario jurídico incluido en el boletín— existen para nivelar condiciones de quienes han enfrentado barreras históricas que les impiden ejercer sus derechos en igualdad de condiciones.

Falencias institucionales: vulneración de derechos por falta de gestión oportuna

La Sala Tercera concluyó que las entidades responsables del caso desconocieron la condición de sujeto de especial protección constitucional del paciente al no gestionar de manera oportuna la totalidad de los servicios ordenados por los especialistas.

La Corte destacó que la situación de Josué representaba circunstancias excepcionales y límite, exigiendo un enfoque interseccional y una comprensión integral basada en los principios propersona, solidaridad y dignidad humana.

Negar o retrasar servicios prescritos por profesionales tratantes, indicó la corporación, contradice la jurisprudencia constitucional que protege a personas con múltiples condiciones de vulnerabilidad.

Órdenes y medidas de cumplimiento inmediato

La Sentencia T-415 de 2025 establece órdenes precisas para garantizar el acceso efectivo del paciente a los servicios:

1. Entidades responsables de atención social

La Corte ordenó realizar una nueva entrevista de clasificación, asegurando que el paciente no sea excluido de la categoría “habitante de calle”, condición que determina medidas de protección reforzada y garantiza el acceso a rutas de atención diferenciadas.

2. Autoridades territoriales de salud

El fallo instruyó a la entidad competente a autorizar de manera inmediata e integral todos los servicios ordenados por los especialistas respecto de sus diagnósticos relacionados con salud mental y farmacodependencia.
Esto incluye valoraciones, intervenciones terapéuticas, prescripciones y seguimientos definidos por el equipo clínico tratante.

Todas estas gestiones deben adelantarse sin barreras administrativas, conforme a los principios de oportunidad y continuidad que rigen el derecho fundamental a la salud.

Nuevas obligaciones para autoridades de salud tras la Sentencia T-415

El pronunciamiento de la Corte Constitucional, fija lineamientos que deberán observar las entidades encargadas de atender a personas en extrema vulnerabilidad:

  • Reconocimiento expreso de los migrantes habitantes de calle como población de especial protección constitucional.
  • Garantía efectiva del derecho al diagnóstico, valoración especializada y continuidad del tratamiento.
  • Eliminación de barreras administrativas que impidan la atención ordenada por especialistas.
  • Aplicación de acciones afirmativas para facilitar adherencia terapéutica y acceso a tratamiento integral en salud mental y farmacodependencia.
  • Respuestas institucionales articuladas entre sectores sociales y sanitarios para evitar interrupciones en la atención.

Este precedente refuerza las responsabilidades del Estado respecto a la protección de personas con múltiples vulnerabilidades, especialmente cuando se encuentran en riesgo vital y requieren intervenciones urgentes.

 

 

Ireland: HIV stigma persists despite progress as stories of migrant women reveal gaps

‘It hits us harder’: immigrant woman shares stigma of living with HIV

HIV Ireland’s Glow Red Campaign aims to raise awareness of the disease and tackle misconceptions
‘With all the racism going on, we are just afraid to come out,” says Marina, one of five HIV activists from migrant communities who feature in HIV Ireland’s Glow Red Campaign. All are masked to protect their identities.
“Because of stigma and discrimination, and as a woman in a foreign country, you don’t want to be seen as a woman living with HIV,” she says.
“I think, because of all the things happening here in Ireland, the far right being against migrants — and definitely we stand out because of our skin — they would attack us.”
The campaign, Glow Red – Let’s Get to Zero HIV Stigma, features advocate Rebecca Tallon De Havilland alongside HIV activists and migrant women, some living with HIV, others not, to show how stigma persists in Ireland.
“This year’s accompanying banner message on the photo is ‘HIV doesn’t discriminate. Neither should we. Unmask stigma’,” says Stephen O’Hare, director of HIV Ireland. He said the new campaign highlights that HIV stigma is a barrier for women as well as men. “It hits women harder, and particularly women of colour who can face intersectional barriers and discrimination such as HIV stigma, misogyny, sexism and racism.”
There were 989 cases diagnosed in Ireland in 2024; 74% were among people born outside Ireland, with 23% born in Ireland and 3% unknown. A new report from the Health Protection Surveillance Centre said: “Since 2022, there has been a steady increase in rates among women while rates among men have remained stable.”
Professor Fiona Lyons, national clinical lead at the HSE Sexual Health Programme, said research has found late diagnosis is often related to fear of diagnosis and stigma.
“Being diagnosed late means a person may have had HIV for some time before they are diagnosed, and it has already started to damage their immune system,” she said.
Marina (not her real name), who arrived in Ireland from Malawi nearly two decades ago to study, was diagnosed in 2018 when she was in the late stages of the disease. In the last five years, she has experienced a change in attitudes in Ireland and repeated racism, mostly while travelling on public transport.
​She now finds herself adjusting her behaviour to avoid confrontation. “Before five years ago, we were comfortable, we were OK. I have a partner, he’s Irish, and I felt at home. But nowadays, when we walk, we’re watching, you know, who’s coming behind. What if they just beat you up for no reason? On the Luas or the train, we might even give up our seats to people just because you don’t want anyone to say something to you,” she says.
She explains that her late-stage diagnosis came after months of worsening symptoms and missed chances.
“When I was diagnosed in 2018, I was just finishing my course of four years, and the last month was very hard, because I didn’t know I was living with HIV.”
The night before her last exam she realised something was seriously wrong. “I read the whole night, but in the morning, everything was gone.”
Despite volunteering at a sexual health service, GOSHH, she was blindsided by her diagnosis.
“I was sitting at the reception every day, ushering people to come in and test. And I never did, not even once, think about testing,” she adds.
“Not everyone knows how they got HIV. I don’t know how I got it.”
When she finally went to her GP reporting exhaustion, flu-like symptoms and her inability to retain information, blood tests were done, but not for HIV.
Instead, an abnormally high platelet count prompted an oncology referral to rule out cancer. Eight months later, with no clear diagnosis and her platelet levels now normal, she sat in front of a Sudanese doctor who was preparing to discharge her from the service.
She protested that she wasn’t fine. “I feel like I’ve got the flu all the time, I’m always tired nowadays, also I feel like my neck is carrying a mountain,” she explained to the doctor.
Listening intently, the doctor asked whether anyone had ever checked her CD4 count — a key HIV marker. Looking back, Marina believes that the doctor recognised the signs instantly.
Two weeks later, she was told she was HIV-positive. Today, she says her medical treatment has completely reversed those debilitating symptoms. “All of a sudden, everything changed, and I started becoming OK.”
Mr O’Hare explains that 50pc of first-time diagnoses in 2023 were among the heterosexual population, a shift from the traditional perception that HIV primarily affects gay men.
“The total number of people living with HIV, pre-pandemic in Ireland, was estimated to be about 8,000, but since the pandemic, and since the change in demographics, including inward migration and the war in Ukraine, you’re probably seeing in excess of 10,000 people now in Ireland with HIV.”
He is calling for Ireland to follow the UK in rolling out opt-out HIV testing in emergency departments.
“They’ve had great success in identifying cases that were unknown. Ireland could follow suit,” he adds.​

South Africa: Court declares anti-migrant actions against health and education access illegal

Anti-migrant group ordered to stop blocking foreigners from South African healthcare

A South African court has ordered an anti-migrant group to stop blocking foreign nationals from accessing public health facilities and schools, saying such actions are illegal.

Operation Dudula has been picketing hospitals and clinics in Gauteng and KwaZulu-Natal provinces, checking identity cards and stopping anyone who is not South African from entering. This has since extended to schools.

But the high court in Johannesburg has ordered the group to stop “intimidating, harassing [or] interfering with access” to these facilities, following a case brought by rights groups.

South Africa is home to about 2.4 million migrants, just less than 4% of the population, according to official figures.

Most come from neighbouring countries such as Lesotho, Zimbabwe and Mozambique, which have a history of providing migrant labour to their wealthy neighbour.

Xenophobia has long been an issue in South Africa, which has been accompanied by occasional outbursts of deadly violence, and anti-migrant sentiment has become a key political talking-point.

Judge Leicester Adams, handing down judgment on Tuesday, also barred Operation Dudula from making statements that can be construed as hate speech, “unlawfully evicting foreign nationals from their homes… [or] from their trading stalls” and instigating others to do so.

“Dudula” means to remove something by force in the Zulu language.

He also barred law enforcement from conducting “warrant-less searches” in foreigners’ private spaces and said they must have “reasonable suspicion” that a person was in the country unlawfully before asking them to identify themselves.

South African police came under scrutiny after human rights organisations accused them of failing to act against Operation Dudula or protect the public from their unlawful conduct.

Several Operation Dudula members were arrested for blocking the entrances of public health facilities in August. They were later released with a warning.

The organisation says it is disappointed by the ruling and intends to appeal against it, according to South African online publication News24.

Kopanang Africa Against Xenophobia, one of the organisations that took the case to court, said the “judgment provides critical protection for those targeted by xenophobic attacks”.

“In a country founded on the rejection of apartheid, we cannot allow ourselves to be subjected to the xenophobic hate promoted by Operation Dudula,” the human rights organisation said in a statement.

Kopanang said there would be proactive monitoring at schools and clinics to ensure compliance with the order and that it would hold the police accountable for enforcing it.

“Should the police fail in their duty to enforce the order… we are prepared to report their inaction to formal oversight bodies,” the organisation told the BBC.

South Africa’s Health Minister Dr Aaron Motsoaledi said the ruling “was to be expected” as it echoed the government’s stance that no-one should be denied access to healthcare, irrespective of their legal status.

Dr Motsoaledi met Operation Dudula leaders in August, at the height of their protests at health facilities, and criticised their methods.

“I told them [at the time] that whatever concerns they have, some of which might be legitimate by the way, they are [using] the wrong method,” he told local broadcaster 702 on Tuesday.

One of the demands the group had for the minister when they met was that anyone without documentation be turned away at healthcare facilities but Dr Motsoaledi said this would be difficult as 11% of South Africans do not have national ID cards.

The minister also criticised South Africa’s neighbours for not doing more to help reduce the pressure on the country’s overburdened healthcare system, suggesting this was being worsened by the influx of migrants.

“It is South Africa which is suffering, not them. In fact, many of them are relieved,” he said.

European studies reveal systemic gaps in HIV care for migrants

EACS 2025: Are Europe’s migrants acquiring HIV after arrival?

More than 60% of HIV diagnoses among migrants in Switzerland occur after arrival, with some groups waiting up to 6 years before detection; findings that expose significant gaps in the country’s prevention and screening strategies.

A new analysis of the Swiss HIV Cohort Study shows that among 1713 migrants diagnosed between 2010 and 2024, 62.1% were diagnosed post-migration. This challenges the longstanding assumption that most infections occur before arrival from high-prevalence regions and aligns with another recent analysis estimating that about 30% of migrants acquire HIV after migration, underscoring ongoing risk in host countries despite prevention programs.

Presenting the 15‑year analysis at the European AIDS Clinical Society (EACS) 2025 Annual Meeting, PhD researcher Jessy J. Duran Ramirez of University Hospital Zurich, Zurich, reported that migrants now account for 49% of new HIV diagnoses in Switzerland — a share that has risen steadily even as rates in other European populations stabilize or decline.

“Despite the overall decrease and stagnation in new HIV diagnoses, migrants remain disproportionately affected,” Duran Ramirez said.

Delayed Diagnosis Patterns Emerge

Among the study’s key findings were notable diagnostic delays across migrant populations. Compared with 5 years for men who have sex with men (MSM) and just 2 years for female heterosexuals, male heterosexuals from migrant populations wait a median of 6 years from immigration to HIV diagnosis.

Key Statistics from 3490 participants (2010-2024):

  • 1777 Swiss nationals; 1713 migrants
  • 62.1% of migrant diagnoses occurred post-migration
  • Median age at diagnosis: 38 years (migrants) vs 44 years (Swiss nationals)
  • CD4 count at diagnosis: 339 cells/µL (migrants) vs 404 cells/µL (Swiss nationals)

Migrants from Asia experienced the longest delays overall, with a median of 12 years from immigration to diagnosis.

These delays resulted in significantly lower CD4 counts at diagnosis compared with Swiss nationals, indicating more advanced disease progression.

The demographic profile of post-migration diagnoses also differed markedly from that of Swiss nationals. Women accounted for 27% of migrant diagnoses vs only 11% among Swiss nationals, while MSM represented 43% of migrant cases compared with 63% of Swiss cases.

Cultural and Structural Barriers

Jürgen Rockstroh, MD, head of the HIV outpatient clinic at the University of Bonn, Bonn, Germany, identified multiple obstacles preventing effective screening among migrant populations across Europe.

“People who are migrating to Europe, or are refugees, have difficulties in accessing the healthcare system because there are language barriers, there are insurance and cost coverage barriers,” he said. “The question is, how can you reach these populations?”

He pointed to successful European models like Malta’s mobile health units, which embed HIV testing within general healthcare services, and Athens’ targeted health centers designed specifically for migrants and refugees, where peers guide others from their community to access care.

“African women, for example, are not going to go to a more gay-dominated testing space. They just don’t feel comfortable there. I think we need more targeted, market-specific checkpoints,” he explained.

Promising Innovative Approaches

The PARTAGE project in France demonstrates one effective strategy for reaching migrant men, a traditionally difficult population to engage in healthcare. By offering health checkups to expectant fathers during their partner’s pregnancy, the program achieved HIV screening rates of 95%-96% across all groups.

PARTAGE Project Results (1347 expectant fathers):

  • 63% held immigrant status; 8% without health coverage
  • HIV screening achieved in 95%-96% across all groups
  • Medical diagnoses: 18% (all participants), 22% (immigrants), and 41% (immigrants without coverage)
  • Healthcare referrals: 17% (all), 20% (immigrants), and 41% (immigrants without coverage)
  • Social support referrals: 11% (all), 17% (immigrants), and 72% (immigrants without coverage)
  • Vaccination updates: 44% (all), 52% (immigrants), and 73% (immigrants without coverage)

Pauline Penot, MD, from Centre Hospitalier André Grégoire, Montreuil, France, who led the PARTAGE study, found the intervention particularly effective among disadvantaged migrants, leading to (any) medical diagnoses and healthcare referrals in 41% of participants without health coverage.

“This is the first structured health intervention to address adult men’s health by using the symbolic event of expecting a child,” Pinot said. “It showed greater attendance, and more effects were observed among disadvantaged migrants.”

Pinot noted that migrants often arrive in Europe healthier than native populations, but their health deteriorates faster, especially among those from poorer regions. She suggested that scaling the PARTAGE model across France and other European countries could help reduce social and gender health inequalities.

Policy Implications

The Swiss data underscores an urgent need for culturally sensitive, accessible screening programs that can identify HIV infections earlier in migrant populations across Europe. With roughly one third of post-migration diagnoses occurring within the first year of arrival — a period of particular vulnerability — the window for intervention remains narrow but critical.

For Duran Ramirez, the next phase of research will focus on determining whether these post-migration diagnoses represent infections acquired after arrival or pre-existing infections that went undetected.

“Understanding the timing of HIV acquisition and diagnosis in migrant populations is essential to designing prevention strategies that reach them earlier,” she said.

The findings suggest that current European prevention infrastructure, while effective for established populations, requires significant adaptation to address the complex healthcare needs of its increasingly diverse migrant communities.

Duran Ramirez reported receiving research grants or fellowships to her institution from Gilead Sciences Switzerland Sàrl and ViiV Healthcare that were unrelated to this work. Rockstroh reported receiving honoraria for educational talks for ViiV Healthcare, Merck, and Gilead Sciences. Penot reported having no relevant financial relationships.

Russia: From March 2026, migrants will be required to undergo screening for hepatitis

New medical requirements are being established in Russia for foreign citizens planning to engage in labor activity. The Ministry of Health of Russia announced that starting from March 1, 2026, migrants will be required to undergo screening for acute hepatitis, as well as chronic viral hepatitis types B and C.

According to the newspaper Vedomosti, this requirement will apply to all foreign citizens entering the territory of Russia for employment, as well as to stateless persons, asylum seekers, and those applying for temporary refuge in the country.

The draft amendments to the procedure for conducting medical examinations have already been posted on the federal portal of regulatory legal acts. The explanatory note states that these changes are necessary “to improve the organizational foundations and the procedure for conducting medical examinations.”

According to the new regulation, every migrant who wishes to obtain a work permit, temporary residence permit, or permanent residence permit in Russia will have to provide a medical certificate. This rule is based on the law governing the legal status of foreign citizens in the Russian Federation.

At present, migrants are mainly tested for the presence of narcotic substances and diseases that pose a danger to others, including HIV, tuberculosis, syphilis, and leprosy. The new requirements provide for broader health monitoring.

According to officials, these measures are aimed not only at protecting public health but also at expanding opportunities for early detection and treatment of illnesses among migrants. In addition, they are intended to ensure medical safety in the labor market and to create a healthier environment.

Given that migration processes in Russia have become more active in recent years and the number of labor migrants continues to grow, the new procedure is viewed not only as a preventive measure but also as part of state policy focused on strengthening public health.

Thus, starting from 2026, every person arriving in Russia in search of work will be required to provide detailed medical information — through this, the state aims to make the labor environment more controlled and safer.

US: Groups of lawfully present immigrants to lose access to federally funded health coverage

1.4 Million Lawfully Present Immigrants are Expected to Lose Health Coverage due to the 2025 Tax and Budget Law

Congressional Republicans and President Trump passed the tax and budget reconciliation bill in July 2025. The new law includes significant cuts to the Medicaid program as well as eligibility restrictions for many lawfully present immigrants, including refugees and asylees, to access Medicaid and the Children’s Health Insurance Program (CHIP), subsidized Affordable Care Act (ACA) Marketplace, and Medicare coverage. Under longstanding federal policy, undocumented immigrants already are ineligible for federally funded health coverage. This policy watch outlines the groups of lawfully present immigrants that will lose access to federally funded health coverage due to the 2025 tax and budget law and the Congressional Budget Office’s (CBO’s) estimates of the increases in the number of uninsured and federal savings and revenue changes due to these provisions.

CBO estimates that the law’s restrictions on eligibility for federally funded health coverage for lawfully present immigrants will result in about 1.4 million lawfully present immigrants becoming uninsured, reduce federal spending by about $131 billion, and increase federal revenues by $4.8 billion as of 2034. Additional lawfully present immigrants are likely to lose Marketplace coverage and become uninsured due to the anticipated expiration of the enhanced subsidies for this coverage. Moreover, under Trump administration regulatory changes, the more than 530,000 Deferred Action for Childhood Arrivals (DACA) recipients are ineligible for federally funded coverage options.

Changes in Eligibility for Lawfully Present Immigrants Under the 2025 Tax and Budget Law

Medicaid and CHIP

Under prior law, to be eligible for Medicaid and CHIP, immigrants were required to have a “qualified” immigration status in addition to meeting other eligibility requirements such as income. Qualified immigrants, as defined by the 1996 Personal Responsibility and Work Opportunity Act and subsequent additions, include lawful permanent residents (LPRs or “green card” holders); refugees; individuals granted parole for at least one year; individuals granted asylum or related relief and certain abused spouses and their children or parents; certain victims of trafficking; Cuban and Haitian entrants; and citizens of the Freely Associated (COFA) nations of the Marshall Islands, Micronesia and Palau residing in U.S. states and territories. In addition, many had to wait five years after obtaining qualified status before they could enroll in Medicaid even if they met other eligibility requirements. States have an option to extend Medicaid and/or CHIP coverage to all children and/or pregnant individuals who are lawfully residing and waive the five-year wait for these groups, which 39 states plus D.C. had taken up as of January 2025. States also have the option in CHIP to provide prenatal care and pregnancy related benefits to targeted low-income children beginning from conception to end of pregnancy (FCEP) regardless of their parent’s immigration status, which 24 states plus D.C. had taken as of April 2025.

The 2025 tax and budget law will restrict Medicaid or CHIP eligibility to LPRs, Cuban and Haitian entrants, people residing in the U.S. under COFA, and lawfully residing children and pregnant immigrants in states that cover them under the Medicaid and/or CHIP option (Table 1). States also will still have the option to extend prenatal and pregnancy-related benefits to targeted low-income children from conception through the end of pregnancy through the FCEP option. These restrictions will eliminate eligibility for many other groups of lawfully present immigrants, including refugees and asylees without a green card, among others (Table 1). This provision will become effective October 1, 2026, and CBO estimates that it will reduce federal spending by $6.2 billion and lead to an additional 100,000 individuals becoming uninsured by 2034.

ACA Marketplaces

Under prior law, lawfully present immigrants have been eligible to enroll in ACA Marketplace coverage and receive premium subsidies and cost-sharing reductions, including individuals with Temporary Protected Status (TPS), those with Deferred Enforced Departure, and people on work visas. In general, Marketplace coverage is limited to individuals with incomes at or above 100% of the federal poverty level (FPL), since most of those with lower incomes would be eligible for Medicaid. However, some lawfully present immigrants with lower incomes remain ineligible for Medicaid (e.g., due to the five-year waiting period and eligibility limits to qualified immigrants). To address this gap, Marketplace eligibility was also extended to lawfully present immigrants with incomes under 100% FPL who do not qualify for Medicaid due to their immigration status, including those in the five-year waiting period for Medicaid coverage. In the years after the ACA was passed, DACA recipients were excluded from eligibility for the Marketplaces despite being lawfully present. Under regulations issued by the Biden Administration in May 2024, DACA recipients were made newly eligible for the Marketplaces and to receive subsidies to offset costs starting November 2024. However, this coverage was blocked in some states due to legal challenges, and on June 25, 2025, the Trump administration finalized a rule that once again made DACA recipients ineligible to purchase ACA Marketplace coverage as of August 25, 2025. Most states will terminate coverage for enrolled DACA recipients on September 30, 2025.

The law will also limit eligibility for subsidized ACA Marketplace coverage to lawfully present immigrants who are LPRs, Cuban and Haitian entrants, and people residing in the U.S. under COFA. (Table 1). A broader group of lawfully present immigrants will lose access to subsidized Marketplace coverage under this change, including refugees and asylees without green cards, people with TPS, and individuals on work visas, among others, beginning January 1, 2027. The CBO estimates that this provision will lead to an additional one million individuals becoming uninsured and reduce federal spending by $91.4 billion over the 2026 to 2035 time period. In addition, the provision is expected to increase federal revenue by $4.8 billion as of 2034. The law also eliminates access to subsidized Marketplace coverage for lawfully present immigrants earning less than 100% FPL who are not eligible for Medicaid due to immigration status, including those in the five-year waiting period for coverage, beginning January 1, 2026. During the 2025 open enrollment period, nearly 550,000 people with incomes under 100% FPL were enrolled in a Marketplace plan, who are likely primarily lawfully present immigrants who are ineligible for Medicaid due to immigration status. The CBO estimates that this provision will lead to an additional 200,000 individuals becoming uninsured and reduce federal spending by $27.3 billion over the 2026 to 2035 time period. In addition, the provision is expected to increase federal revenue by $176 million as of 2034.

Medicare

Lawfully present immigrants have been eligible for Medicare if they have the required work quarters and meet the disability or age requirements. Those without required work history could also purchase Medicare Part A after residing legally in the U.S. for five years continuously.

Under the new law, Medicare eligibility also will be limited to lawfully present immigrants who are LPRs, Cuban and Haitian entrants, and people residing in the U.S. under COFA, eliminating eligibility for refugees and asylees without a green card, people with TPS, and people with work visas, among others (Table 1). Current beneficiaries subject to the new restrictions will lose coverage no later than 18 months from the enactment of the legislation (January 4, 2027). The CBO estimates that this provision will lead to an additional 100,000 individuals losing coverage, with a federal spending reduction of $5.1 billion and a federal revenue decrease of $123 million as of 2034.

Qatar: Alleged deportations of HIV positive Kenyans highlight stigma and rights issues

Uproar over claims of HIV+ Kenyans facing deportation in Qatar

For thousands of Kenyans working abroad, Qatar, to be precise, the promise of retaining the job comes with a lot of rules and uncertainty. Now, unverified reports of HIV+ workers facing deportation have surfaced.

Recently, there have been claims online suggesting that hundreds of Kenyans living and working in Qatar are facing deportation after testing positive for HIV. The reports, originating from diaspora-focused blogs and social media accounts, allege that over 200 Kenyans are at risk of being sent back home on medical grounds.

Though these stories have attracted a lot of attention both in Kenya and the diaspora community, it is important to note that these claims have not remained unverified. More trusted sources, such as the diaspora media, human rights, or the Qatari/ Kenyan government, have not issued an official statement regarding the claims.

Some Kenyan bloggers, such as DJ Mbayaz have posted on their TikTok claiming that all the Kenyans who are being deported went there while they were negative, claiming that they contracted it in Qatar, hence the deportation seems unfair.

This has raised wider questions about the health policies in the Gulf, the human rights of migrant workers, and the persistent stigma surrounding HIV/AIDS. Advocacy groups stress the need for diplomacy.

“If these reports are true, the Kenyan government has a duty to protect its citizens abroad, while also engaging with Qatar on the importance of upholding human rights,” one Nairobi-based HIV activist told this writer.

Qatar, like several other countries, has always required a mandatory medical screening, including checks for tuberculosis, hepatitis, and HIV/AIDS, for incoming migrants before issuing residency permits.

If one is found positive for any of the above, they are automatically denied work permits. The human rights organization has criticized these policies as they don’t align with the international standards on non-discrimination of people living with HIV.

What remains unclear is how these rules apply to migrant workers who contract the disease while already living in Qatar.

Whether or not the reported deportations are taking place, the controversy highlights an ongoing tension.

It underlines how stigma is continuing to shape policies in ways that can harm public health. The conversations have been triggered about how migrant workers with HIV are being treated.

Until official clarification emerges, what is clear is that the issue has struck a nerve with Kenyans both at home and in the diaspora.

Canada: HIV Legal Network seeks to rejoin a constitutional challenge against immigration law

Returning to Federal Court in constitutional challenge of Canada’s “Excessive Demand” Regime 

On September 18, 2025, at 9:30 a.m., the Federal Court will hear the HIV Legal Network’s motion to rejoin a constitutional challenge to Canada’s “excessive demand” regime in immigration law. This hearing is a critical moment in the fight to ensure that Canada’s immigration laws respect the Charter and protect the rights of people living with HIV.

This case arises from Immigration, Refugees and Citizenship Canada’s decision to deny a work permit to an applicant based on his HIV status, citing s. 38(1)(c) of the Immigration and Refugee Protection Act. This provision bars entry or stay in Canada for people whose health needs are expected to create an “excessive demand” on public healthcare services.

The HIV Legal Network has fought against this discriminatory regime since its introduction in 2001, highlighting how it stigmatizes people living with HIV and excludes them from equal access to immigration pathways. At this hearing, the Legal Network – supported by Downtown Legal Services – will argue that it should be granted public interest standing because of its deep expertise, long record of advocacy, and unique ability to bring forward the voices and evidence of people most affected by this law.

Details

  • Hearing: September 18, 2025, 9:30 a.m. (Federal Court)
  • Case #: IMM-12720-23
  • Observation: Members of the public and media can register to observe virtually via the Federal Court website (https://www.fct-cf.ca/en/court-files-and-decisions/hearing-lists). We recommend registering at least 24 hours prior to the hearing to ensure you receive a link.

Related documents:

Motion Record of the HIV Legal Network

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Memorandum of Fact and Law of the HIV Legal Network

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Affidavit of Sandra Ka Hon Chu (On behalf of the HIV Legal Network)

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Affidavit of Anonymized Applicant

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Applicant’s Memorandum of Argument

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Lithuania: Migrants influence the dynamics of HIV infection

HIV in Lithuania: migrants from Ukraine and Eastern Europe are changing the epidemiological picture.

More than a third of new HIV cases in Lithuania are from foreigners. Most of them are from Ukraine and other countries of Eastern Europe. These statistics reflect not only the migration processes caused by war and economic difficulties, but also indicate the continuing problem of the spread of HIV in the region, which Europe considered almost under control.

According to the National Center for Public Health of Lithuania, the country has seen an increase in the incidence of HIV since 2022. In the center, he is associated with the influx of infected foreign citizens.

Statistics for 2024 indicate that almost 90% of infected foreigners came to Lithuania from Eastern Europe – Ukraine, Belarus, Azerbaijan, Georgia and Moldova.

Angela Moiseenko, head of the Chernihiv branch of the charitable organization “All-Ukrainian Network of People Living with HIV/AIDS”, told LRT.lt about how the situation with HIV is developing, and how the system of detection and treatment of infection works in the conditions of military conflict.

“Ukraine occupies one of the leading places in the spread of HIV in Eastern Europe. More only in Russia and Kazakhstan,” she says.

Nevertheless, in recent years, systematic work has been built in Ukraine to combat the epidemic, especially in terms of identifying new cases. “Over the past 10 years, a lot of attention has been paid to this topic in Ukraine. We are actively engaged in HIV detection, because what we see is only the tip of the iceberg. The more tests are carried out, the better we know the real situation,” Moiseenko explains.

The system covers both state institutions and initiatives supported by international partners. The country has the Global Fund to Fight AIDS, Tuberculosis and Malaria, which funds large-scale HIV testing and prevention programs. Too, both state and public organizations participate in this process.

“We actively use rapid tests that allow us to determine the presence or absence of antibodies within 20-30 minutes. Our organization has been working in the field of overcoming HIV infection for 20 years, and we are also actively engaged in identifying, referring for treatment and accompanying people,” the expert says.

The health care system in Ukraine is built on a three-level model: primary care – family doctors, secondary – polyclinics and hospitals, as well as tertiary – specialized institutions. At the second level, there is a network of “trust offices” that provide HIV treatment services.

“There are such offices in almost all second-level hospitals. Funding goes through the National Health Service of Ukraine, which pays for medical services under the so-called packages. For example, an HIV test is included in 11 medical care packages at once,” Moiseenko explains.

Nevertheless, the proportion of foreigners among new cases is gradually decreasing:

  • in 2022 they were 47%;
  • in 2023 – 37%;
  • in 2024 – 34%;

For comparison, the EU average is about 50%.

In 2024, among registered foreign citizens with HIV, 86.8% came from Eastern European countries – Ukraine, Belarus, Azerbaijan, Georgia and Moldova. This trend has been maintained since 2022.

More than 80% of these patients receive antiretroviral therapy, which indicates an understanding of the importance of treatment and prevention.

Of the 68 foreign citizens identified with HIV in 2024, 59% are men and 41% are women. The main ways of infection:

  • 46% – heterosexual contacts;
  • 22% – homosexual contacts;
  • 4% – injecting drugs;
  • 31% – unknown ways;
  • 3% – perinatal (from mother at birth).

The age of 37% of infected foreigners is from 40 to 49 years old, and 24% are from 30 to 39.

Recommendations for HIV testing, approved by the order of the Minister of Health of Lithuania. They provide in which cases – in certain epidemiological or clinical conditions – it is recommended to conduct HIV testing. The doctor, having received information from the patient and evaluated it, should offer to conduct testing.

Colombia: HIV risks for LGBTIQ+ migrants linked to gaps in care and prevention

Translated with Google Translate. Scroll down for article in Spanish.

NGO warns of increase in HIV cases in LGBTIQ+ migrants

The lack of delivery of medicines and preservatives to health entities would increase the risk among the diverse population.

The NGO Caribe Afirmativo, which defends the rights of LGBTIQ+ people (lesbians, gay, bisexuals, intersexuals, trans and queer), warned about the increase in HIV infections (Human Immunodeficiency Virus, which can cause AIDS) among migrants belonging to this population.

The warning was issued from the Migration Summit that takes place in Riohacha (La Guajira) by Wilson Castañeda, spokesman for Caribe Afirmativo, who pointed out that the prevalence of increase occurs especially among Venezuelan migrants living in Colombia.

For Caribe Afirmativo, which works to transform prejudices, imaginaries and social and institutional practices around sexual and gender diversity, the lack of delivery of medicines and condoms in health entities would be increasing the risk among migrants who make up the diverse population.

“When specifically looking at LGTBIQ+ migrants, it was identified that there was a prevalence that for every 10 migrants living with HIV, 5 were trans people,” Castañeda explained.

For the social activist, this “shows that in the universe of migrants living with HIV, 70% are LGTBIQ+ people.” He considered that “care must be reoriented to people of gender diversity, especially in countries such as Colombia.”

Castañeda called for the State to re-improve the attention to this population living with HIV, taking into account the increase figures that not only include migrants but also the returned population.

The NGO Caribe Afirmativo specified that one of the challenges facing Colombia in the face of HIV is access to medicines, taking into account that, despite the efforts of organizations such as AHF Colombia, obtaining antiretroviral medication for Venezuelan migrants is a constant challenge.

Another challenge would be the need for health and humanitarian care programs to support the provision of services and the distribution of treatments among this population.

ONG alerta aumento de casos de VIH en migrantes LGBTIQ+

La falta de entrega de medicamentos y preservativos en las entidades de salud, estaría aumentado el riesgo entre la población diversa.

La ONG Caribe Afirmativo, que defiende los derechos de las personas LGBTIQ+ (lesbianas, gais, bisexuales, intersexuales, trans y queer), advirtió sobre el incremento de infecciones con el VIH (Virus de Inmunodeficiencia Humana, que puede ocasionar sida) entre migrantes pertenecientes a esta población.

La advertencia fue lanzada desde la Cumbre Migratoria que se desarrolla en Riohacha (La Guajira) por parte de Wilson Castañeda, vocero de Caribe Afirmativo, quien señaló que la prevalencia de aumento se da especialmente entre los migrantes venezolanos radicados Colombia.

Para Caribe Afirmativo, que trabaja en transformar los prejuicios, imaginarios y prácticas sociales e institucionales en torno a la diversidad sexual y de género, la falta de entrega de medicamentos y preservativos en las entidades de salud estarían aumentando el riesgo entre los migrantes que conforman la población diversa.

“Cuando se miraba específicamente las personas migrantes LGTBIQ+ se identificaba que había una prevalencia de que cada 10 personas migrantes viviendo con VIH, 5 eran personas trans”, explicó Castañeda.

Para el activista social, esto “deja en evidencia que en el universo de migrantes viviendo con VIH, un 70% son personas LGTBIQ+”. Consideró que “hay que reorientar la atención a personas de diversidad de género, especialmente en países como Colombia”.

Castañeda llamó a que el Estado vuelva a mejorar la atención a esta población viviendo con VIH, teniendo en cuenta las cifras de aumento que no solo incluyen personas migrantes sino, además, población retornada.

La ONG Caribe Afirmativo precisó que uno de los desafíos que afronta Colombia frente al VIH son el acceso a medicamentos teniendo en cuenta que, a pesar de los esfuerzos de organizaciones como AHF Colombia, obtener la medicación antirretroviral para migrantes venezolanos es un desafío constante.

Otro de los desafíos sería la necesidad de programas de salud y atención humanitaria para fundamentar la prestación de servicios y la distribución de tratamientos entre esta población.