Washington D.C., USA, July 2012www.aids2012.org HIV Vulnerabilities of Asian Migrant Workers: Sustaining the Response Malu S. Marin ACHIEVE, Inc./ CARAM-Asia CARAM Asia Action for Health Initiatives (ACHIEVE), Inc.

Washington D.C., USA, July 2012www.aids2012.org It Figures… Temporary labor migration towards the Middle East and, in particular, the Arab States, represents the dominant flow (estimated 28.5 million migrants). There are 13.2 million migrants in South East Asia and East Asia. 1.2 million are working in Malaysia alone. The Philippines has an estimated 3.8 million contract workers abroad and majority of these work in Asia and the Gulf States The total remittance inflow in Asia was USD billion in 2009 (39% of total global remittances). Action for Health Initiatives (ACHIEVE), Inc.

Washington D.C., USA, July 2012www.aids2012.org In the Philippines, 10% among all registered HIV cases are migrant workers (2012 data). In Malaysia 0.03% of migrant workers screened, tested HIV positive as of Cambodian migrant workers have an HIV prevalence rate of 2.5 %, the highest of any migrant population in Thailand. In Bangladesh, 47 of the 259 cases of people living with HIV between were infected as a result of migration. In 2004, 57 of the 102 newly reported HIV cases were among returning migrants. Action for Health Initiatives (ACHIEVE), Inc.

Washington D.C., USA, July 2012www.aids2012.org HIV Prevalence: Migrant workers in 6 high- prevalence provinces of Thailand, 2010 MaleFemaleTotal Age %1.4%1.1% All ages1.7%2.1%1.9% Source : IBBS, Ministry of Health, Bureau of Epidemiology - Thailand, 2010 Action for Health Initiatives (ACHIEVE), Inc.

Washington D.C., USA, July 2012www.aids2012.org MIGRATION, in and by itself, is not a risk factor for HIV infection. Need to look at conditions, in which migrant workers are situated, that predispose or result to ‘risky behaviors’. – Personal factors – Socio-cultural factors – Economic factors Need to look at impact of HIV infection Action for Health Initiatives (ACHIEVE), Inc.

Washington D.C., USA, July 2012www.aids2012.org Initiatives on migration and HIV Pioneered the HIV and migration response in Asia (beginning 2007). – pre-departure – post-arrival – reintegration – policy advocacy (national, regional and international) Placed HIV and AIDS in the map of national and regional responses (18 countries)

Washington D.C., USA, July 2012www.aids2012.org Began in 1997 Inclusion of HIV in national AIDS Plans (2000 onwards) Representation of migration in the National AIDS Body Integration of HIV in training curriculum of all foreign service personnel Sporadic funding and support Migration and HIV response in the Philippines

Washington D.C., USA, July 2012www.aids2012.org – Multisectoral platform for regional advocacy on migration and HIV – Country score card / diagnostics card on access to health for migrant workers in the ASEAN Region – High-level multi-stakeholder dialogues on migration and HIV – Facilitating in-country support Action for Health Initiatives (ACHIEVE), Inc.

Washington D.C., USA, July 2012www.aids2012.org Challenges Political issue – issue of rights, citizenship, security, public health ‘Migration and HIV’ is slipping off in the agenda of country responses and the UN Evidence-based programming is hampered by ‘absence of epidemiological data’ Action for Health Initiatives (ACHIEVE), Inc.

Washington D.C., USA, July 2012www.aids2012.org Migrants fall into the cracks of health care systems of their countries of origin and destination Migrant workers are not a homogeneous group – No interaction with key populations, e.g. sex workers, MSM, IDU, etc. Action for Health Initiatives (ACHIEVE), Inc.

Washington D.C., USA, July 2012www.aids2012.org Lessons learned Partnerships across the migration continuum Community involvement Address policy barriers Need to frame migration as a context, rather than a risk factor Need to look at KPHR in the context of migration or how risky/unsafe behaviors occur in the context of migration Address gender and sexuality issues in the context of migration. Action for Health Initiatives (ACHIEVE), Inc.

Washington D.C., USA, July 2012www.aids2012.org Action for Health Initiatives (ACHIEVE), Inc.