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SEMINAR ON HEALTH AND MIGRATION REGIONAL CONFERENCE ON MIGRATION GUATEMALA, 2004

SEMINAR ON HEALTH AND MIGRATION REGIONAL CONFERENCE ON MIGRATION GUATEMALA, 2004 THE IMPORTANCE OF REGIONAL ACTION IN HIV/AIDS PREVENTION IN MOBILE AND MIGRANT POPULATIONS IN CENTRAL AMERICA Ana Leonor Ramírez, IO M.

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SEMINAR ON HEALTH AND MIGRATION REGIONAL CONFERENCE ON MIGRATION GUATEMALA, 2004

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  1. SEMINAR ON HEALTH AND MIGRATION REGIONAL CONFERENCE ON MIGRATION GUATEMALA, 2004 THE IMPORTANCE OF REGIONAL ACTION IN HIV/AIDS PREVENTION IN MOBILE AND MIGRANT POPULATIONS IN CENTRAL AMERICA Ana Leonor Ramírez, IOM

  2. HIV/AIDS PREVENTION IN MOBILE AND MIGRANT POPULATIONS AS THE FIELD OF WORK • HIV/AIDS SITUATION AND MIGRATION PROCESSES IN CENTRAL AMERICA • ACHIEVEMENTS OF THE REGIONAL INITIATIVES RELATED TO HIV/AIDS PREVENTION AND MOBILE POPULATIONS • CHALLENGES

  3. HIV/AIDS PREVENTION IN MOBILE AND MIGRANT POPULATIONS AS THE FIELD OF WORK: • RELATIVELY NEW • ARTICULATES TWO COMPLEX GLOBAL PHENOMENA, IN TERMS OF NATURE AND MAGNITUDE: THE HIV/AIDS EPIDEMIC AND THE MIGRATION PROCESSES • BOTH PHENOMENA ARE INCREASING

  4. IOM HAS SYSTEMATIZED ITS WORK EXPERIENCE IN THIS FIELD IN THE FOLLOWING GUIDELINES: • HIV/AIDS in mobile and migrant populations should be addressed including the complete spectrum of mobility and should go beyond borders. For this reason it is fundamental to consider regional approaches. • All mobile and migrant populations have to be considered; refugees, displaced persons, migrant workers, and victims of traffic and trade. • The main objective is to reduce the vulnerability of these populations regarding HIV/AIDS infection.

  5. IOM HAS SYSTEMATIZED ITS WORK EXPERIENCE IN THIS FIELD IN THE FOLLOWING GUIDELINES: • HIV/AIDS should be addressed within a wide and comprehensive context of health as a right, regardless of the condition of migration. • The generally precarious mobilization conditions of people have to be recognized as risk factors for infection. • Orientation, education, community mobilization, and defense of human rights should be fostered for and with these populations.

  6. The relevance of the relationship between the HIV/AIDS epidemic and migration was recognized by United Nations in the Extraordinary Session of the General Assembly on HIV/AIDS that was held in June 2001. In this session it was agreed that the Member States should: “develop and start implementing national, regional, and international strategies to facilitate access to HIV/AIDS prevention programs for migrant workers and mobile populations, including the provision of information on social and health services, by 2005”

  7. HIV/AIDS and MIGRATION are two complex phenomena in terms of nature and magnitude, with a tendency of increasing. In 2003 it was estimated that: 37.8 million people live with HIV/AIDS (35 million in 2001) 175 millon people live outside their country of origin because they left in search of better living conditions and work opportunities (150 million in 2001)

  8. BOTH PHENOMENA ARE ABOUT POPULATIONS WHO ARE: -IN POVERTY CONDITIONS -YOUNG -INCREASINGLY MORE WOMEN BOTH PHENOMENA SHOULD PREVENT AND ADDRESS: HIV/AIDS: PREVENTION OF NEW INFECTION AND TREATMENT FOR PEOPLE LIVING WITH HIV MIGRATION: PEOPLE WHO MOVE AGAINST THEIR WILL AND WITHOUT THE REQUIRED DOCUMENTS, MAINLY VICTIMS OF TRADE AND TRAFFIC

  9. THE RELATIONSHIP BETWEEN HIV/AIDS AND MIGRATION IN CENTRAL AMERICA REFLECTS GLOBAL TENDENCIES THE HIV/AIDS EPIDEMIC CONTINUES INCREASING: 4 of the 6 Latin American countries with high VIH prevalence rates are located in this region: BELIZE GUATEMALA HONDURAS PANAMA

  10. THE CHARACTERISTICS OF THE EPIDEMIC IN CENTRAL AMERICA ARE AS FOLLOWS: • Predominant sexual transmission, mainly heterosexual, with the exception of Costa Rica. • The most affected populations are young people (15 - 49 years). • It affects populations with restricted socioeconomic conditions and high risk groups like men who have sex with other men, sex workers, people who are deprived of freedom, socially excluded girls, boys, and teenagers, and security forces (police and military). • In addition, there is an increase in incidence rates among women.

  11. THE EPIDEMIC IN THE CENTRAL AMERICAN REGION IS: GENERALIZED IN GUATEMALA, HONDURAS, AND PANAMA CONCENTRATED IN EL SALVADOR, NICARAGUA, AND COSTA RICA

  12. THE EPIDEMIOLOGIC SURVEILLANCE SYSTEMS ALTHOUGH OBLIGATORY: HAVE AN ESTIMATED 20 – 60% SUB RECORD OF CASES BETWEEN REPORTED AND ESTIMATED CASES

  13. Belize Costa Rica El Salvador Guatemala Honduras Nicaragua Panama AIDS Cases (*) HIV Positive Cases 2,676 (**) ------ 2,546 ------ 6,208 ------ 6,540 ------ 15,751 4,566 665 566 6,141 ------ Reported AIDS Cases and HIV Positive Cases (*) December 2003 (**) Includes HIV/AIDS Total of AIDS cases in the region: 40,517

  14. Total 217,606

  15. OTHER RELEVANT PROBLEMS THAT THE EPIDEMIOLOGIC SURVEILLANCE SYSTEMS ARE FACING ARE: • Lack of standardized AIDS case definition • Lack of behavior data on the report card for HIV/AIDS • Insufficient or irregular mortality records

  16. IN ADDITION, THE MIGRATION PROCESSES IN THE CENTRAL AMERICAN REGION ARE COMPLEX IN NATURE AND MAGNITUDE: extra-regional and intra-regional The extra-regional processes refer to Central American migrants and migrants from other countries that migrate to the United States and Canada. For example, 2 million Central Americans left their country of origin and hundreds of thousands crossed the border between Mexico and the USA in 2000.

  17. The intra-regional processes refer to people who mobilize between the countries in the region. Entry and exit data show that 506,753 or 60% of the people who mobilized last year are in Costa Rica and 16% are in Panama. In addition, there is mobilization from Nicaragua to El Salvador and Honduras, and to a lesser degree from Honduras to Nicaragua and El Salvador, and from Costa Rica to Nicaragua and Panama.

  18. -In both cases - extra-regional and intra-regional movements – most of the people do not have the required documents, so the official data do not include them. -The countries in the region face limitations to developing migration policies in accordance with real conditions where these types of movements are generated. In addition, there are inequity conditions. -There are still judicial schemes in place that violate human rights of these populations.

  19. THE REGIONAL INITIATIVES: The regional initiatives began as a result of recognizing that the mobility of populations is a factor that determines vulnerability to HIV, with serious consequences for the social and economic development of the countries. It was also recognized that the national response could be strengthened to influence prevention of the epidemic.

  20. REGIONAL INITIATIVES: 1)1999: “Poblaciones Móviles y VIH/SIDA en México Centroamérica y Estados Unidos”, Instituto Nacional de Salud Pública, Mexico (INSP) 2)2002: “Protegiendo a las Poblaciones Migrantes del VIH/SIDA en Centroamérica y México” (UNFIP, UNDP, UNFPA). This initiative became the Iniciativa Mesoamericana de Prevención del SIDA (IMPSIDA) 3)2003: “Promoción de una mayor conciencia entre parlamentarios y otros tomadores de decisión, acerca de las infecciones de transmisión sexual, el VIH/SIDA y los derechos sexuales y reproductivos en Centroamérica” UNFPA/IIDH 4)2003: “Proyecto para la prevención del VIH/SIDA en Centroamérica y el Caribe” OPEC/UNFPA 5)2003: “Proyecto para policies y fuerzas armadas”, ONUSIDA / UNFPA 6)2003: “Mesoamerican Project in Integral Care for Mobile Populations: Reducing Vulnerability of Mobile Populations in Central America to HIV/AIDS” 7)2003: Proyecto Regional de ITS/VIH/SIDA para América Central, World Bank

  21. ACHIEVEMENTS (1) Articulating both phenomena Within the context of the Central American reality with a regional perspective based on recognizing the relationship between the “high population mobility” and the presence of HIV/AIDS. (2)Establishing and strengthening relationships for a regional coordination Of a high political and technical level between national entities that are responsible for formulating and developing national policy on HIV/AIDS, civil society organizations and technical cooperation organizations. (3) Having incorporated people who are living with HIV/AIDS Into the work teams at the national and regional level.

  22. ACHIEVEMENTS (4) Developing national, binational and regional interventions This allowed to include the southern border of Mexico because of the magnitude, complexity and implications of migration at that border. (5) Mobilizing resources: US $ 22 million This strengthens national initiatives approved by the Global Fund for US$39 millones. If this amount is added to the previous amount the total sum is $61,5 million. (6) Incorporating the component of treatment This would be strengthened due to the guarantee of non-obligatory HIV/AIDS tests that are established by the laws of the countries (except qualified exceptions), and because of the possibilities to negotiate better prices as a region for purchasing drugs for treatment. 

  23. CHALLENGES: (1) Taking advantage of the regional initiatives and broadening the perspective toward a comprehensive health intervention of health for mobile and migrant populations in the region. (2) Adressing HIV/AIDS prevention based on the framework of Human Rights to visualize health as a right, regardless of the migration condition of people. (3) Taking advantage of the interest of the organizations that are already participating in order not to duplicate structures, and incorporating other Sectors that are particularly important for migration.

  24. CHALLENGES: (4) Maintaining and strengthening regional coordination. (5) Integrating the aspects related tomigration processes in HIV/AIDS prevention, especially legal and political aspects that delimit them.  (6) Improving the epidemiologic surveillance systems with the goal of collecting reliable and timely information on HIV/AIDS incidende and prevalence In mobile and migrant populations. (7) Strenghtening institutional capacity at government and non governmental organizations that work in prevention and care for mobile and Migrant populations. (8) Strenghtening the sanitary infrastructure at the national and local level in the border communities.

  25. CHALLENGES: (9) Promoting the concordance of laws on HIV and migration for people living with HIV/AIDS, and promoting pertinent legal reforms regarding mobile and migrant populations. (10) Continue developing actions for prevention and treatment with and for mobile and migrant populations, mainly for the young population. (11) Strengthening sexual education to reduce sexual practices than constitute risks. (12) Strenghtening advocacy with the goal of changing opinions, preconceived ideas, and stereotypes in the general population and the health, education and labor staff.

  26. CHALLENGES: (13) Incorporating the gender perspective in legislation, policy and HIV/AIDS programs to establish different actions for men and women. (14) Promoting the development of integral policies based on specific legal frameworks, health, migration, labor and education. (15) Fostering regularization of the condition of migration with the goal of increasing access to HIV/AIDS prevention and/or treatment programs. (16) Ensuring comprehensive care for mobile and migrant populations that are living with HIV/AIDS and their families.

  27. FINALLY, CHALLENGES WITHIN THE CONTEXT OF THIS SEMINAR AND PARTICULARLY FOR THE RCM: PARTICIPATE IN STRENGTHENING AND FACILITATION OF THESE PROCESSES FROM A WIDE PERSPECTIVE OF THE RELATIONSHIP BETWEEN MIGRATION AND HEALTH THANK YOU!

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