HIV, HUMAN RIGHTS AND MIGRATION IN LATIN AMERICA

1. HIV, HUMAN RIGHTSAND MIGRATION IN LATIN AMERICA Tamil Kendall1,2 1 University of British Columbia, Canada 2Balance. Promoción y desarrollo para la juventud, México

2. Acknowledgements Manuel Angel Castillo GretchenKuhner ReneLeyva Diego Lorente FabienneVenet

3. OUTLINE Context Specific vulnerabilities of women Good practices in HIV prevention and care

4. 20 million people of Mexican origin in the USA Approx. 50% women since 1960s 2009: Mexicans to US 600, 000 repatriated 360,000 temporary 220,00 permanent 130,000 CA repatriated by Mexico MIGRANT FLOWS

5. Central America-Mexico-US Migration and HIV HIV prevalence among Central Americans migrants transiting Mexico correlated with prevalence in country of origin1 A third of Mexican AIDS cases are from states with a long history of labor migration to the USA2 A quarter (25%) of people with AIDS in Mexico spent long periods of time in the USA 3 In 2007, Latinos represented 18% of new HIV or AIDS cases in the US4 HIV transmission risk 3 x that of white non-Latinos Among women: incidence is 5 times higher than among white non-Latinas • Leyva, R. et. al. Proyecto Multicéntrico: Migración y derechos sexuales y reproductivos de migrantes en tránsito por México. Encuesta a Migrantes en tránsito, 2010 • Shedlin MG, Decena CU, Oliver-Velez D. Initial acculturation and HIV risk among new Hispanic immigrants. Journal of the National Medical Association 2005; 97 (7) (suppl): 32S-37S. • UCSF Center for AIDS Prevention, “What Are the HIV Prevention Needs of Mexican Immigrants in the US?” http:// www.caps.ucsf.edu/pubs/FS/pdf/mexicansFS.pdf.Accessed May 14, 2010. • S.P. Wallace and X. Castaneda, 2010, Fact Sheet on HIV/AIDS and Latinos in the US. http://www.binationalhealthweek.org/HIV-n-AIDS-%20English%20Final.pdf

6. Mexican migrants in Sacramento and Fresno, CA(2004, n=782) MSMW MSW Women (n=197) (n=75) (n=510) HIV+ (0.6%) 5.3% 0.2% 0.0% Commercial sex 8% 15.1% 1% partner(12 months) Unprotected vaginal - 93% 77% 25% regular (last act) Unprotected vaginal - 19% 53% *** Casual partner Unprotected anal, regular 29% 76% *** Unprotected anal casual 30% 69% *** Meth, coke or crack 28.0% 21.2% 1.0% MT Hernandez, MA Sanchez, JD Ruiz, MC Samuel, C Magis, MV Drafke, GF Lemp. “High STI Rates and RiskBehaviorsamongMexicanMigrants in California”, National HIV PreventionConference, June 2005, Atlanta, Georgia.

7. HUMAN RIGHTS VIOLATIONS AND VULNERABILITY TO HIV Contexts of violence Militarization of borders OrganizedCrime Genderviolence UnitedNationsConventionontheRights of AllMigrantWorkers and Members of TheirFamilies As soon as wearrivedtheysaid: getoutyourphonenumberstocallyourfamily, becausewewant 1000 dollarsforyoutostayalive. Ifnot, we’regoingtokill you1 1Ministerio de Relaciones Exteriores de El Salvador, 2010, Informe de violaciones a los derechos humanos y delitos graves contra personas migrantes en transito salvadoreñas en México durante el año 2010.

8. INCLUSION OF MOBILE POPULATIONS IN NATIONAL HIV PLANS

9. Women, Migration and HIV Vulnerability: HOME Biological vulnerability to STI/HIV infection, sexism, dominant constructions of sexuality and gender violence Condom use is the exception rather than the rule, independent of HIV risk perception among female partners of male migrants Rural: Knowledge of AIDS (90%) but only 5% reported consistent condom use (1996)1 Migrant factory workers: Unprotected sex is normative even when multiple sexual partners are known or suspected (2003-2004)2 Urban and suburban female partners of male migrants: 53% feel at risk, but paradoxically HIV is still constructed as a problem for “others” (2009)3 • Salgado de Snyder VN, Díaz Pérez MJ, Maldonado M. (1996). SIDA: comportamientos de riesgo entre mujeres rurales mexicanas casadas con trabajadores migrantes en los Estados Unidos. Educación y Prevención de SIDA. 8:134-142. • Kendall, T. & Pelcastre, B. (2010). HIV Vulnerability and Condom Use Among Migrant Women Factory Workers, Health Care for Women International, 31, 515-532, 2010 • Leyva, R. y Cabballero M. (2009). Las que se quedan: contextos de vulnerabilidad a ITS y VIH/SIDA en mujeres companeras de migrantes. INSP: Cuernavaca. 9

10. Women, Migration and HIV Vulnerability: TRANSIT Almost half of women report experiences of violence during transit1 60% report having had at least one sexual relation during transit2; Sexual violence is common.3 “We were on the train, close to Apizaco, Tlaxcala. There was a checkpoint. A security agent came on the train and raped me. He said that if I reported anything to the police, they would take me back to Guatemala. Then he took 40 dollars from me.”4 Sexual exchange and commercial sex are survival strategies 1) Sin Fronteras. Sin Fronteras: Violencia y Mujeres Migrantes en México. D.F., México: Sin Fronteras, 2005. 2) Caballero M et al. Migration, Gendre and HIV/AIDS in Central America and Mexico. Monduzzi Editore: Bologna, Italy, 2002. 3) Leyva, R. et. al. Proyecto Multicéntrico: Migración y derechos sexuales y reproductivos de migrantes en tránsito por México. Encuesta a Migrantes en tránsito, 2010 4) Gabriela Díaz y Gretchen Kuhner. Globalización y migración femenina. Experiencias en México, CEPI Working Paper, Núm. 12, México, Centro de Estudios y Programas Interamericanos-Instituto Tecnológico Autónomo de México (ITAM), 2007. 10

11. Women, Migration and HIV Vulnerability: DESTINATION Poverty and social vulnerability Insertion into traditionally “feminine” occupations Low salaries (thought similar to latino men in 2009) Lack of access to social services Poor working conditions Domestic workers: physical and verbal violence, sexual abuse Sociodemographic characteristics of Mexican women migrants Young (52% between 20 and 45 years old) Low educational attainment Without papers: 45% 30% domestic workers 11

12. Good practices for prevention Culturally appropriate communication using multiple media “La Lotería”, soaps Peer education “Pedagogy of the oppressed” Individual counselling based on behavior change theory Single sex rather than mixed groups Structural Interventions Family housing for agricultural workers (Napa) Medium-term government commitment to HIV prevention for migrants (Switzerland) Haour-Knipe, M., Fleury, F., Dubois-Arber, F. (1999). HIV/AIDs prevention for migrants and ethnic minorities: three phases of evaluation. Social Science & Medicine 49, 1357-1372; Kendall, T. & Langer, A., (2006).VIH/SIDA y Migración México-Estados Unidos: Evidencias para enfocar la prevención [HIV/AIDS and US-Mexico Migration: Evidence to focus prevention]. In Los mexicanos de aquí y de allá: problemas comunes, Memoria del Segundo Foro de Reflexión Binacional, Fundación Solidaridad Mexicano Americana, A.C. y Senado de la República. Fundación Solidaridad Mexicano Americano: Mexico, pp. 139-153; Organista, K.C., Carrillo, H., & Ayala, G. (2004). HIV prevention with Mexican migrants: Review, critique, and recommendations. Journal of Acquired Immune Deficiency Syndrome, 37(Suppl 4), 227-239. 12

13. Good practices for healthcare delivery Mesoamerican Project-HIV Prevention in Transit Stations Increase in prevention skills among young people and sex workers (p<.05: increased HIV knowledge, reduced HIV stigma, increased access to condoms) 16,431 rapid tests; 8822 mobile pops tested and treated for other STIs Harmonization of ARV regimens and access to treatment Informal: El Salvador, Honduras Formal: Mexico “right to healthcare independent of migratory status” (nov. 2010) US-Mexico Migrant Health Primary care package (NGO and out-of-pocket) and referral to hospital services in Mexico (Seguro Popular) Informal: ARV for people without papers: ADAP, clinical protocols, medicine banks

14. CONCLUSIONS Some examples of successful HIV prevention and care initiatives for mobile populations Challenges Sustained political will Emergency healthcare vs. Long-term care Gender differentiated strategies Recognition by governments and mainstream migration organizations PReP, female condoms, PEP, emergency contraception 14