Migrant Population and HIV: Supporting HIV Prevention, Care and Treatment towards Migrants in Thailand

1. Migrant Population and HIV: Supporting HIV Prevention, Care and Treatment towards Migrants in Thailand Consultation Workshop on Situation Review on the Current HIV/AIDS Prevention and Care Service to Migrant Populations International Organization for Migration 16 August 2013 Bangkok, Thailand

2. Current Situation and Issues of Concerns

3. Migration and Vulnerability to HIV • Separation from family; new found freedom, loneliness, Level of social exclusion • Existence of xenophobia, discrimination, stigma in host community • Availability of migrant friendly services • Exclusion from HIV programmes and services • Limited/lack of access to clean water and sanitation • Availability or lack of safe, clean housing • Often poor working conditions and lack of occupational health schemes • Access to / existence of jobs that provide a living wage; disposable income Migration cuts across the social determinants of health • Educational attainment • Economic status • Legal status • Lack of knowledge and skills on how to protect oneself and others • Lack of awareness of services and rights available • Exploitation or abuse may expose them to risky behavior – unprotected sex or drug use. • Lack of legislation ensuring migrants’ access to health regardless of status • Existence and effectiveness of labour policies to protect workers’ rights • Policies prohibiting discriminatory practices • Policies in other domains affecting the health of migrants Adapted from: Commission on Social Determinants of Health. Closing the gap in a generation: health equity through action on the social determinants of health. Final report of the Commission on Social Determinants of Health. Geneva, World Health Organization, 2008.

4. HIV Prevalence in the Greater Mekong Sub-Region No Data Reference: World Health Statistics 2012. WHO 2012. Accessed online at http://www.who.int/gho/publications/world_health_statistics/EN_WHS2012_Full.pdf

5. Barriers to Improving Access to Health in Border Areas

6. Migrant’s access to ARTs in Thailand - current situation • Thailand’s National Strategy for 2012-2016 aims to provide access to quality HIV treatment and care for any person living with HIV in Thailand, regardless of their nationality. • Health care security: • Registered migrants –1,300 baht (abt. USD 43) for health insurance. Includes ART to prevent mother to fetus infection but not ARV for people living with HIV. 600 baht /check up (USD) (MoPH). • Undocumented migrants – 1,300 baht/year (USD 43), health promotion and disease prevention. Includes ART to prevent mother to fetus infection. Out/inpatient (30 Baht/visit (USD 1) at contracted hospital). Work related disability (employers, work related fund). A&E (any hospital). • There is provision of ARVs for certain categories of low skilled migrants but demand is higher than provision. • Cambodian migrants can return home to obtain a 3 month supply of ARVs. A scheme developed by the Thai and Cambodian authorities. • Challenges among Cambodian mobile workers living with HIV – lack of adherence, late appointments, no information before travelling to Thailand.

7. Thailand: Strengthening Health Service Provision and Policy Development • Registration of migrant workers; health assessment and enrolment to health insurance scheme • Establishment of networks of paid, full-time migrant community health workers (CHWs) and volunteers (CHVs) • Introduction of the concept of “migrant-friendly” or “migrant-sensitive” health services delivery to improve accessibility of service • Investing on health promotion and awareness raising interventions to improve knowledge of migrants on health • Promoting multi-sectoral collaboration including non-health stakeholders • Research on Health Financing Schemes • Border Health Development Master Plan and Health Policy Development

11. Strategic Approaches to Support HIV Prevention, Treatment and Care for Migrants in Thailand

12. World Health Assembly Resolution on Health of Migrants (WHA 61.17)Calls upon Member States: “to promote equitable access to health promotion and care for migrants”“to promote bilateral and multilateral cooperation on migrants’ health among countries involved in the whole migration process”

13. Global Operational Framework

14. Pillar 1: Monitoring of Migrant Health • Include migrants in HIV national data collection systems • Identify key indicators on HIV and Migration that can be used across the GMS • Promote data collection and analysis of key populations across border areas; including the identification of “spaces of vulnerability” where migrants interact with local community and engage in high-risk behaviour • Monitor migrants’ health seeking behaviour especially those in trans-border movements • Analyze available data for evidenced based policy and programme formulation

15. Pillar 2 : Promote conducive policies and legal frameworks on the health of migrants • Harmonize national HIV, public health and migration policies and encourage inter-sectoral collaboration • Enforce regulations to protect migrants from mandatory HIV testing and adherence to generally accepted testing standards • Establish minimum labour standards and health rights for migrant workers, access to health and insurance schemes • Adopt international standards on right to migrants’ health • Develop and implement national and multi-sectoral policies including monitoring frameworks to improve standard of health for migrants livings with HIV • Standardize pre-departure training on HIV vulnerability and prevention in coordination with migrant sending countries • Promote extending social protection based on good migrant health programming

16. Pillar 3: Migrant Sensitive Health Systems • Facilitate, provide and promote equitable access to comprehensive HIV services for migrants and mobile population throughout the migration process • Ensure that programmes are targeted to address “spaces of vulnerability” for migrants • Develop frameworks for monitoring migrant sensitive health service performance • Improve quality of services for migrant focused programmes and mainstreaming migrant friendly services • Assign focal points in government for migrant health • Advocate multi-stakeholder approach towards health and migration

17. Pillar 4: partnerships, networks and multi-country frameworks in migrant health • Involve various actors in the countries of origin and destination to protect migrants’ rights and health • Create multi-stakeholder working groups and develop resource mobilization plan for increasing programmes on HIV and migration • Engage with all stakeholders to assist in HIV policy and programme development for migrant populations • Work towards harmonization of treatment protocols, procurement and interventions with neighbouring countries • Promote inclusion of migrant health needs in existing regional and global funding mechanisms

18. Thank you Dr. Montira Inkochasan, minkochasan@iom.int Dr. Jaime Calderon, jcalderon@iom.int