Living with HIV as a Migrant Woman in the Diaspora Navigating Multiple Spaces

1. Living with HIV as a Migrant Woman in the DiasporaNavigating Multiple Spaces Presented by: Marvelous Muchenje Women’s Health in Women’s Hands CHC Toronto, Canada

2. Introduction Once Migrant women are diagnosed with HIV, they enter an environment which is highly technical dominated by western medical models of service provision that leaves many of them feeling alienated and vulnerable without an in-depth understanding of HIV disease, its treatment modalities, and impact on overall wellbeing.

3. Migration Journey (UNAIDS 2009)

4. Pre-departure Conditions • Prior access to health care • Most migrants originate from countries where basic resources required for health are scarce • Some have poor access to health care prior to arriving in host country, due to • Breakdown of health services • Countries have limited capacity to treat acute health concerns • Likely to have limited mental health support

5. Transition Conditions Trauma and torture -Immigrants are exposed to traumatic experience • Periods of deprivation • Human rights abuse • Loss of loved ones • Rape – HIV infection • Physical and psychological torture • Limited social and family support • Loss of place, identity & culture

6. Host Country Conditions HEALTH CARE Is the least of the migrant’s concern

7. Resettlement - Issues • The settlement period is an enormous adjustment period for a migrant woman • Learning new culture, acquiring new language, learning how to use public transport, negotiating new and complex education system, negotiating income support and health care system • Dealing with people in authority may be a great challenge, impacting a woman’s efficacy and self-determination • Unemployment/under employment/poverty

8. Resettlement - Issues • Multifaceted, intersecting dimensions of stigma and discrimination: • (HIV status, • race/racism, • Gender discrimination, • sexual orientation/homophobia • immigration status • Impacts actions at the individual, community and systems levels • exclusion and marginalization • limits access to health and social support • Gender based violence and vulnerabilities associated with sponsorship by an abuse spouse/partner

9. Organizing Locally to support a broader global movement Women’s Health in Women’s Hands Community Health Centre in collaboration with Black Coalition for AIDS Prevention (Black CAP) and Africans In Partnership Against AIDS (APAA) started the Health Promotion and Skills Development project to: • organize information sessions • facilitate discussions between women and service providers to increase access to services • simplify highly technical information provided in the field of HIV/AIDS treatment and care.

10. HIV-Positive Women’s Program: Re-conceptualizing stigma and discrimination from an intersectional approach (Logie, James, Tharao, Loutfy, WCB Project, 2011)

11. Programs and Services related issues • Lack of an in-depth understanding of the underlying factors from a gender/rights-based approach • Lack of long-term support strategies and limited skills development opportunities • Lack of linkages between relevant departments • Lack of disclosure to “other” relevant health providers limits access to effective and coordinated services. • Failure to incorporate trauma experienced during the migration process as part of service delivery

12. Programs and Services related issues • Linguistically and culturally inappropriate Programs and resources • Limited effective psychological support system to deal with mental health and other HIV/AIDS related issues • Cultural norms, values, practices and understanding of health, illness, death and dying differ from those of providers

13. Access to health care - Issues • Difficulties in accessing and making the best use of health services (e.g. transportation costs; childcare) • Numerous medical investigations & follow-up appointments that don’t make sense to women • Anxiety associated with physical examination, invasive procedures particularly for women with FGM • Revisiting of traumatic experiences

14. Recommendations • Develop programs and services based on the realities of migrant women’s lives • Programs should address: • Socio-cultural factors • Economic factors e.g. poverty, unemployment • Gender-based violence • Harmful cultural beliefs, values, norms and practices • Intersections of stigma and discrimination - racism, sexism, homophobia, HIV-related stigma and other types of discrimination • Stigma reduction activities • Involvement of migrant women in the development, implementation, and evaluation of HIV/AIDS programs and services

15. Recommendations • Address women’s lack of knowledge on their rights to access treatment and care regardless of immigration status • Utilizing a service delivery framework that recognizes impacts of HIV pre-migration, settlement and post migration • Understanding of impacts of long distant relationships on HIV acquisition, transmission and coping • More multi-disciplinary research to understand • Impact of intersectional stigma and discrimination • Migration, HIV and their impacts post settlement • Immigration policies, entry, stay and access for migrant women living with HIV

16. Thank You