Malu S. Marin Action for Health Initiatives (ACHIEVE), Inc./CARAM-Asia

1. Malu S. MarinAction for Health Initiatives (ACHIEVE), Inc./CARAM-Asia Return and reintegration: Towards a comprehensive response to HIV positive migrants

2. Context • Mandatory HIV testing among migrant workers (pre-departure and onsite requirement) • Denial of entry, employment and stay • In the Asian region, there are an estimated 55.6 million migrants, representing 29.6% of the total migrants in the world (UNDP HDR 2009). • In 2005, the estimated top three migrant-sending countries situated in Asia: • China (35.0 million) • India (20.0 million) • Philippines (7.0 million) • Continued incidence of HIV cases among migrant workers, especially in Asia (Bangladesh, Philippines, Pakistan, Indonesia) • In 2008, the AIDS Commission Report noted that migration and mobility are among the driving factors in several of Asia’s HIV epidemics. Action for Health Initiatives (ACHIEVE), Inc.

3. Conditions of HIV+ MigrantsUpon Return Economic • Declared “unfit” to work abroad • Lack of local employment opportunities • Lack of or depletion of savings • No reintegration programs in place • High cost of living and health care Action for Health Initiatives (ACHIEVE), Inc.

4. Conditions of HIV+ Migrants Upon Return Social • “Fall from grace” (relationship with partner/spouse and children affected; family expectations of economic support) • Social stigma and discrimination (peers, community) • Isolation, marginalization (unable to disclose) • Self-policing in terms of social relationships Action for Health Initiatives (ACHIEVE), Inc.

5. Conditions of HIV+ Migrants Upon Return Psychological • Depression, suicidal thoughts,anger • Resignation and fatalism • Self-blame esp. if the spouses/partneris also infected • Fear of being found out and stigmatized • Constant fear of the future, esp. for children Action for Health Initiatives (ACHIEVE), Inc.

6. Access to treatment and services • Circumstances of return affect level of access • Deportation (as a result of compulsory testing) means lost opportunity for interventions and referrals • Stigma and discrimination • Being a migrant, HIV status is a source of shame • Renewed calls for compulsory testing for returning migrants • No specific treatment programmes for migrants, because as citizens, they fall within the national HIV programme. • Unwillingness to return because of fear that treatment may not be available. Action for Health Initiatives (ACHIEVE), Inc.

7. Main Challenges • No comprehensive and sustainable reintegration programmes for returning HIV+ migrant workers • Economic • Social • Psychosocial and mental • Treatment access (limited, different treatment regimen from other countries, access to second and third line drugs) • Need to address community preparedness towards returning HIV+ migrants. Action for Health Initiatives (ACHIEVE), Inc.

8. Proposed Actions • Support formation of + migrant support groups, if needed. Build capacity and facilitate scaling up of their involvement in the response. • Integrate migration issues into the National HIV response (prevention and TCS). • Pursue regional and global action to address issues of deportation of HIV+ migrants and access to treatment care and support. Action for Health Initiatives (ACHIEVE), Inc.

9. Support Migrants' Right to Health Action for Health Initiatives (ACHIEVE), Inc.