SEMINAR ON HEALTH AND MIGRATION

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• 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

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• 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

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• 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

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• 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.

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• 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.

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• 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

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• 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)

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• 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

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• 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

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• 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.

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

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• THE EPIDEMIOLOGIC SURVEILLANCE SYSTEMS
• ALTHOUGH OBLIGATORY
• HAVE AN ESTIMATED 20 60 SUB
• RECORD OF CASES BETWEEN
• REPORTED AND ESTIMATED CASES

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Reported AIDS Cases and HIV Positive Cases

• 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 ------

() December 2003 () Includes HIV/AIDS
Total of AIDS cases in the region 40,517
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Total 217,606
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• 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

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• 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.

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• 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.

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• -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.

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• 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.

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• 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

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• 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.

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• 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 US39 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. 

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• 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.
•  
•  

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• CHALLENGES
• (4) Maintaining and strengthening regional
  coordination.
• (5) Integrating the aspects related to migration
  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.

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• 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.
•  

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• 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.
•  
•   

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•   
• 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!