Forced Migration and HIV/AIDS in Asia: Some Observations
Sadik, Nafis, Forced Migration Review
Although most of Asia has not suffered from a generalised HIV epidemic, there is reason to be concerned about how forced migration and economic crisis-related migration may increase the risks.
A thorough discussion of how and why forced migration can increase risks of HIV transmission in the region would require reviewing a myriad of social, cultural, economic and even physiological dynamics. So I will focus on a few issues of particular relevance - HIV in humanitarian settings, security-related programme developments, and the special needs of the millions of Asians who, out of desperation, find themselves exploited and unprotected as labourers in foreign lands.
In my capacity as Special Envoy, I have advocated for stronger prevention, better care, and destigmatisation of HIV/AIDS throughout the region. I have also worked for the recognition that migration within and outside the region plays an important ep id emio logical role and that there must be much greater attention paid to the rights, needs and protection of migrants. Over the past decade, there has been significant progress in HIV awareness and adoption of ever more progressive and effective policies and programmes by many governments. A good example of recent change is the lifting of immigration restrictions based on HIV status by China, setting a good example for other countries.
But there remains much room for improvement when it comes to widespread establishment of effective, rights-based policies and programmes for HIV prevention and care. There are particular needs for more attention to those at risk due to being displaced. There are millions of Asians who have left their homes and areas of origin and are living, often without their families or other social support, in new communities. Many are facing circumstances which make them more vulnerable to contracting HIV while at the same time they have lost access to information and means of prevention.
Over the past decade there has been a great deal of conflict-related displacement in the region. Civil war or insurgencies in Afghanistan, Nepal, Myanmar, Sri Lanka, Indonesia, Pakistan, India and the Philippines and across Central Asia have created large numbers of refugees and IDPs who have required humanitarian support. Although HIV prevention, as a part of the minimum package of reproductive health services, was adopted as a critical component of humanitarian response in 19941, resource constraints and social and cultural factors have impeded universal access to information and means of prevention among these populations. (It should also be pointed out that for some people the first information they ever received on HIV was from humanitarian agencies.)
Some types of conflict or displacement have brought much more particular risks of HIV infection. For example, long years of refugee camp life and lack of employment or recreational opportunities have contributed to intravenous drug use in Afghanistan and Pakistan border areas; this is a driving factor in the epidemic in these countries just as it is in Central Asia. The destitution of Burmese refugees in Thailand has led to widespread 'survival sex' which has driven the infection in that sub-region. The sexual violence used as a weapon of war in Timor Leste, Central Asia, Sri Lanka and other conflicts has undoubtedly increased HIV risks. And although it is often not considered an armed political conflict, the horrific levels of social and interpersonal violence in Papua New Guinea are also thought to be important factors in the epidemic there. Throughout the region, there is not only need to ensure that HIV prevention and care services are provided for displaced populations but there is also need for serious analysis of the HIV impact of the conflicts and for the inclusion of the special needs of the displaced in every national AIDs action plan.
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