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| What is
Migration |
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| Migration is the crossing of the boundary of a political
or administrative unit for a certain minimum period of
time. It includes the movement of refugees, displaced
persons, uprooted people as well as economic migrants.
Internal migration refers to a move from one area (a province,
district or municipality) to another within one country.
International migration is a territorial relocation of
people between nation-states. (UNESCO) |
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| Mobile people can be described broadly
as people who move from one place to another temporarily
or permanently for a host of voluntary and/or involuntary
reasons - (International Organisation for Migration) |
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| The Process
of Migration |
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| Classical theories have reviewed migration
as a rational decision made by an individual to move from
a less advantageous situation, to a more advantageous
one after weighing risks and benefits. Recent analyses
of the trends in the South Asia region have recognised
that migration generally results from the decision making
of collectives, such as families or households. The risks
associated with migration are therefore backed by the
resources of the whole family in the hope of future benefit
to all. The decision is often based on little more than
an ill-defined sense that life will offer more elsewhere,
with very little information about the reality the migrant
will face. |
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| According to IOM, migration and population mobility
are best seen as a process with stages comprising: |
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- Source: from where people come, why they leave,
what relationships they maintain at home while they
are away;
- Transit: the places through which people pass,
how they travel, how they maintain themselves while
they travel;
- Destination: where people go, the attitudes of people
they meet when they get there, the living and working
conditions in the new place;
- Return: the communities to which people return,
their families, their resources (or lack thereof).
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| Much population movement is highly fluid, with people
moving back and forth through these stages frequently,
often over the course of days, weeks or months, and both
within countries and between them. |
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| Migration and
HIV in Asia |
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| South Asia, which is burdened with the
one of the lowest human development indicators and increasing
socio-economic inequalities, is home to the world’s
second largest number of people on the move. Annually
more than 200 million people are estimated to migrate
within and between countries in the region, in desperate
search for a better life. This intense movement of people
is accentuated by the growing mismatch between pockets
of economic activity and deprivation brought about by
the new global economic order. |
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| To a large extent, migration is a beneficial
process, not only for individuals, but also for communities
and nations. While new economic opportunities meet the
livelihood needs of migrating individuals and their families,
their remittances play a crucial role in strengthening
the economy of their countries and host communities. Migrant
remittances are indeed a major source of national income
for the countries of the region. |
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Afghanistan: Over 1,500,000
refugees living in Pakistan and Iran
Bangladesh:
200,000 documented migrants per year moving from the country
India: 200,000,000 persons not living
in their place of birth
Nepal: More
than 250,000 migrants living in India
Pakistan:
2,790,221 persons in 1999 registered as living abroad
Sri Lanka: 788,000 persons living
overseas; 60 percent of them women |
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| Obvious Benefits, But Challenges
Too |
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| According to IOM (International Organisation for Migration),
worker remittances represent the second largest monetary
trade flows globally, exceeded only by the petroleum industry.
For instance, in 2002 alone India received $ 11.5 billion
as remittances. In Bangladesh, foreign employment is the
second largest source of foreign earnings and in Sri Lanka,
remittances, mostly from women migrants, are the highest
foreign exchange earner. In Pakistan, remittances equal
44 percent of total merchandise exports. |
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| Various factors such as economic distress, violence,
oppression, different forms of discrimination and conflicts
force people to move, often with little or no knowledge
of the complex mix of vulnerabilities that await them
on the way. Reports from the region indicate that a large
number of migrants face an acute risk of exploitation,
physical violence, sexual abuse and socio-political marginalisation.
Added to these factors, the acute gender bias that is
widespread in the region makes women especially vulnerable.
HIV thrives in such situations. |
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| Migration is a process that is governed by various
push and pull factors. In simple terms, push factors force
people to move, while the pull factors lure them to seemingly
greener pastures. |
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| The Push Factors include: |
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• Low and variable agricultural
productivity
• Lack of local employment or opportunities
for advancement
• Landlessness
•
Marginalisation
• Population pressure
•
Domestic or community conflict
• War, political
unrest, natural calamities |
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| The Pull Factors include: |
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• Rapid urbanisation and industrialisation
• Consumerism and increased access to information
• Better opportunities for livelihood, education
etc.
• Improved system of mobility
•
Spirit of exploration |
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| Migration
and HIV: the Complex Link |
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| Asia is also home to the second
largest number of people living with HIV/AIDS and a region
with one of the fastest rates of HIV infection in the
world. Though the HIV prevalence rates are still reportedly
low, the huge population of the region translate them
to large numbers, there are over 7.6 million people living with HIV in South and South east Asia. In India alone accounted for
5.7 million infections in 2005. All over South
Asia there are concentrated epidemics among the vulnerable
groups such as sex workers, injecting drug users and MSM
(Men having Sex with Men). The infection is steadily spreading
to the general population, closing fast the window of
opportunity for prevention. Experience from the region
and other parts of the world clearly show that the apparent
low prevalence does not offer any room for complacence. |
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| As the epidemic spreads wider, the link
between migration and HIV is emerging stronger than ever
before. A recent study by UNDP, in partnership with PLWHA
groups in the Asia Pacific region, irrefutably demonstrates
this reality. Nearly 67 percent of the people living with
HIV/AIDS, who participated in the study, said that migration
was the main factor that led to their HIV-vulnerability
and better access to information and services could have
helped to protect them. |
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| HIV and migration do not have a linear, cause and effect
relationship, but are laterally linked. HIV is a manifestation
of the inequalities and deprivation faced by migrants.
Hostile and lonely environments, separation from families,
lack of access to information and services and social
support systems can lead to social and sexual practices
that make them more susceptible to HIV exposure. However,
it may be noted that migration in itself is not a vulnerability
factor for HIV, but it is the unsafe process of migration
that creates conditions of vulnerability (See Table).
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Benefits |
Challenges |
| Individual |
Increased income, options, choices and “freedom” |
Isolation, loneliness, exploitation, hardships,
hostility from host societies. |
| Families |
Better standard of living, education for children,
access to health care and sense of financial security |
Separation from partners, strains in relationships,
challenges in the absence of remittances, extra
burden on women who stay behind |
| Community |
Increased remittances, exposure/ linkages with
the outer world, flow of ideas/information, improved
infrastructure |
Increased single parent households, loss of social
capital, inequalities between families and a sense
of competition |
| Nation/Economy |
Improved economic situation through remittances,
better diplomatic/bilateral relations |
Depletion of human resources, treatment of migrants
as mere “economic tools”, strained internal/bilateral
relations |
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| Migration
and Impact of HIV: the Multiple Burden |
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| HIV-positive migrants carry a double burden as the
epidemic reinforces and deepens existing inequalities,
further increasing their multitude of vulnerabilities.
Besides affecting themselves severely, HIV infection also
creates a huge impact on their families, host communities
and countries. |
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| What are the links between migration and HIV/AIDS? |
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| High vulnerability due to migration: Migrant populations are at higher risk of contracting HIV because of their status. The situations they face in their migration –poverty, exploitation, and separation from families and partners- that put them at risk. |
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| Marginalized from prevention opportunities and health services: Migrant populations are often working individuals, subject to poor and unstable living and working conditions. Such conditions usually mean that they have limited access to reliable and culturally appropriate information on HIV/AIDS and to health services, when offered.
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| Difficult to reach out to: Even if health and social services are prepared to assist migrant populations, they often encounter difficulties accessing them. Many migrants live in indeterminate state, having no stay or work permit in the host country and live in constant fear of deportation. Any contact with official government agencies, even if related to health matters, increases the fear of being reported to the police and is, therefore, often accompanied by suspicion . This factor combined with the hardships of daily life makes providing HIV testing, care, support and treatment particularly challenging for these populations. |
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| Subject to compounded forms of discrimination: Migrants living with HIV/AIDS face multiple forms of discrimination and stigmatisation, within and outside their own communities, due to their HIV status as well as their ethnic origin, religious beliefs and practices, socio-economic condition, migration status and more. Migrant women living with HIV confront additional forms of discrimination because of prevailing gender inequalities. Accumulated, these forms of discrimination create among migrant women a sense of powerlessness that exposes them even further to exploitation, violence and poverty and thwarts their capacities to mobilize the power they do have for change. |
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| HIV/AIDS can be a driving force of migration: Last, but not least, HIV/AIDS may also be a cause of mobility. People with HIV (PWHA) may be driven to move or leave their homes because of stigma and discrimination towards PWHA, lack of sufficient health services, non-availability or poor access to treatment and lack of trust in confidentiality of HIV testing .
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| Individuals |
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| At the personal level, rising healthcare costs, loss
of jobs and stigma and discrimination can cripple their
lives. In addition, they are also burdened with the blame
for spreading HIV - both for bringing HIV into the host
countries and for taking it back to the countries of their
origin. Studies in the region also illustrate that lack
of legal rights in host countries leaves them extremely
vulnerable to discriminatory practices such as forced
testing, violence and deportation. |
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| Families |
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| Families of HIV-positive persons are often led to a
life of impoverishment as household incomes diminish with
a spurt in health care expenditure. Further, the stigma
of having an HIV-positive person in the family leads to
discrimination and ostracism by the community. It has
also been observed that the lack of information creates
a vicious cycle of transmission of the virus to partners
back home. Many children in the region have been orphaned.
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| Communities and Nations |
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| The effects are not limited to the individual and the
family alone. Communities experience a waning of income
flows, affecting their development. National economic
development also gets hampered in the wake of HIV as countries
bear the increased burden of health care expenditure,
coupled with a fall in migrant remittances. Moreover,
as in the case of the community, it is a loss of valuable
human resource and social capital. |
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| Women: Specially
Vulnerable |
| South Asia is not an exception
to the increasing feminisation of the process of
migration in the world witnessed over the last two
decades. It is estimated that roughly 48 percent
of all migrants in the world are women (IOM, 2000).
Women migrants from Asia constitute the largest
number of unskilled migrant workers in labour receiving
countries. Rampant gender inequalities, low social
status and lack of understanding of their sexuality
and reproductive health, together with lack of access
to information and services make migrant women specially
vulnerable to HIV/AIDS. The problems are compounded
for undocumented women workers and those who are
trafficked. The situations of selective migration
where women are usually not allowed free movement
or granted permission to accompany their spouses
create even greater vulnerabilities. |
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| What needs to be done? |
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| Given the fact that millions of people migrate within
and outside the region and that the HIV-vulnerability
of migrants is high, containing the spread of the virus
among them, their families and communities is extremely
important while addressing the challenge of the epidemic
in the region. Migrants also sustain many local economies
and hence their health and well being is critical to the
development of the region. An area of special concern
is the spread of the infection from high to low prevalence
areas and also emergence of new pockets of high prevalence.
In this context, migrants become the medium through which
the virus transmits itself. |
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| Facilitate Safe mobility: a Rights Based
Response |
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| The critical elements of HIV-vulnerability
of migrants result from unsafe mobility - mobility that
results from uninformed choices and that is fraught with
the risks mentioned above. Therefore a response that makes
migration processes safer in every respect is best suited
to reduce their vulnerability to HIV. Given the complexity
of the situation, it calls for the involvement of every
sector of civil society, governments and other stakeholders.
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| The journey of the migrants usually traverses three
stages: source, from where they originate; transit, where
they stop over; and destination, where they finally reach
in search of jobs. Therefore, responses that facilitate
safe mobility have to be initiated at every stage and
these responses have to be coordinated between these three
areas. |
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| Empowering Migrants through Informed
Choices |
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| Safe mobility, in essence, is migration of people based
on informed choices and reducing the risks on their way.
Informed choices begin with the basic ability of people
to decide whether to migrate at all or not. To make this
feasible, there should be increased avenues for livelihoods
in their host societies, better social and gender equality,
less distress situations, not to mention conflicts and
various forms of discrimination. Efforts on this count
will prepare the ground for a sustainable, multi-sectoral
response. |
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| Another important step is to empower potential migrants
with information and services that make migration safer,
free from exploitation and situations that make them vulnerable
to HIV at source, transit and destination areas. This
includes providing them with information about the situation
in destination areas, the opportunities, services and
networks available. HIV information and services specifically
to prevent HIV infection should be an integral part of
this effort. Studies and experience of working with migrants
in the field have shown that faced with challenges for
survival, migrants do not see HIV as a priority issue.
Therefore, the information and services on HIV should
be part of an integrated package that also addresses other
vital needs such as livelihoods, shelter, banking and
health care. Special emphasis has to be given to make
the outreach efforts innovative and effective owing to
the displaced status of migrants, particularly in the
case of those who are undocumented. |
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| Many migrants return to the source areas periodically
and such visits can be considered as a possible route
of HIV transmission to their spouses, partners and host
community. In order to prevent this mode of transmission,
initiatives are needed to equip the migrants, their spouses,
partners and others on how to protect themselves against
possible infection. More importantly, the special vulnerability
of women needs to be addressed through concerted empowerment
efforts. |
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| Another challenge that calls for attention is the need
for reintegration of returning migrants, both permanent
and temporary, with a particular emphasis on the HIV context.
Avenues for investment, jobs, socio-cultural reintegration,
access to treatment and care and a stigma-free environment
need to be seriously looked at. |
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| In view of their vulnerability to HIV/AIDS, there is
an increasing need for treatment and care at the destination
and source areas. Voluntary counselling and testing services,
treatment for opportunistic infections and referral for
antiretroviral treatment are the elements that should
form part of a comprehensive treatment and care plan. |
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| Back to Top |
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| Links |
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| Portal
for the Promotion and Protection of the Rights of Migrants
|
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| "Migration,
Human Rights and HIV" |
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| "Mobility,
Gender and HIV" |
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| "Nepal
study on Migration, HIV and Trafficking" |
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| "Urbanization,
Migration & HIV" |
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| "China
Scenario - Migration and AIDS" |
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| "World
Bank site on Migration & HIV" |
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| "Migrant
Women Workers and HIV" |
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| "UNESCO on Migration & HIV" |
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| "International
Migration and Mobility" |
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