INTERNATIONAL MIGRATION

Switzerland (Geneva) 51

1998 - VOLUME 36, NUMBER 4

SPECIAL ISSUE: MIGRATION AND HIV/AIDS

99.51.1 - English ? UNAIDS and IOM, 17 route des Morillons, Case postale 71, CH-1211 Geneva 19 (Switzerland)

Migration and AIDS (p. 445-468)

AIDS and migration are two salient features of the latter half of this century. Over 30 million persons world-wide are estimated to be infected with HIV, the virus that causes AIDS. Concurrently, about 100 million persons move voluntarily within or between nations each year, while almost 40 millions are either internally displaced or refugees outside their own countries. Previously, governments' main concern was that incoming migrants might bring HIV with them. While this scenario still applies, there is increasing recognition that migrants may be more vulnerable than local populations to acquiring the infection during migration, and that they may spread the infection upon return to their respective homes. The International Organization for Migration (IOM) upholds the principle that humane and orderly migration benefits migrants and society. Among its responsibilities, the IOM is dedicated to advancing understanding of migration issues and work towards effective respect of the human dignity and well being of migrants. The United Nations Joint Programme on AIDS (UNAIDS) is the main advocate for global action on HIV/AIDS. Part of its mission is to lead, strengthen and support an expanded response to the epidemic. (UN, SPECIALIZED AGENCIES, AIDS, MIGRATION)

99.51.2 - English ? Nathalie LYDIE, Centre fran?ais sur la population et le d?veloppement (CEPED), 15 rue de l'Ecole, 75006 Paris (France), and Noah Jamie ROBINSON, Institut national de la sant? et de la recherche m?dicale (Inserm), Unit? 88, Paris (France)

West and Central Africa (p. 469-511)

In West and Central Africa, countries with high rates of emigration and immigration tend to have higher rates of HIV infection. However, there is one exception, Senegal, an exception demonstrating that high levels of mobility and migration do not necessarily lead to rapid and extensive spread of HIV infection. Five different population groups are considered in this article, either because their numbers are substantial or because their role in the spread of HIV and STDs is known to be important. They are migrant labourers, truck drivers, itinerant traders, commercial sex workers (CSWs), and refugees. The research indicates a complex relationship between migration and HIV infection. Clearly not all migrants have the same risk of infection and thus do not contributre equally to the spread of HIV. However, there is little analysis to date on the influences of different types of migration. Practical strategies for preventing the spread of HIV/AIDS among migrant populations in West and Central Africa must aim at providing information before departure, along the communication routes, at the final destination and at the time of their return journey. The degree of concentration at each stage will depend on the characteristics of the population. Whatever strategy is used, however, solid collaboration will be required between countries, particularly with respect to information and prevention campaigns, and to the avoidance of stigmatization of any group of individuals. (WESTERN AFRICA, MIDDLE AFRICA, AIDS, MIGRATION)

99.51.3 - English ? Brendan GIRDLER-BROWN, Department of Community Health, University of the Witwatersrand, Johannesburg (South Africa)

Eastern and Southern Africa (p. 513-551)

Very little research has specifically addressed the important issue of the relationship between migration and HIV/AIDS in these regions of Africa. However, there is a great deal of information about migration, and also about HIV/AIDS, in isolation from each other. Since HIV prevalence rates are now high in almost all African countries, the concern that migrnts may bring the virus with them is no longer appropriate. Instead, the concern is that migrants may be vulnerable to acquiring the infection during migration. After exploring its situation and implicated factors, the author examines the health services accessible to migrants and raises some serious deficiencies in this sector. (SOUTH AFRICA, EASTERN AFRICA, AIDS, MIGRATION)

99.51.4 - English ? Irene BAIN, APICT-UNAIDS, Bangkok (Thailand)

South-East Asia (p. 553-585)

This article investigates the issue of HIV and mobile populations in the Mekong Region countries. Economic opening in the region is occurring rapidly as some Mekong States move from centrally planned to market economies and some locations undergo unprecedented economic growth. The uneven nature of economic development has resulted in imbalances between rural and urban, agricultural and industrial areas, and in most places the health and education systems are inadequate for the needs of these new residents. Much of the movement between countries is illegal. HIV/AIDS is highly prevalent in much of the region; responses to the epidemic range from extremely limited approaches (in Cambodia, Laos and Myanmar) to wide-ranging and sophisticated strategies (in Thailand). In recent years China has begun to devote increased efforts to HIV/AIDS research and interventions in its huge "floating population" and to the provinces bordering the other South-East Asian countries. However, there is as yet little systematic focus on migration and HIV/AIDS at a national level, and no significant regional cooperation on the issue. Several region-wide research/interventions have been created by aid organizations, NGOs and academic institutions in recent years, and these show considerable potential as models. The author describes some of these projects. Thailand displays the most diversity in research approaches and the highest level of research capacity at difference levels to face up to this problem. (SOUTHEASTERN ASIA, AIDS, MIGRATION)

99.51.5 - English ? Agnes AXMANN, Hungarian Tropical Health Institute, Imre Hayal University of Health Sciences, Budapest (Hungary)

Eastern Europe and Community of Independant States (p. 587-607)

The collapse of the USSR and the communist systems in the late 1980s and early 1990s has had profound social, economic and political consequences for these regions. The most significant consequence relating to HIV/AIDS is the opening of the region's borders, making it much easier for populations to migrate. Available research shows a serious lack of information and awareness about HIV/AIDS in these regions. Nor is there evidence of coordinated programmes shared between AIDS and STD services within the countries. The number of refugees was 870,000 between 1989 and 1996 and there are large numbers of "internally displaced people". No in-depth research appears to have been done on the prevalence of HIV/AIDS among migration populations in the CIS. Among the general populations, the number of HIV-positive cases has increased rapidly, particularly among the Injecting Drug User (IDU) population. Alarming rises in STD rates have also been noted in the region. No written information is available on prevention, diagnostic or counselling services for migrants; services available to the general public are not "migrant-friendly" for a variety of reasons. Level of HIV infection in the general pouplation remain very low in Eastern Europe, but is becoming increasingly common in some places. In all Eastern European countries, treatment of HIV/AIDS cases is expensive. If the patient has no legal status in the country, such as a residence permit, treatment may be refused. The author considers that the development on epidemiological, quantitative and qualitative research on HIV/AIDS is urgently needed in both regions. (EASTERN EUROPE, COMMONWEALTH OF INDEPENDANT STATES, AIDS, MIGRATION)

99.51.6 - English ? Mario BRONFMAN, Center for Research in Health Services, National Institute of Public Health, Mexico (Mexico)

Mexico and Central America (p. 609-642)

The main destination of migrants is the US, Mexico is also a destination for Central Americans and a transit place on their way to the US. Migrant population comprises mainly illiterate and unqualified men, rural in origin and of economically active age. Many return home after having lived in the US for a time. According to little data available on HIV/AIDS, Honduras is the most affected country. Studies on HIV/AIDS in the migrant population of Central America mostly concern migrants in their places of destination. Among current AIDS cases in Mexico, 10% have a history of residence in the US. This group is clearly differentiated from the rest of People Living With HIV/AIDS's (MLWHA) recorded in the country, with a demographic profile similar to that of temporary migrants. Studies assessing risk behaviours and levels of knowledge of HIV/AIDS among migrants to the US show a descending grandient: almost everyone has heard of condoms, few know about its preventive possibilities, fewer still have appropriate information about its correct use, only a minority use it, and even fewer do so correctly. Widespread risk and vulnerablility factors among migrants include highly stressful living environments, high rates of alcohol use and sexual intercouse, etc. Migration in Mexico and Central America is profoundly related to economic and political conditions. Police and restrictive measures in the US have resulted in high levels of undocumented migration which has had signifiant and broadly documented consequences of the spread of HIV, whicle restricing migrants' use of services. Two priorities are suggested. First, more research on Central American migrant flows to Mexico and the US. Second, reducing illegal migration will require intense political and technical work to convince decision makers of the risks that restrictive measures generate for the public health. (CENTRAL AMERICA, MEXICO, UNITED STATES, AIDS, MIGRATION)

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