Migrants with HIV of Extra Concern in COVID-19 Era

Rukhshona Qurbonova, IOM’s Sub-Regional Coordinator on Migration Health for Central Asian countries.

In 2019 more than 500,000 Tajiks left their Central Asian home to work abroad. The current COVID Pandemic is causing concerns for all of them, but particularly for those who are already vulnerable, such as those living with HIV and AIDS.

The proportion of migrants among registered HIV cases has nearly doubled this decade, from 10.1 percent in 2014 to 18.8 percent in 2018. Little is known about the migration of vulnerable populations—such as people who use drugs and men who have sex with men—or about their behavior in accessing health services while working abroad.

We spoke to Rukhshona Qurbonova, IOM’s Sub-Regional Coordinator on Migration Health for Central Asian countries.    

How is the current coronavirus pandemic likely to affect people with HIV, specifically migrants with HIV in and outside of Tajikistan?

People living with HIV in Tajikistan, including foreign nationals have free access to antiretroviral therapy (ART). The Ministry of Health and international partners have ensured enough stock even in case of a COVID-19 outbreak. 

However, it is more complex for Tajik migrants with HIV abroad. They must work as undocumented migrants because being HIV positive is grounds for deportation from some countries. Tajik migrants living with HIV use informal networks for access to ART, or relatives send them medicine, or other people living with HIV share their medicines, or they buy locally. 

COVID-19, quarantine measures, the economic downturn and job cuts have left many Tajik migrants jobless and stranded.  Some of those living with HIV will have to interrupt their treatment, weakening their immune status and making them more vulnerable to COVID-19. 

To enhance Tajik migrants’ access to HIV services, particularly key populations, IOM Tajikistan together with AFEW International (AIDS Foundation East-West) and AFEW Kyrgyzstan launched a project to improve migrants’ access to HIV services last year.

Why it is so important to work with migrants?

Migrant workers significantly contribute to the economy of the countries of origin and countries of destination but are often left out when it comes to health programming. Most Tajik migrants work in low-skilled jobs, even if they have a good education. The prerequisite for good performance – even for low skilled work – is good health; therefore, both countries of origin and destination benefit from healthy migrants. But migrants can be stressed by facing a new environment, culture, language, and they are often exposed to poor working and living conditions in the receiving country. This all can put their health at risk.

How do they become more vulnerable to HIV?

The majority of Tajik migrants are young men from rural areas, where strong social control is part of the traditional patriarchal society. When they arrive in big cities with different norms and morals their sexual behaviour can change. A difference in social control, little knowledge about prevention of sexually transmitted infections and HIV, alcohol consumption and drug use, and casual sex all play into migrants’ vulnerability to Sexual Transmitted Infections and HIV. Integrating migrants into national health programmes and strategies is part of the agenda of the Universal Health Coverage approach promoted by the WHO and other UN organizations including IOM.

How long has IOM Tajikistan been working with migrants?

IOM Tajikistan has been working on migrants’ health since 2005 and implemented projects on the prevention of STIs, HIV and TB among outbound and inbound migrants. We have implemented innovative approaches to reach migrants through peer education, engagement of the diaspora, the creation of teams in the districts, issuing publications in all the relevant (Tajik, Russian, Uzbek, Chinese, Dari, Turkish, and others) and ensuring a multisectoral approach and cross border cooperation.

Which barriers might you face in Tajikistan and how you are going to overcome them?

Stigma and discrimination are the main barriers faced by migrants and the general population in Tajikistan in accessing HIV services. There is also strong stigma against people who are using drugs, and sexuality is a taboo topic. With our peer-to-peer-approach, we want to reach out to key populations, working with migration officials and health workers to reduce stigma and discrimination.