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HIV, HUMAN RIGHTS
AND MIGRATION IN LATIN
AMERICA
Tamil Kendall1,2
1 University
of British Columbia, Canada
Balance. Promoción y desarrollo para la juventud,
México
2
Acknowledgements

Manuel Angel Castillo
 Gretchen Kuhner
 Rene Leyva
 Diego Lorente
 Fabienne Venet
OUTLINE
Context
 Specific vulnerabilities of women
 Good practices in HIV prevention and care

MIGRANT FLOWS




20 million people of
Mexican origin in the USA
Approx. 50% women since
1960s
2009:
Mexicans to US
600, 000 repatriated
 360,000 temporary
 220,00 permanent


130,000 CA repatriated by
Mexico
Central America-Mexico-US Migration and HIV
HIV prevalence among Central Americans migrants
transiting Mexico correlated with prevalence in
country of origin1
 A third of Mexican AIDS cases are from states with a
long history of labor migration to the USA2
 A quarter (25%) of people with AIDS in Mexico spent
long periods of time in the USA 3
 In 2007, Latinos represented 18% of new HIV or AIDS
cases in the US4

HIV transmission risk 3 x that of white non-Latinos
 Among women: incidence is 5 times higher than among
white non-Latinas

1.
2.
3.
4.
Leyva, R. et. al. Proyecto Multicéntrico: Migración y derechos sexuales y reproductivos de migrantes en tránsito por México. Encuesta a Migrantes en tránsito, 2010
Shedlin MG, Decena CU, Oliver-Velez D. Initial acculturation and HIV risk among new Hispanic immigrants. Journal of the National Medical Association 2005; 97 (7) (suppl): 32S-37S.
UCSF Center for AIDS Prevention, “What Are the HIV Prevention Needs of Mexican Immigrants in the US?” http:// www.caps.ucsf.edu/pubs/FS/pdf/mexicansFS.pdf.Accessed May 14,
2010.
S.P. Wallace and X. Castaneda, 2010, Fact Sheet on HIV/AIDS and Latinos in the US. http://www.binationalhealthweek.org/HIV-n-AIDS-%20English%20Final.pdf
Mexican migrants in Sacramento and Fresno, CA
(2004, n=782)
MSMW
MSW
(n=75)
5.3%
8%
(n=510)
0.2%
15.1%
0.0%
1%
93%
77%
25%
19%
53%
***
Unprotected anal, regular 29%
76%
***
Unprotected anal casual
30%
69%
***
Meth, coke or crack
28.0%
21.2%
1.0%
HIV+ (0.6%)
Commercial sex
partner(12 months)
Unprotected vaginal
regular (last act)
Unprotected vaginal
Casual partner
Women
(n=197)
MT Hernandez, MA Sanchez, JD Ruiz, MC Samuel, C Magis, MV Drafke, GF Lemp. “High STI Rates and Risk Behaviors among
Mexican Migrants in California”, National HIV Prevention Conference, June 2005, Atlanta, Georgia.
HUMAN RIGHTS VIOLATIONS AND
VULNERABILITY TO HIV

Contexts of violence
Militarization of borders
 Organized Crime
 Gender violence

United Nations Convention on the
Rights of All Migrant Workers and
Members of Their Families
As soon as we arrived they said: get out your
phone numbers to call your family, because
we want 1000 dollars for you to stay alive. If
not, we’re going to kill you1
1Ministerio
de Relaciones Exteriores de El Salvador, 2010, Informe de violaciones a los derechos humanos y delitos graves contra personas migrantes en transito salvadoreñas en
México durante el año 2010.
Prevention
Mentioned Migrants/
Women
HIV/STI ARV
(condoms)
in National
mobile OFmigrants/
Testing
Treatment
INCLUSION
MOBILE POPULATIONS
HIV Plan
pops
partners
IN NATIONAL
HIV
PLANS
NO
NO
NO
Bolivia
NO
NO
(2006-2010)
Colombia
YES
NO
NO
NO
NO
YES
???
YES
NO
NO
YES
???
NO
NO
NO
YES
???
NO
NO
NO
NO
NO
NO
NO
NO
YES
???
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
0%
11.1%
0%
0%
(2008-2011)
El Salvador
(2005-2010)
Guatemala
(2006-2010)
Honduras
(2008-2012)
Mexico
(2007-2012)
Nicaragua
(2006-2010)
Paraguay
(2008-2012)
Peru
(2006/2011)
TOTALS 55.5%
Women, Migration and HIV Vulnerability: HOME


Biological vulnerability to STI/HIV infection, sexism,
dominant constructions of sexuality and gender violence
Condom use is the exception rather than the rule,
independent of HIV risk perception among female
partners of male migrants



Rural: Knowledge of AIDS (90%) but only 5% reported consistent
condom use (1996)1
Migrant factory workers: Unprotected sex is normative even
when multiple sexual partners are known or suspected (20032004)2
Urban and suburban female partners of male migrants: 53% feel
at risk, but paradoxically HIV is still constructed as a problem for
“others” (2009)3
1)
Salgado de Snyder VN, Díaz Pérez MJ, Maldonado M. (1996). SIDA: comportamientos de riesgo entre mujeres rurales mexicanas casadas con
trabajadores migrantes en los Estados Unidos. Educación y Prevención de SIDA. 8:134-142.
2)
Kendall, T. & Pelcastre, B. (2010). HIV Vulnerability and Condom Use Among Migrant Women Factory Workers, Health Care for Women International,
31, 515-532, 2010
3)
Leyva, R. y Cabballero M. (2009). Las que se quedan: contextos de vulnerabilidad a ITS y VIH/SIDA en mujeres companeras de migrantes. INSP:
Cuernavaca.
9
Women, Migration and HIV Vulnerability:
TRANSIT


Almost half of women report experiences of violence during
transit1
60% report having had at least one sexual relation during
transit2; Sexual violence is common.3
“We were on the train, close to Apizaco, Tlaxcala. There was a
checkpoint. A security agent came on the train and raped me. He
said that if I reported anything to the police, they would take me
back to Guatemala. Then he took 40 dollars from me.” 4

Sexual exchange and commercial sex are survival strategies
1) Sin Fronteras. Sin Fronteras: Violencia y Mujeres Migrantes en México. D.F., México: Sin Fronteras, 2005.
2) Caballero M et al. Migration, Gendre and HIV/AIDS in Central America and Mexico. Monduzzi Editore: Bologna, Italy, 2002.
3) Leyva, R. et. al. Proyecto Multicéntrico: Migración y derechos sexuales y reproductivos de migrantes en tránsito por México. Encuesta a Migrantes
en tránsito, 2010
4) Gabriela Díaz y Gretchen Kuhner. Globalización y migración femenina. Experiencias en México, CEPI Working Paper, Núm. 12,
México, Centro de Estudios y Programas Interamericanos-Instituto Tecnológico Autónomo de México (ITAM), 2007.
10
Women, Migration and HIV Vulnerability:
DESTINATION
Poverty and social vulnerability
Insertion into traditionally “feminine” occupations
 Low salaries (thought similar to latino men in
2009)
 Lack of access to social services
 Poor working conditions
 Domestic workers: physical and verbal violence,
sexual abuse
Sociodemographic characteristics of Mexican women
migrants
 Young (52% between 20 and 45 years old)
 Low educational attainment
 Without papers: 45%
11
 30% domestic workers
Good practices for prevention


Culturally appropriate communication using multiple
media
 “La Lotería”, soaps
 Peer education
 “Pedagogy of the oppressed”
 Individual counselling based on behavior change
theory
 Single sex rather than mixed groups
Structural Interventions
 Family housing for agricultural workers (Napa)
 Medium-term government commitment to HIV
prevention for migrants (Switzerland)
Haour-Knipe, M., Fleury, F., Dubois-Arber, F. (1999). HIV/AIDs prevention for migrants and ethnic minorities: three phases of evaluation. Social Science & Medicine 49, 1357-1372;
Kendall, T. & Langer, A., (2006). VIH/SIDA y Migración México-Estados Unidos: Evidencias para enfocar la prevención [HIV/AIDS and US-Mexico Migration: Evidence to focus
prevention]. In Los mexicanos de aquí y de allá: problemas comunes, Memoria del Segundo Foro de Reflexión Binacional, Fundación Solidaridad Mexicano Americana, A.C. y
Senado de la República. Fundación Solidaridad Mexicano Americano:
Mexico, pp. 139-153; Organista, K.C., Carrillo, H., & Ayala, G. (2004). HIV prevention with Mexican migrants: Review, critique, and recommendations. Journal of Acquired Immune
Deficiency Syndrome, 37(Suppl 4), 227-239.
12
Good practices for healthcare delivery




Mesoamerican Project-HIV Prevention in Transit Stations
Increase in prevention skills among young people and sex
workers (p<.05: increased HIV knowledge, reduced HIV stigma,
increased access to condoms)
16,431 rapid tests; 8822 mobile pops tested and treated for other
STIs
Harmonization of ARV regimens and access to treatment
Informal: El Salvador, Honduras
 Formal: Mexico “right to healthcare independent of migratory
status” (nov. 2010)




US-Mexico Migrant Health
Primary care package (NGO and out-of-pocket) and referral to
hospital services in Mexico (Seguro Popular)
Informal: ARV for people without papers: ADAP, clinical
protocols, medicine banks
CONCLUSIONS





Some examples of successful HIV prevention and care
initiatives for mobile populations
Challenges
Sustained political will
Emergency healthcare vs. Long-term care
Gender differentiated strategies
 Recognition by governments and mainstream
migration organizations
 PReP, female condoms, PEP, emergency
contraception
14
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