The Intersection of Migration with HIV Risk in Vulnerable Populations and Their Families in Canada:  Wangari Tharao

Women’s Health in Women’s Hands CHC/African and Caribbean Council on HIV/AIDS in Ontario

Family Front and Centre: The Role of Families in Adapting to and Preventing HIV/AIDS

Mars Centre, 101 College Street, TorontoAugust 6th, 2009

Introduction Factors impacting on risk and vulnerability to HIV/AIDS Entry into Canada by Migrant and Refugee (M/R)

Populations Factors influencing risk and vulnerability to HIV/AIDS for

M/R populations in Canada Systemic issues: Programs and services related issues Research related issues:

Examples of interventions Conclusions

Presentation outline

Introduction:

Why do people migrate?

Introduction (cont’d):

By 2008 more than 200 million people were international migrants (IOM 2008a) Europe: 64 million - 9% Asia and the Pacific: 58 million Northern America: 45 million Latin America and the Caribbean: 6.5 million Africa: 17 million

Introduction (cont’d)

At the end of 2007, approximately 16 million people were refugees (IOM 2008b) people who crossed an international border as

they fled armed conflict, violence, human rights violations or natural or human-made disasters.

The majority of refugees are hosted by neighbouring countries,

80% remain within their region of origin. 26 million persons were displaced due to

conflict in 2007

Factors impacting on risk and vulnerability to HIV/AIDS

(UNAIDS 2009)

7

Entry into Canada by Migrant and Refugee (M/R) Populations: Canada sustains a growing population through

immigration Immigration policy allows entry:

To sustain population growth Support of a strong viable economy Reunification of families Fulfillment of the country’s international obligations and

humanitarian tradition Refugees Other displaced persons

Entry into Canada by Migrant and Refugee (M/R) Populations (cont’d): Migrants enter into Canada under several

categories which include: Economic migrants refugees or refugee claimants family members students visitors.

10

Factors influencing risk and vulnerability to HIV/AIDS for M/R populations in Canada Individuals/families experience a multitude of

challenges accessing information and services ranging from: Systemic issues: Programs and services related issues Research related issues:

Systemic issues:

Immigration and Government legislative policies Citizenship and Immigration Canada’s (CIC)

mandatory HIV testing policy for all immigrants

HIV testing policies for reducing maternal transmission targeted to individual women

Disclosure and Criminalization of HIV

Transmission policies:

Systemic issues (cont’d):

Multifaceted, intersecting dimensions of stigma and discrimination (HIV status, race/racism, gender, sexual orientation/homophobia, immigration status, etc) Dimensions of intersecting frameworks of

discrimination are interconnected and effect is cumulative

“Being homosexual you’re the bottom of the barrel. You add AIDS on to that, you’re underneath the damn barrel…the underside of the bottom of the barrel. And then you’re just totally shunned. …[the Trinidadian community] don’t accept it, they don’t understand it...But when you’re from the West Indies, it’s not something you’re supposed to see or talk about.”

- HIV positive Trinidadian man, Stigma Study

Systemic issues (cont’d):

“It’s not just HIV. First of all I’m Black. Second of all I’m a woman. Third of all I was a single Mom for awhile. I’m on social assistance. Right there I cover all the grounds for you. So it’s like racism, you can’t hide from it.”

- HIV positive Jamaican woman, Stigma Study

Systemic issues (cont’d):

Effects/Impacts create unique risk situations for transmission of HIV

limit access to settlement, social and health services e.g. housing, employment, access to care

Low self esteem

family/relationship breakdown

ability to negotiate safer sex

Systemic issues (cont’d):

High rates of unemployment/under-employment/poverty: Working in multiple low paying jobs Struggles to alleviate poverty takes priority over

access to HIV/AIDS information and services

17

Programs and services related issues: Linguistically and culturally inappropriate

programs Language barriers limited understanding/exploration of cultural

norms, values, beliefs and practices Female Genital Mutilation vaginal cleansing dry sex family honor wife inheritance polygamy,

Important to incorporate in interventions

Programs and services related issues (cont’d) Limited outreach and

prevention/education programs Failure to maximize on prevention

opportunities offered when migrants enter the health care system

Failure to incorporate trauma experienced during the migration process as part of service delivery

“Some of the issues that these particular women face that I think are unique is that in life they’re dealt a multitude of crises at one particular time. Many women are diagnosed in the context of pregnancy, so they’re adjusting to the reality of being HIV positive. Sometimes they’re dealing with the crisis of diagnosis at a time when there is pressure for them to take medication to prevent prenatal transmission, they have to actually deal with the drug and being HIV positive………So again, they may be dealing with various members of the family being tested together at the time that they’re being referred to the clinic. So they’re also dealing with that. Trying to assimilate new information, maybe in the middle of immigration process application for status in Canada, so they’re going through a status shift. They may be trying to maintain some course of action through, They may have an immigration broker that they don’t want to deal with because now they’re afraid that that person knows that they’re HIV positive, and they may be uncomfortable with that broker. Sometimes the women feel abandoned, or their partners in the context of the diagnosis treat them in a hostile or sometimes abusive manner.”. - HIV Clinic Provider 2 -Silent Voices Study)

Programs and services related issues (cont’d)

Lack of linkages between relevant departments: Disconnection between social, health and

immigration departments limited sharing of information to support

service delivery for M/R populations.

22

Research Issues:

Lack of evidence to inform policy and programs: Failure of surveillance systems in capturing

ethnicity data Limited research has been undertaken in

migrant population in general

24

Existing interventions within M/R Populations in Ontario Ontario has the largest no of M/R populations

particularly those from the high HIV prevalence regions of Africa and the Caribbean

Several groups funded to work primarily with mobile/migrant populations Black Coalition for AIDS prevention Africans in partnership Against AIDS Alliance for South Asian AIDS Prevention Asian Community AIDS Services Community for Accessible AIDS Treatment The African and Caribbean Council on HIV/AIDS in Ontario Latinos Positivos of Ontario

Existing interventions within M/R Populations in Ontario These agencies have developed innovative

programs tailored to the needs of M/R populations

Service targeted to youth, women, PHAs, service providers etc. as individuals and as collective entities.

Examples of Interventions that are evidence based: CAAT’s CMAP Project

B’CAPs root of risk project targeted to young

women

ACCHO’s “Keep It Alive Campaign”

2828

Examples of Interventions that are evidence based:Keep it aliveKeep it alive province-wide communications campaign province-wide communications campaign

Over 4 years (2006-2009)Over 4 years (2006-2009)

Raise awareness of HIV among African and Caribbean communitiesRaise awareness of HIV among African and Caribbean communities

Promote HIV prevention (testing and safer sex)Promote HIV prevention (testing and safer sex)

Reduce stigma and fearReduce stigma and fear

Delivered throughDelivered through- outdoor media, community media, posters and postcards, TV, Internet, events- outdoor media, community media, posters and postcards, TV, Internet, events