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IOM
Training
Course in Reproductive Health/Sexual Health Research
WHO, 6th March 2006=
Michela Martini=
Coordinator =
on
HIV/AIDS Mobility
for the Mediterranean and SEE
<=
/b>
IOM Rome
=
;
=
HIV/AIDS
AND MOBILITY
FROM THE EVIDENCE TO CRITICAL ISSUES=
FROM THE EVIDENCE TO CRITICAL ISSUES=
IOM
=
=
1. Exploring the evidence
3. Key issues and concerns
=
4. Ways forward
HIV/AIDS and STIs in the migrant
populations
=
=
2. International mobility
IOM
the movement of people”<=
/span>
…To the evidence that
From the assumption...
=
•Hu=
man
mobility has impacted the spread of HIV
•Mo=
bile
groups are more vulnerable to HIV/AIDS
Mobility
and HIV/AIDS: exploring the
evidence
IOM
Countries reporting a
high migration flow experimente=
d a =
higher HIV
prevalence rate
![](3D"slide0073_image003.png")
The
scientific evidence
Decos=
as
Migration and AIDS, Lancet 1995;
WHO The current global situation of the
HIV/AIDS pandemic Geneva: WHO/GPA: 1995
Legar=
de Int.
Journ. Of Epidemiology 32,744-52
![](3D"slide0073_image005.png")
•Côte d’Ivoire-one
quarter of the population was made of migrant=
s from
neighbouring countries. Côte d’Ivoire had t=
he
highest HIV prevalence rate in West Africa.
Similar association was found in relation =
to
Southern Africa.
Observational studies
A recent publication confirmed this =
in
relation to West Africa
IOM
Countries reporting a
high migration flow experimente=
d a higher HIV
prevalence rate
Higher HIV
prevalence among mobile groups vs.
people who do not move.
Seroprevalence studies
Observational studi=
es
The
scientific evidence
IOM
=
0.5 % (2 cases out of 414) among control group: those who never moved
27% among those who had travelled in other African countries
11.3 % among spouses of expatriated
Kane F,N Doyle. AIDS 1993
Sample=3D
7000 adults Country=3D Senegal
HIV
prevalence among mobile people
IOM
1.4 % those who never moved=
7.6% among those who had trave=
lled
in other African
countries
Lydie et at J. of Acq. I=
mm. =
Sy=
ndrome
2004
<=
/span>
Sample=3D
1913 adults Country=3D Cameroon
HIV
prevalence among mobile people
IOM
Countries reporting a
high migration flow experimente=
d a higher HIV
prevalence rate
Higher HIV
prevalence among mobile groups vs. people =
who
do not move.
people on the move higher vulnerability <=
/span><=
span
lang=3DEN-GB style=3D'font-family:Arial;font-size:92%;color:white;mso-colo=
r-index:
0'>to HIV/AIDS
![](3D"slide0124_image006.png")
<=
span
style=3D'font-family:Arial;font-size:75%;color:white;mso-color-index:0'>•=
risk behavi=
our
<=
span
style=3D'font-family:Arial;font-size:75%;color:white;mso-color-index:0'>• =
low awarene=
ss
behavioural studies
Seroprevalence stud=
ies
Observational studi=
es
The
scientific evidence
IOM
truck drivers in Africa and India . Y.=
singh,
Int.. Jour. of STD & AIDS 1994
De=
cosas,
Lancet 1995; 346:826-28
“T=
he
current global situation of the HIV/AIDS pandem=
ic”
Geneva: WHO/GPA: 1995<=
span
style=3D'mso-spacerun:yes'> non-mobile partner<=
b> The commonly held assumption was that =
the
transmission of HIV is unidirectional, f=
rom
infected mobile to uninfected resident.
Some studies show now the evidence =
that
in the discordant mobile couple a r=
elevant
percentage it is the resident partner who is with HIV.
Inter. Jour. Epidemiology 2003;32
Lurie et al. AIDS 2003
Behavioural studies
IOM
Mobility
and HIV/AIDS: exploring the evide=
nce
![](3D"slide0107_image008.png")
B
B
B
B
A,C
D,=
F,G,H
G.o,m=
HIV-2=
1980s Global Distribution of HIV subty=
pes
Source: Italian National Institute of =
Health,
Dr. Schinaia =
3;
IOM
![](3D"slide0108_image009.png")
B,A/E,C,A/G
D,G.o,HIV-2
=
;
B,F,B/F,C
B,A/B,A,A/E,C,D,F
G,H,J,A/G,G.o,HIV-2
B
A,C,A/G
D,F,G,H,J,A/E
G.o,m,HIV-2
altri rec.
=
;
C,A/E,B
B/C, HIV-2
Mobility
and HIV/AIDS: exploring the evide=
nce
Current Global Dist=
ribution
of HIV Subtypes
<=
/div>
Source: National Institute of Health, Dr. Schinaia
IOM
•=
![](3D"slide0131_image011.png")
HIV infections newly diagnosed
(2001):
Cases with part=
ner
from a country with a generalised HIV epidemic
Source:UNAIDS/WHO report n° 66
Total cases 2001
12
11
4
5
Mobility
and HIV/AIDS: exploring the evide=
nce
IOM
High HIV prevalence in the country of origin is
frequently cited as one reason of higher vulnerability
While this approach c=
an
be epidemiologically correct, it runs the risk of being perceived as
stigmatising
…Stigma creat=
es
barrier to effective response
Mobility and HIV/AIDS:
exploring the evidence
IOM
but the social
disruption
which characteri=
ses
certain types of migration,
which determines
vulnerability to HIV”.
J. Decosaa, et al. Lancet 1995; 346:826-28.
=
Kane et al. AIDS 1993; 7:1261-65
IOM
Which are the roots of this vulnerability ?
Mobility and HIV/AIDS: exploring the evidence
The Social science
contribution....
IOM
•
=
discrimination, xenophobia;
<=
span
style=3D'font-family:Arial'>•Lac=
k of
legal protection;
<=
span
style=3D'font-family:Arial'>•Work in isolated environment with easy access to CSWs<=
span
style=3D'font-family:Arial;display:none'>
<=
span
style=3D'font-family:Arial'>•Vul=
nerability
to sexual exploitation, harassment
<=
/div>
![](3D"slide0004_image013.png")
• Poverty, marginalization
Structural
factors
Mobility
and HIV/AIDS: exploring the
evidence
IOM
<=
span
style=3D'font-family:Arial;font-size:92%;color:white;mso-color-index:0'>• =
separation/distance from
families and
partners
communities, norms=
<=
span
style=3D'font-family:Arial;font-size:92%;color:white;mso-color-index:0'>• =
alienation
<=
span
style=3D'font-family:Arial;font-size:92%;color:white;mso-color-index:0'>• =
de=
spair
<=
span
style=3D'font-family:Arial;font-size:92%;color:white;mso-color-index:0'>• =
loneliness
<=
span
style=3D'font-family:Arial;font-size:92%;color:white;mso-color-index:0'>• =
se=
nse of
freedom
<=
span
style=3D'font-family:Arial;font-size:92%;color:white;mso-color-index:0'>• =
di=
fferent
perception of risks
Individual factors
Mobility
and HIV/AIDS: exploring the
evidence
IOM
Studies have confirmed that
migration does play an important role in the HIV epidemic...
•
…revealing a more complex pi=
cture
than expected and challenging some basic assumptions.
=
IOM
International
migrants trend
![](3D"slide0092_image014.png")
![](3D"slide0092_image015.png")
1965
1975
1985
1990
2000
100
140
180
![](3D"slide0092_image016.png")
![](3D"slide0092_image017.png")
![](3D"slide0092_image018.png")
![](3D"slide0092_image019.png")
![](3D"slide0092_image020.png")
![](3D"slide0092_image021.png")
![](3D"slide0092_image022.png")
60
![3D"Text](3D"slide0092_image023.png")
Million migrants
over the past 35 y=
ears the
number of international migrants has more than
doubled.
![](3D"slide0092_image024.png")
![](3D"slide0092_image025.png")
230 mil
175 mil
![](3D"slide0092_image026.png")
![](3D"slide0092_image027.png")
2050
![](3D"slide0092_image028.png")
IOM
Migrants: who are they?
•
(In)voluntary
![](3D"slide0139_image029.png")
MIGRATION
![](3D"slide0139_image030.png")
Forced
Flee=
ing from
countries struck by economic crises of tran=
sition,
in search of a better life / education
=
Ø<=
span
style=3D'mso-spacerun:yes'> Migrant workers
<=
/div>
Ø<=
span
style=3D'mso-spacerun:yes'> Families
of immigrants
ØT=
ourists
ØS=
tudents
![](3D"slide0139_image031.png")
11
Conflict
related
ethnic,
religious, politic persecutions
natural
disasters
<=
span
style=3D'font-family:Rockwell;font-size:83%;color:white'>Øi=
nternally
displaced person,
![](3D"slide0139_image032.png")
IOM
![](3D"slide0093_image033.jpg")
![](3D"slide0093_image034.png")
Reviewing International migration data: =
women
2.9% of the world
population
=
é=
48%
are women.
<=
span
style=3D'font-family:Rockwell;color:white;mso-color-index:0;visibility:hid=
den'>•=
Both migration and HIV epidemi=
c are
going along a process of feminisation
Women are also disproportionately
affected by the HIV epidemic
African women ( 15-24 years-old) are 3.4 times more likly to be infected then their male counterpart- UNAIDS
2004 <=
i>
IOM
Why are women more vulnerable to HIV =
infection ?
<=
span
style=3D'font-family:Arial;font-size:90%'>åLarger =
mucosal
surface; microlesions which can occur during intercourse;
<=
span
style=3D'font-family:Arial;font-size:90%'>åMore vi=
rus in
sperm than in vaginal secretions;
=
åAs with STIs, women are at least =
four
times more vulnerable to infection;
åCoerced sex increases risk of
microlesions;
åClinical management based on research on men=
åWhen in treatment may experience stronger side effects.
Biologically:
<=
/div>
Sourc=
e: WHO Fa=
ct sheet
N°242 June 2000
IOM
<=
span
style=3D'font-family:Arial'>åFinancial or material dependen=
ce on men
å
<=
span
style=3D'font-family:Arial'>åFinancial needs
å
<=
span
style=3D'font-family:Arial'>åNeglected of health needs
Why are women more vulnerable to HIV infection?
Economically:
IOM
<=
span
style=3D'font-family:Arial;font-size:90%'>åHarmful cultural
practices; =
åStigma and discrimination in relation to AIDS (and all ST=
Is) :
much stronger against women who risk violence, abandonment;
åCultural Belief: Men are seeking younger partners in the belief that sex wit=
h a virgin cures AIDS=
and
other diseases;
åDisclosure of status, partner notification, confidential=
ity
Socially and culturally: =
Why are women more vulnerable to HIV infection?
IOM
![](3D"slide0135_image036.jpg")
=
![](3D"slide0135_image037.png")
Migration might imply
discrimination, being migrant woman lead to a double discrimination:
![](3D"slide0135_image038.png")
of category (being migrant)
<=
/b>of gender ( men vs. women).
Ha=
iti 1996
© IOM 1996
IOM
=
é700.000 to 2
million women/children are estimated to =
be
trafficked each year.
=
;
IOM
Trafficking
and sexual/reproductive health=
3;
IOM Kiev Rehabili=
tation
Center (Feb 2002 to Apr 2003):
Assisted: 427 women / adolescents
Detected:
309 Pelvic
inflammatory diseases (salpingitis, cervicitis, n-s vaginitis)
=
213 Mixed
infections (2 or more STIs)
13 HIV
positive, of them 2 pregnant
244 Mycoplasmosis
182 Chlamydia
infection
87 Bacterial
vaginitis
45 Trichomonas
infections
29 Vaginal
candidiasis
23 Syphilis
2 Gonorrhea
18 Unwanted
pregnancies
* note: data includes trafficked persons for vario=
us
reasons,
<= span style=3D'mso-tab-count:2;width:17.6%'> but majority were trafficked= for sexual exploitation
<= span style=3D'mso-tab-count:2;width:17.6%'> but majority were trafficked= for sexual exploitation
15
IOM
•=
•=
•=
•=
•=
Migra=
nts and
Mobile populations have the least access
to programmes and research as well a=
s care
& services.
Migran=
ts and
Mobile populations are often perceived as abusers of the social welfa=
re
system, as criminals, and as the bridge of the infection.
Migrants =3D
population “left out” &=
#13; Highly
stigmatized
<=
span
style=3D'font-family:Arial;color:white;mso-color-index:0'> Hard to reach
Hard to reach
In terms of cultural barriers, languages as w=
ell
as logistics
Exact
numbers of migrant populations unknown
No data on HIV
prevalence in this group
=
;
Mobile
people and migrants :
the …evi=
dence