SITUATION AND ECONOMIC ANALYSIS OF HIV SERVICES FOR INTERNATIONAL MIGRANTS IN KAZAKHSTAN
The report presents the results of a situational and economic analysis conducted in 2021-2022which examined the availability of health care to HIV-positive migrants temporarily residing in the Republic of Kazakhstan, and analysed the barriers and trajectories of their overcoming in access to health care for international migrants living with HIV.
The study was conducted in two stages: a desk study with the analysis of previous papers and an analysis of empirical data obtained by semi-structured interviews with HIV-positive migrants and AIDS service specialists.
The provision of medical care, including antiretroviral therapy for international migrants living with HIV, is a pressing issue for all countries. For Kazakhstan, this problem is also of great importance, given the flows of migrant workers, including illegal ones, mainly from nearby Central Asian countries (Kyrgyzstan, Uzbekistan, etc.). The issue of ensuring adequate and sustainable funding for state bodies and NGOs for HIV prevention, treatment and care of patients with HIV, including migrants, also remains urgent. Despite measures taken by governmental structures, non-governmental and international organisations, HIV continues to grow in Kazakhstan. The prevalence of the disease is predominantly among people of working age (20-49 years), where key populations (people who inject drugs, sex workers, men who have sex with men) are most at risk of infection.
Goals and objectives
The goals of the study were to analyze the availability of medical services for HIV-positive foreign citizens in Kazakhstan and to identify legislative and financial barriers to obtaining them. The study analyzed barriers at the legislative and law enforcement levels, and it was shown by cases and interviews with HIV-positive migrants how such barriers affect the life of people and their environment in Kazakhstan and in their countries of origin, especially during the COVID-19 pandemic.
In the course of the study,
1) the legislative field was described and accessibility of HIV-related medical services and services for domestic and foreign migrants, including citizens of Russia, Uzbekistan, Tajikistan, and Kyrgyzstan;
2) barriers in the access of HIV-positive foreign and domestic migrants to health services, as well as trajectories of overcoming these barriers were described;
3) current and potential expenditures from the state budget for the provision of medical services to foreign migrants with HIV in Kazakhstan with the development of various models of financial costs for treatment were analyzed;
4) recommendations for budgetary and NGOs to eliminate barriers and organize the treatment of HIV-positive foreign migrants in Kazakhstan were given.
The data indicates an increase number of HIV cases among Kazakhstan citizens, despite ongoing measures for the prevention, diagnosis, and treatment of the disease. The low effectiveness of the HIV control measures may be one of the main reasons for the increase in the number of new cases. Attempts to avoid solving the issues of treatment of foreign migrants with HIV lead to infection of Kazakhstan citizens and an increase in treatment expenditures. The differences and discrepancies in the normative legal acts regulating the provision of medical care and diagnosis of HIV have been revealed. The study shows the stigmatization of people with HIV — almost all HIV-positive migrants, both domestic and foreign, changed their place of residence after they learned about their positive HIV status.
The desk study, as well as the survey of patients, made it possible to identify legislative and financial barriers to obtaining medical care. Despite the legal possibility of obtaining a residence permit, which would guarantee free medical care for HIV-positive migrants, foreign citizens must pass an HIV test. A positive result subsequently becomes a barrier when submitting documents to the migration service, as employees refuse to accept documents from such foreigners. The survey results indicate the social insecurity of foreign HIV-positive migrants, which does not allow them to legalize their stay in the country, find a legal job, or get affordable medical care and other HIV-related services.
In the course of the study, an economic analysis of the provision of medical care to foreign citizens and stateless persons was carried out. An analysis of public expenditures related to emergency medical care for HIV-positive international migrants were conducted, as well as analysis of potential state budget expenditure on possible HIV services for foreign citizens.
In order to determine the financial costs of the State Budget of Kazakhstan for treatment of international migrants living with HIV in Kazakhstan we made modeling based on two scenarios:
– Treatment with basic ART drugs at the outpatient level;
– Treatment of HIV-associated conditions at inpatient level in case of opportunistic diseases and complications in case of absence of timely basic ART treatment at the outpatient level.
The analysis shows that annual financial savings to the Republican budget in case of treatment of one HIV-positive foreign citizen at the outpatient level will range from 1.6 times (when using the ART preferred scheme) to 4 times (when using the first-line ART) compared to treatment of one HIV-positive foreign citizen at the in-patient level.
It is 6 times more profitable for Kazakhstan to allocate funds from the national budget to treat international migrants living with HIV at the outpatient level compared to the treatment of HIV-positve patients who could potentially be both international migrants and citizens of Kazakhstan.
To reduce the spread of HIV, all efforts should be directed at reducing risk factors and vulnerability. From this point of view, the provision of ART from the moment the virus is detected, both to citizens of the Republic of Kazakhstan and migrants, is crucial in terms of HIV infection prevention. Protecting the rights of HIV-positive migrants, including undocumented and uninsured, as well as providing them with treatment were proposed as priority measures to combat HIV.