A new REG report – “Access to HIV and Other Healthcare Services for Refugees and Displaced Persons from Ukraine in the Russian Federation in 2022”

In July 2022, the Regional Expert Group on Migration and Health (REG) issued a report on an assessment of access to HIV and other healthcare services for refugees and displaced people from Ukraine in the Russian Federation. The authors aimed to assess the needs of refugees and foreign nationals living with HIV in the Russian Federation who are in a difficult situation due to the hostilities, in particular their need for medical and other care, as well as their level of access to required services or to receive care.

According to the UN, as of July 2022, over 7.1 million refugees from Ukraine were registered in Europe; over 1.5 million refugees were registered for temporary protection or other similar schemes in European countries (mainly under the EU directive on temporary protection for refugees from Ukraine). More than 2.4 million people were displaced or having no other option had to leave to Russia individually. However, it is important to note that these figures are changing rapidly.

The authors of the report have conducted 15 semi-structured interviews with HIV-positive migrants and refugees from Ukraine (in Moscow, Moscow Region, St. Petersburg, Leningrad Region and Voronezh as a border region that hosts a large number of Ukrainian citizens) and five expert interviews with relevant professionals from different regions working with this group. The interviewed experts included employees of both state institutions and NGOs: employees of the AIDS centre, an infectious disease doctor, a lawyer, coordinators of humanitarian projects and social workers.

The survey participants – foreign nationals can be divided into two groups: those who came to Russia as labor migrants (6 people), and those who were forced to leave home due to hostilities of 2014 – 2022 – refugees (9 people).

The questions were related to the reasons for moving to Russia, receiving HIV-related care, the challenges and needs they face in Russia, interaction with state institutions and NGOs, and plans for their future stay in Russia. The survey showed that respondents in the “migrant” group came to Russia mainly for the purpose of improving their standard of living and quality of life; they mentioned “seeking work” as the most frequent reason for moving. Refugees did not plan to leave the territory of Ukraine and the reason for their urgent move was the military action. At the same time, the problems and needs of those who arrived consciously several years ago and those who arrived spontaneously after February 2022 are completely identical.

These include, first of all, the lack of documents and, as a consequence, the inability to find work and seek medical assistance from state organisations, the lack of financial and material resources, and the inability to receive treatment and other medical care due to HIV infection. Other problems mentioned included laws that do not allow for legalisation due to HIV infection, a lack of any rights, and a lack of housing. The main needs of this group are ARV therapy, the need for full legalisation and to obtain documents (passport, voluntary health insurance policy), material resources (housing, work, clothes) and money.

When asked about their interaction with state institutions and NGOs, respondents were divided between those who applied only to a specific NGO and received all assistance in one place, and those who had experience of applying to several different organisations. This was partly due to a reluctance to disclose their diagnosis and draw attention to themselves as foreign nationals, and partly due to a lack of information about rights, opportunities and ways to get assistance. At the same time, those who have applied to state structures (MFC, Rospotrebnadzor, etc.) and several NGOs have more knowledge and a clearer understanding of their rights.

The data indicates that most of the respondents plan to stay in Russia, obtain documents and legalise. Some respondents plan to do so because they have in Russia relatives, social ties and opportunities, and some because they simply have no other options.

The specialists interviewed as part of the survey, regardless of the region where they work, noted a high number of HIV-positive foreign nationals seeking help, as well as a significant increase in the number of appeals after the start of the full-scale hostilities in February 2022.

An important feature of the current wave of Ukrainian refugees in Russia is the absolute numerical predominance of women and children and the conditional division of migrants from Ukraine into two social groups: those who have relatives and housing and are going to Moscow or Saint Petersburg, and those who left their country in an emergency, have no social connections in Russia or means of subsistence and were directed to temporary accommodation centres in Voronezh and other bordering regions.

The data on the needs of HIV-positive foreign nationals seeking help from specialists fully coincide with the data obtained from interviews with HIV-positive Ukrainian migrants and refugees: these are primarily ARV therapy and tests, as well as medical and social care.

Specialists point to the same difficulties cited by HIV-positive foreign nationals: lack of legal status, lack of financial resources, including for medical care, inability to receive free medical care within the public health system, need for ARVT and regular testing, fear and stigma, for some also lack of housing, employment, any material resources for subsistence.

Special attention was given to the fears and anxieties experienced by migrants with HIV in Russia, in particular the fear of deportation due to HIV infection.

Russian charities and other NGOs, to the extent of their capacities and resources, cover certain needs of migrants and refugees who turn to them. The assistance provided to migrants by these organisations is multifaceted and comprehensive, covering both medical and social aspects. This includes assistance in arranging consultations with medical specialists, psychologists, lawyers, and social workers, and HIV related assistance: HIV tests, antiretroviral treatment, etc.

The authors of the report note that despite the significant amount of assistance that NGOs provide to their beneficiaries, including foreign nationals, their resources are limited and do not allow them to meet all requests. The issue of funding, in particular, remains acute for all NGOs.

The report concludes with a set of recommendations, based on the findings of the analysis, which would make it possible to work more effectively with HIV-positive foreign nationals and prevent new HIV infections.

The full report “Assessment of Access to HIV and Other Health Care Services for Refugees and Displaced Persons from Ukraine in the Russian Federation in 2022” can be requested by contacting REG at migration.health.eeca@gmail.com.