13 Apr 2021
The Regional Expert Group on Migration and Health has conducted a sociological study to evaluate the accessibility to healthcare services for HIV-positive foreign citizens in Russia.
Stage I: literature review
In the last two decades, many countries stroke down laws discriminating against HIV-positive migrants. These countries include the USA, South Korea, El Salvador, Chile, Bulgaria, Armenia, and Ukraine, among others. The removal of the discriminating laws against HIV-positive migrants has helped decrease the general prevalence of the virus in these countries. Lowering systematic barriers which prevent the access to antiretroviral therapy for migrants has facilitated the path leading this important public health milestones.
According to the results of international studies, the mere existence of law criminalizing HIV-positive migrants has shifted the focus of public attention. Instead of analyzing the efficacy of healthcare system and prevention campaigns on HIV and other STDs, the attention has moved to migration issues.
The law on deportation does not only violate human rights but also directly affects epidemiological safety in a country.
Stage II: interviews with migrants and experts
The second stage included analysis of 10 interviews with HIV-positive migrants living in Russia, and 13 interviews with doctors and experts from HIV-related organizations, secondary data from academic publications and analytical reports on migration topic were also used.
A review of the system of HIV-positive foreigners registry, creation of limitations and the making of decisions on undesirable stay in Russia has shown that the existing system is not only violating migrants’ rights but is also ineffective. It does not consist of a pooled register (the Ministry of Health register and the register of Federal Scientific Medical Center on AIDS Control and Prevention are independent of each other). It uses different data sources.
Factors such as gender inequality, language barrier, and asymmetric legal status of labor migrants of different origins complicate the prevention, diagnostics, and informing migrants on their health status during their stay in Russia. Female migrants are more vulnerable than males from this point of view of HIV. They have less awareness, often depend on their husbands, and are less socialized. They find it more difficult to resist to social stigma.
“She told me she would not have anything to do with me anymore, because this [HIV infection] is a disease of bad women. I told her she was mistaken. I told her a hundred times, but she would not listen. She does not talk to me,”a female migrant from Uzbekistan.
In addition, migrants who must take HIV test to obtain a work or residence permit, have higher risk of becoming undocumented and living in constant fear.
Foreign citizens living with HIV cannot be officially treated with ART in Russia — neither for free, nor paid treatment. ART medications cannot be sold without a doctor’s prescription. Each migrant is faced with a choice: go to his/her home country and receive treatment for free there, or stay in Russia illegally, constantly risking deportation, or seek treatment in semi-legal ways.
It is not an uncommon situation that returning to the country of origin may be complicated, impossible, and even life-threatening for an HIV-positive labor migrant. Examples include life threats (especially for LGBT people), stigmatization, financial losses. Even worse, antiretroviral therapy is unavailable in some countries.
“All these difficulties, also unemployment… How, how will I get treatment there? How can I help my mother? Currently I support my mother with money, at least a little… What can I expect after [I go there]? … There is no internet there, nothing. Well, there is internet, but it costs money. Everything costs money… expensive internet, expensive treatment… you need to pay for everything there. Everywhere, you need money everywhere. And here I have an opportunity to earn at least some money. Just to buy medications. You earn a little, you send it home. Then you earn a little, you can eat something normal,”from an interview with a man from Uzbekistan.
To stay undocumented in Russia means to accept the risk of detention and be in constant fear of deportation. In addition, a person has to regularly buy ART; the cheapest option is about 1500 RUR per month, and in case of intolerability or resistance, other and more expensive drugs might be prescribed. Nevertheless, many migrants choose this option: to stay undocumented and try to survive, and not go to their country of origin.
Migrant subgroups: pregnant women and students
Pregnant women and students form a specific subpopulation of HIV-positive migrants in Russia, and they have been studied separately.
During the follow-up of pregnancy, an HIV-positive migrant who has a Russian residence permit has a right to ART medications, but the treatment ceases just after delivery. If an HIV-positive woman is undocumented, she cannot receive treatment and medical follow-up during pregnancy. This leads to serious risks for her and her baby’s health.
Foreign students must present a medical certificate confirming HIV-negative status to obtain a student visa. If a person does not need a visa, their HIV status may stay unknown to the university. However, when the student’s HIV positive status becomes known, it may result in deportation.
Effects of pandemic
An analysis shows that COVID-19 pandemic has become a global factor increasing inequality and preventing migrants’ access to medical care. Lockdown measures and the closure of borders has led to temporal hiatus of physical transnational connections, issues with the import and export of ART drugs, and a fall in income and financial instability.
This empirical study resulted in defining several challenges which HIV-positive migrants face in Russia:
- Fear of HIV status discovery.
- Fear of deportation.
- Lack of information and legal uncertainty.
- Language barrier.
- Stigmatization and self-stigmatization.
- Gender inequality.
- Impossibility of return to the country of origin.
Decriminalization of HIV-positive for foreigners may become a move to decrease HIV spread and allow labor migrants to be legally protected and harness their full potential in Russia.
Among suggested recommendations, the following may be highlighted:
- A need to establish international collaboration to provide ART to the patients from neighboring countries.
To circumvent the language barrier and breakdown communication barriers with foreign patients. It is necessary to systematically inform foreign citizens about the access to healthcare in the receiving country. This should be done in languages understandable for them. Such information should be presented in the form of short leaflets, memos, videos in migrant groups on social media. It is also important to engage diasporas and migrant-oriented cultural, educational, and other organizations.
Another effective measure is to provide volunteer translation service to migrants, especially from far-abroad countries, when visiting clinics.
full text of the study is available in Russian. English version will be uploaded soon.
Based on: MV Vyatchina, DS Kashnitsky, KA Barskiy, ZB Abrosimova, AV Fedoryak. Situational analysis of access to HIV services for foreign migrants in the Russian Federation. Regional Expert Group on Migration and Health.
This article was prepared with the support of Oxfam in the Russian Federation