The Intersection of Migration with HIV Risk in Vulnerable Populations and Their Families in Canada:...
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Transcript of The Intersection of Migration with HIV Risk in Vulnerable Populations and Their Families in Canada:...
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)
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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.
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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
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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
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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”
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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