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2. Unreliable data on migration volume and migrant profile Insufficient bases for estimating who and how many migrant workers are at higher HIV risk 3. Migration patterns of concern: High proportion of irregular migrants difficult to track and to reach Increasing female migrants in low-level and low-skilled occupations high-risk HIV contexts GMS countries evolving into source, transit, and destination point need to have harmonized HIV services and policies
Lao PDR
0.2
Myanmar Thailand
0.5 1.3
21.9 21.9
13.4 N/A
Study Highlight 1
Except for Thailand, there is no monitoring or surveillance system of migrant workers, thus there is limited knowledge of the HIV prevalence, vulnerabilities and risk behaviors of migrant workers.
4 3 2 1 0 Thai Migrants Thai Migrants Thai Migrants Trat Ranong Tak Source: IOM, Thailand Ministry of Public Health, UNAIDS, CSEARHAP, 2010. 2004 2005 2006
Border with Cambodia (Trat): 8 times higher among non-Thai fishermen than Thai fishermen between 2004-2006
Border with Myanmar (Prachuap Khiri Khan, Tak, and Ranong): 2-4 times higher among non-Thai male workers than Thai military conscripts between 2004-2006
Study Highlight 2
A risk-zone/hot spot HIV strategy is needed, as not all migrant workers equally at risk. Settings that have a combination of heavy mobility, large concentrations of migrant and mobile populations, and an associated sex and entertainment industry are HIV high-risk zones.
High-risk zones
Cross-border areas
Heavy mobility Large concentrations of mobile and migrant populations Associated sex and entertainment industry
Transport corridors
HIV Prevalence in Border Areas: Overlap of commercial sex and injecting drug use
Lao PDR Viet Nam (North), Dien Bien: 42.9% (2009): Vietnamese male IDUs 20% (2009): Vietnamese FSWs PRC -- Viet Nam: 23% (2009): Vietnamese IDUs in Lang Son 46% (2005): Vietnamese IDUs in Lang Son 17% (2005): Chinese IDUs in Lang Son 18.3% (2005): Chinese IDUs in Ning Ming Cambodia Viet Nam: 24.3% (2002): Vietnamese street-based FSWs in Dong Thap 2.5% (2002): Border traders in An Giang 1.3% (2002): Vietnamese karaoke-based FSWs in Kien Giang Yunnan, PRC Myanmar: 1.9% (2007-10): Dai migrant women workers
Fishermen: Wide mobility trajectory and accepted norm of sexual risks and multiple relationships
Source: United Nations Economic and Social Commission for Asia and the Pacific, 2007.
Study Highlight 3
Community-level HIV programs and services for migrant workers are highimpact interventions in high-risk/hot spot zones but are few, usually projectbased, and reach only a few.
Male and Female Migrant Workers Good knowledge of VCT, but poor action
Study highlight 4
A stronger, more migrant-sensitive enabling environment is needed to increase access of most-at-risk migrant workers to HIV services.
Need sharper, more direct focus on migrant and mobile populations: strategic information, resource support
HIV Policies
Only one country provides ART services for migrant workers Need harmonized ART policies to prevent ART disruption Adult sex work illegal in 4 GMS countries MOUs should prohibit mandatory HIV testing Operationalization of MOU for Joint Action to Reduce Vulnerability Associated with Population Movement: mapping migration patterns, HIV services, advocacy
Conclusion
First steps taken Reducing vulnerabilities of female migrant workers High-level political will needed Migration issue beyond health sector: multi-sector dialogue; coherent policies needed Sub-regional collaboration for policy and program actions
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