Why HIV-positive migrants tend to stay in Russia illegally

As the discussions showed, there is an understanding in Russia that the deportation provisiob should be abolished. However, the Russian side is concerned about the financial side of the issue: the need to pay for the treatment not only of its own citizens, but also of migrants.

In 1995, Russia passed a law on the deportation of foreigners with HIV-positive status. Junior researcher of the Higher School of Economics, Program Advisor of the ECUO (East Europe and Central Asia Union of People Living with HIV) Daniil Kashnitskyi explained in an interview for the Fergana media:

“Migrants who receive patents for labor in Russia, the citizens of Uzbekistan, Tajikistan and Moldova, must take HIV tests. If the test is positive, they are denied a patent and, according to the law, must be deported. But since there is no money for this, they are included into the database of the persons banned from entering the territory of Russia. This is driving migrants into the shade and forcing them to stay in Russia for years, illegally and without access to treatment. Thus, the deportation rule is not only discriminatory, but also harmful from the epidemiological and economic point of view.
In 2016, at the request of the Constitutional Court, the ban on staying in Russia was lifted for migrants who have a family in Russia. Then the ban was lifted for the citizens of Ukraine, however, this provision continues to apply to all other foreign citizens.

Despite the urgency, the issue of HIV transmission and treatment among migrants does not get in the focus often. This year, a broad discussion of this topic was held in the framework of the VI International Conference on HIV/AIDS in Eastern Europe and Central Asia, held in Moscow on April 18-20. The event was attended by experts not only from Russia, but also from Tajikistan and Uzbekistan, who expressed their readiness to support their compatriots. The main issue is the abolition of the deportation provision, and then it is possible to arrange reimbursement of funds spent for the treatment of migrants, or create an intergovernmental fund to provide people with antiretroviral therapy (ART) in migration.

The question about the HIV prevalence and tackling the treatment problem among migrants from Kyrgyzstan is still outstanding, there is no such data: since Kyrgyzstan is part of the Eurasian Economic Union, people coming from there are not required to take an HIV test.
“People are not only “bringing” HIV to Russia, they also get it here. According to the UNAIDS data of 2016, more than 50% of HIV-positive women in Central Asia had husbands who had been in migration to Russia”, said Yelena Romanyak, Member of the Management Committee of the Eurasian Network of Healthy Key Groups.

Natalia Ladnaya, Senior Researcher of the Federal Scientific and Methodological Center for AIDS Prevention and Control of the Central Research Institute of Epidemiology of the Federal Service for Consumer Rights and Welfare (Rospotrebnadzor) provided some more detailed statistics.

According to her, in 2017, 2.5 million people were tested for HIV. At the end of 2017, 32,885 HIV cases were detected among the citizens of the CIS countries. However, as explained by Natalya Ladnaya, this is only the top of the iceberg.

The key virus “suppliers” are Ukraine, Uzbekistan and Tajikistan, which account for 70% of HIV-positive people. 60% come from Ukraine, 20% – from Uzbekistan and 12% – from Tajikistan. The remaining countries: Belarus, Moldova, Kazakhstan, Azerbaijan, Armenia, account for 3-4%, that is, 100-200 new cases per year. The Turkmenistan is a curious case, as the country officially reports two cases of HIV infection on its territory, while Rospotrebnadzor in Russia recorded 136 cases of HIV infection among Turkmen citizens in 2017, although the inflow of migrants from there is minor.
“In 2014-2015, 4000-4500 new cases of HIV infection were detected among foreign citizens, mainly from Ukraine, who traveled to Russia in considerable numbers. Now there are about 3,500 cases a year. But there are more migrants with HIV, because some of them prefer to get tested anonymously, and some avoid testing, knowing that they are infected”, Natalia Ladnaya said.

The expert noted that the need to test migrants for HIV contributes to the fact that almost half of all HIV cases reported in the country of origin have been detected on the territory of Russia. For example, at the end of 2016, 2,500 cases were identified in Armenia, of which in 1100 cases, the first analysis was done on the territory of Russia.

“In Armenia, I saw a mark in people medical records with my own eyes, showing that the first HIV test was done in Russia. Situation in other countries is similar: 25% of HIV-infected people of Uzbekistan and 27% of Tajikistan were tested for the first time in Russia”, Natalia Ladnaya said.

Touching upon the topic of deportation, she noted that in 2011-2017, 17 million foreign citizens passed medical examination, 17,500 were recognized unsuitable for the stay in the country, 6,500 of them were disallowed to stay due to HIV.
Observing the testing patterns, you may understand that not all of the infected in Russia, someone brought the virus with them, the expert said.

“Some migrants are well socialized and communicate with Russians, and they may get HIV from Russians. Others communicate only with their peers, and they can contract HIV from the citizens of their countries, within the diaspora. Another way of transmission is through contacts with sex workers, this route is quite often found among migrants from Central Asia”, – Ms. Ladnaya said.

The expert also reported on the good news: Rospotrebnadzor developed a Regulation to cancel the decision on the unsuitability of the stay of a foreign citizen.

“I have repeatedly raised the issue regarding the restriction of HIV-positive people movement in the government and the State Duma, but they always asked if the funding will be required. Yes, if we abolish the provision, we will have to make the next step – to provide medical assistance to migrants. Antiretroviral therapy in Russia is more expensive than in Central Asia, so we will have to spend more money. Intergovernmental agreements will become an effective method of providing assistance”, said Natalia Ladnaya.
Delegation from Uzbekistan at the HIV/AIDS conference
Delegation from Uzbekistan at HIV/AIDS conference. Photo by Yekaterina Ivashchenko, Fergana media

Medications brought from Uzbekistan

Daniil Kashnitskyi is quite convinced that planning such interstate cooperation is possible:

“Delegations from both Uzbekistan and Tajikistan have already expressed their readiness to create a joint fund for the exchange of medications or to reimburse funds for the medicines that Russia will use for treating migrants. It is crucial that patients receive therapy. However, it is important to note that such a model can only be implemented if the deportation rule is abolished”.

An example of the fact that the migrants’ countries of origin are ready to help their patients, may be the story of the Director of the Uzbek Republican AIDS Center, Nurmat Atabekov, who, using the occasion, brought medications to the HIV-positive migrant in Moscow, because “returning home to get the medicines will cost too much for this patient”.
“We provide a stock of medicines for a month, but if a person leaves for another country, we can give them the sufficient stock for three months, as well as a letter for the country of arrival, informing that a person needs medications. When our specialist is on a business trip somewhere, he takes medication with him, so that the patients do not have to spend money to fly home and back”, Atabekov noted.

Mr. Atabekov also spoke about the HIV situation among labor migrants in his country. In 2017, 399,950 labor migrants were examined for HIV, 588 of which were HIV-positive – one-eighth of all infected citizens of Uzbekistan.

“In migration, people stay outside the family for a long time and the traditional social control is loosened and the number of sexual contacts increases, thus, the risk of infection intinsifies”, Mr.Atabekov explained.
74% of infected people are men, 26% are women. The age of patients is 29-59. 40% of infected people are construction workers, 27.9% are unskilled workers, 6.2% are workers, waiters, guards, cooks, shop assistants. And 71% of infected people are married. 33% had casual sexual partners, 28% had permanent partners.

When asked why they did not use condoms during the contact, 36% of the infected answered “they do not consider it necessary”, 16.9% explained this by their partner’s reluctance, and 8.4% said that “they did not have one at hand”. Among migrants, 40% never used protection means, and 37% practiced risky behaviors.

“The number of detected patients is growing, albeit slowly. At the same time, the population’s awareness of HIV is reported at 84%, but we doubt it, since such high infection rates exist”, – the Director of the AIDS Center noted. – “The country has a program for testing migrants for HIV, but it covers only those who have worked outside of Uzbekistan for more than six months. As the awareness of migrants needs to be increased in order to reduce the infection, the President instructed to prepare the action plan for the coverage with testing and working with the population and migrants. The most important thing is that migrants can be tested outside of medical institutions, so we will prepare special vehicles for counseling and testing at border crossings, places of festivities and sports competitions, and also to travel to remote areas. Also, we will ensure that air and railway ticket offices issue leaflets with information about HIV together with tickets”.
Nurmat Atabekov is sure that since labor migrants are a vulnerable group, it is necessary to legalize their mandatory testing for HIV:

“Previously, this was considered an infringement of human rights, and now, given that testing is welcomed, we will only benefit from the introduction of this rule”, the expert believes.

Statistics for Tajikistan

The Director of the Department of Family Medicine of the Tajikistan State Medical University, Dilrabo Kadyrova, presented the overview of the HIV situation in the country, and recognized that “the risks in migration are also related to the lack of knowledge about HIV prevention and the occurrence of risky sexual practices”.

“Among new HIV infections in Tajikistan, the proportion of those who had been in migration increased from 7.7% in 2012 to 14.9% in 2016. The main transmission route is sexual transmission. Among the migrants with HIV-positive status, 87% of men and 13% of women. This is due to the fact that mainly labor migrants from Tajikistan are men”, Ms. Kadyrova explained.
More than 80% of migrants had sexual contacts in countries of migration, including commercial ones. Only 50% of men and 25% of women used condoms. As many people in migration are married, this predetermines the further spread of HIV in the family and in the homeland.

Delegation from Uzbekistan at the HIV/AIDS conference. Photo by Ekaterina Ivashchenko, Fergana

Treatment at home

While the official authorities of the countries where the migrants originate from are thinking about how to remove the deportation provision, the help of migrants with HIV can be organized through civil society organizations or diaspora, according to Daniil Kashnitskyi. However, there is still another problem – migrant communities are not focused on the problem of HIV prevention.

– One of these days I was at a conference in Uzbekistan, where I was assured that they were ready to help their citizens in migration – to send them the medicines right after the deportation provision is lifted. A similar understanding exists on the Tajikistan side. But while this issue is not resolved at the interstate level, only HIV-servicing NGOs and diaspora organizations can help their compatriots, and this assistance is more about awareness and referral.
“Recently I have been providing HIV/AIDS training at the International Organization for Migration for Tajikistan’s diaspora organizations in Russia”, Mr. Kashnitskyi says. – At the beginning, the participants had many myths about HIV, but now they are ready to contribute to the dissemination of information about HIV and in the work on referral of migrants who need HIV services. It is the diaspora organizations that can effectively explain to a migrant who got to know in Russia that he is HIV-positive, that this is not a death verdict, that the disease can be treated, and that if he decides to return to his homeland, he can get enrolled in the AIDS center confidentially and receive treatment free of charge.

Tursunoi Alimardonova, deputy director of the “Migrant Workers’ Union”, confirmed that they were ready to work with migrants who were in trouble.

“Having learned about their status, people lose their heart. They are sure that this is their personal apocalypse, they do not know what to do, and they become out of reach. Unfortunately, the Russian VHI (voluntary health insurance) does not cover ART-therapy. And because of the lack of money, the migrant, even if he wants, cannot be treated in Russia (the price of ART therapy varies from 11,000 to 800,000 rubles a month.) – Note: Fergana). Therefore, our main task is to explain to migrants that there is no need to hide, that this illness can be treated”, – Ms. Alimardonova noted.
At the same time, experts agree that HIV-positive migrants would often choose any country other than theirs, because the mentality and stereotypes in the Central Asia countries are stronger than the understanding that HIV is not harmful to society if HIV-positive persons adhere to the treatment and the safe lifestyle. In addition, migrants with HIV are afraid of condemnation and admonition, therefore, it is so difficult to work with them. For this reason, a competent counseling of migrants should be organized by NGOs, where only qualified specialists should work.

“Voices of migrants are not heard, because of stigma”, says Daniil Kashnitskyi. – “The discussions on abolishing the deportation provision can continue for another year or two, and no one will go to a street picket in support of migrants because of stereotypes, so civil society must take action. On Facebook, we began to create a database of cross-border NGOs helping people with HIV-positive status in Russia and in the Central Asia countries. Regardless of the progress with the abolition of the deportation provision and the success of providing treatment for migrants, we plan to create a platform for the exchange of information and effective referrals of migrants who need assistance between civil society organizations in the Eastern Europe and Central Asia region”.

“It is important to join the efforts of HIV-servicing NGOs and diaspora organizations”, – said Kirill Barskyi, Program Coordinator of the “Steps” Foundation, one of the few Russian NGOs that help HIV-positive migrants. – “For example, we can submit a joint application for a presidential grant and work together to better inform labor migrants about HIV/AIDS and help them in difficult life situations”.

As the discussions showed, there is an understanding in Russia that the deportation provision should be abolished. However, the Russian side is concerned about the financial side of the issue: the need to pay for treatment not only of its citizens, but also of migrants. Now the governments of Uzbekistan and Tajikistan should convince Russia that the countries of the region are ready to pay for the treatment of their citizens.

In the meantime, NGOs and diaspora organizations can assist migrants. And migrants should not be afraid to seek this assistance.

Yekaterina Ivashchenko

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