Tuesday, June 24, 2014

HIV Care for Refugees

By Adriana Ganci 

Since 2001, June 20th has been recognized as World Refugee Day.  A refugee is defined as someone who is forced to flee her country due to violence or fear of persecution due to reasons of “race, religion, nationality, political opinion or membership in a particular social group.”  [1]  Refugees face an array of difficulties in resettling. They are often hundreds or thousands of miles away from home, in a place where they know no one and in a culture of which they are not a part. Resettlement can be particularly difficult for those refugees and displaced persons living with HIV. They are subject to facing a variety of the stigma of being in a cultural or ethnic minority as well as  the stigma of living with HIV.

Luckily, there are agencies who make it part of their mission to guide HIV-positive populations to the proper resources and help ease their transition as much as possible. The UN Refugee Agency (UNHCR) has seven strategic objectives in their Strategic Plan for HIV and AIDS, these include:

  1. Protection  
  2. Coordination and Integration      
  3. Prevention  
  4. Care, Support and Treatment      
  5. Durable Solutions 
  6. Capacity Building  
  7. Assessments, Surveillance, Monitoring and Evaluation and Operational Research

In setting these seven objectives, UNHCR supports and promotes HIV and AIDS programs which aim to reduce mortality and enhance the quality of life among refugees. The UNHCR works with many partners to ensure the best care for refugees, including governments, NGOs, and health care providers. [2]

Unfortunately, all HIV care for refugees is not created equally. The heath care the individual receives is obviously based on the country in which they have resettled. In the U.S., those with refugee status are given a caseworker that will set them up with Medicaid. In Canada they are enrolled in the Interim Federal Health Program, ensuring that they will receive the full gamut of HIV services. But if a refugee is resettled into Ethiopia their access to HIV care will be limited. Resettlement agencies will often try to take these caveats into consideration when placing a person or a family, but nothing is guaranteed. Organizations such as UNHCR and the International Organization for Migration work to advocate for refugees in order to find a home that can accommodate these needs. However, even if placed in a setting with a strong health care system, cultural differences may still pose additional challenges. For example, a traditional woman from Somalia might not be comfortable in an urban health clinic that is largely geared toward supporting homosexuals, indicating a strong need to guide refugees to culturally appropriate resources.  

Fortunately, policies regarding refugees and HIV are improving. In recent years, UNAIDS and the World Health Organization have come out against mandatory HIV testing of refugees, stating that it is a violation of human rights and leaves those living with HIV open to discrimination and persecution. [3] Hopefully, policies like this will continue to be made to improve the lives of refugees living with HIV. 

Furthermore, there have been more resources published for resettlement agencies, host countries, and for refugees themselves. The U.S. Committee for Refugees and Immigrants has included a guidebook for resettlement agencies serving refugees with HIV/AIDS.[4] The USCRI also has many toolkits for healthy living in many languages. They cover everything from mental health, to communicable disease, to cultural orientation, all of which are relevant to those living with HIV and can be found here.[5]  Canada’s Source for HIV and Hepatitis C Information also has lengthy information available for both refugees and immigrants living with HIV. [6] 

While it is fantastic that these resources exist, they are still limited. With over 15 million refugees in the world, many of whom come from high HIV prevalence areas, there needs to be more advocates for those living with HIV. Health care services can be complicated enough to navigate in one’s own country, let alone in a foreign setting, with the stigma of living with HIV and being  a national, ethnic, or religious minority posing an additional hurdle.  Many organizations suggest lawyers for those refugees living with HIV to ensure that they get the support they need. However, the burden cannot be on these populations who are already grappling with so many challenges and changes. We must urge governments, intergovermental organizations, NGOs, and other stakeholders to put their efforts into improving the lives of these refugees living with HIV so that they may lead the fulfilling life everyone deserves.

1.   http://www.unrefugees.org/site/c.lfIQKSOwFqG/b.4950731/k.A894/What_is_a_refugee.htm
2.  http://www.unhcr.org/488495642.pdf
3.  http://www.unfpa.org/emergencies/manual/5a1.htm
4.http://www.uscrirefugees.org/2010Website/5_Resources/5_1_For_Refugees_Immigrants/5_        1_1_Health/5_1_1_1_Healthy_Living_Toolkit/5_1_1_1_1_Communicable_Diseases/English_Guidebook_HIV.pdf
5. http://www.refugees.org/resources/for-service-providers/hiv-aids.html
6. http://www.catie.ca/en/practical-guides/managing-your-health/17 

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