Sevara Khalimova (not her real name) moved from Uzbekistan to the Russian Federation to earn money to pay for her children's education. After living in the country for many years, living with a relative and working in a shop with her, her relative discovered that Ms Khalimova was living with HIV. She was thrown out of her home, leaving her not only homeless but also without work and support.
Ms Khalimova was one of many migrants living with HIV in the Russian Federation who participated in a series of studies conducted by the Regional Expert Group on Migrant Health (REG).
"Migrants, especially migrants living with HIV, are among the most vulnerable and marginalized groups. Health issues are not a priority for migrant associations," said Daniil Kashnitsky, the head of REG. "The stigma and discrimination that accompanies HIV is a serious barrier to their access to health services and their ability to defend their rights. The study was the first attempt to give a voice to migrants. We hope that the results of the study will not only equip us with a better understanding of the barriers to health services for migrants but will also contribute to a change in legislation."
According to the Ministry of Internal Affairs, more than 5 million foreign citizens migrate to the Russian Federation annually, although with undocumented migrants the number is likely much higher. However, the Russian Federation remains one of the few countries in the world that deports migrants who are living with HIV, so they face a stark choice: go home and lose their income or stay in the country illegally, risking deportation, and without HIV treatment. Foreign citizens living with HIV cannot legally buy or be given antiretroviral therapy in the Russian Federation.
The study found that migrant women are at a higher risk of HIV infection-they often have less access to HIV-related information, are often dependent on their spouse, are at a higher risk of forced sex work and are more stigmatized. Pregnant migrant women living with HIV in the Russian Federation who have a residence permit have the right to receive antiretroviral therapy, but that treatment is stopped immediately after childbirth. Undocumented migrants have no right to treatment.
According to the REG study, lack of information, legal uncertainty, language barriers, stigma and discrimination, gender inequality and inability to return to their country of origin prevent migrants in the Russian Federation from accessing HIV prevention and testing services and information on HIV.
The study calculated the cost of treating people living with HIV, based on the prices charged by private medical centres and laboratories in the Russian Federation. The researchers estimated that the cost of outpatient consultations and the provision of antiretroviral therapy is about US$ 1200 per year, which at present is not covered by the state and is not allowed to be paid for by individuals or the health-care schemes of foreign governments. They also calculated the cost of treating an opportunistic HIV-related infection as a result of someone living with HIV not accessing antiretroviral therapy. Inpatient treatment for 21 days would cost US$ 3200, which would be paid for by the government. The researchers did not estimate the significant non-medical costs associated with the deportation of migrants living with HIV, which are borne by the state.
The study shows that migrants living with HIV should be able to access antiretroviral therapy and not be subject to deportation from the Russian Federation. Such a change in legislation would help to reduce new HIV infections and would reduce expenditure on medical care and non-medical expenses.
In the past two decades, many countries, including Armenia, Bulgaria, the Republic of Korea and the United States of America, have removed legal provisions that discriminate against migrants living with HIV. Reducing barriers to migrants accessing antiretroviral therapy brings about significant results for public health.
"Lifting restrictions on the long-term stay of people living with HIV and removing barriers to people seeking health and social care will improve overall public health outcomes, support the most vulnerable and create a more robust, effective and equitable response to the HIV epidemic," said Alexander Goliusov, Director, a.i., of the UNAIDS Regional Support Team for Eastern Europe and Central Asia.
