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HIV/AIDS and Mobility in South Asia

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HIV/AIDS and Mobility in South Asia UNDP is the UN’s global development network, advocating for change and connecting countries to knowledge, experience and resources to help HIV/AIDS and Mobility people build a better life. Regional HIV, Health and Development Programme for Asia and the Pacic in South Asia UNDP Asia-Pacic Regional Centre United Nations Service Building, 3rd Floor Rajdamnern Nok Ave. Bangkok Thailand 10501 Email: [email protected] Tel: +66 (2) 288-2129 Fax: +66 (2) 288-3032 Web: http://asia-pacic.undp.org/practices/hivaids/ 2010 November The content, analysis, opinions and policy recommendations expressed in this publication do not necessarily reflect the views of the UNDP. The designations employed and the presentation of material on the maps contained within this publication do not imply the expression of any opinion whatsoever on the part of the Secretariat of the United Nations or UNDP concerning the legal status of any country, territory, city or area or its authorities, or concerning the delimitation of its frontiers or boundaries. Copyright © UNDP 2010 Regional HIV, Health and Development Programme for Asia and the Pacific UNDP Asia-Pacific Regional Centre United Nations Service Building, 3rd Floor Rajdamnern Nok Ave. Bangkok Thailand Email: [email protected] Tel: +66 (2) 288-2129 Fax: +66 (2) 288-3032 Web: http://asia-pacific.undp.org/practices/hivaids/ All rights reserved ISBN 978-974-680-277-2 Design and layout: Ian Mungall Images courtesy of Adam Rogers, Doungjun Roongruang, McKay Savage, Munah Ahmed, Pattanoot Pongpanit, and UNDP/UNCDF. HIV/AIDS and Mobility in South Asia With funding and support provided by: ACKNOWLEDGEMENTS This report presents the results of a number of qualitative Jennifer Branscombe, Ian Mungall and Nashida Sattar research studies carried out in countries across South for their contributions and validation of the report’s Asia, under the oversight of the UNDP Regional HIV, fi ndings. It is our hope that the collaborative process Health and Development Programme for Asia and which helped shape this report does not end here, that the Pacifi c, in close partnership with Coordination of this comprehensive analysis of situations, standards, Action Research on AIDS and Mobility in Asia (CARAM and practices aff ecting vulnerable mobile populations Asia), ILO Subregional offi ce in Delhi, and with support can strengthen regional programming and advocacy in from UNAIDS. The study profi les seven countries of the the region, and drive stronger collaboration throughout South Asian region, namely Bangladesh, Bhutan, India, South Asia in the future. The goal remains that mobile Maldives, Nepal, Pakistan and Sri Lanka. populations will have access to HIV prevention, care and support services throughout the full cycle of migration. The production of this report has been a particularly collaborative process, driven throughout by a desire to strengthen HIV/AIDS programming at a regional level, and defi ne strong and relevant responses and recommendations that can best address the needs of vulnerable mobile populations in South Asia. We would like to acknowledge the colleagues and partners across the region whose substantive contributions have made this report possible. Clifton Cortez HIV/AIDS and Mobility in South Asia benefi ted from Practice Team Leader regional and country level technical reviews, including Regional HIV, Health and Development Programme for a joint consultation based on the initial fi ndings of the Asia and the Pacifi c country studies convened by the SAARC Secretariat, UNDP Asia-Pacifi c Regional Centre UNDP and ILO in June 2008 in Nepal. The consultation brought together participants of all member states of the SAARC, including representatives of Civil Society and Trade Unions, Ministries of Health and Ministries of Labour and UN Agencies, to discuss in depth and validate the initial fi ndings of the country studies, presented by CARAM Asia. Our thanks to CARAM Asia, a leading regional network of CSOs working on migration and HIV in Asia, and their national counterparts. Particular thanks goes to Cynthia Gabriel of CARAM Asia and Afsar Syed Mohamed of ILO, as well as the SAARC Secretariat and HIV focal points from member states for their role in providing validation of data and valuable advice and input throughout the various stages of this publication. We gratefully acknowledge lead writers Javita Narang and Sue Carey, and editor John Tessitore for their substantive contributions to the production of this report, which was prepared under the overall guidance of Caitlin Wiesen-Antin, former Regional HIV/AIDS Practice Leader and Programme Coordinator for Asia and Pacifi c, UNDP Regional Centre. Special thanks as well to our UNDP colleagues Marta Vallejo Mestres, FOREWORD For the millions who seek greater employment and economic opportunities migration is an increasingly attractive option. Migrants not only comprise an essential component of the workforce in more economically developed countries, but also provide signifi cant contributions to the national economies of their home countries. Nicholas Rosellini Deputy Assistant Administrator and Migrants, however, are often exploited, marginalized, Deputy Regional Director and stigmatized throughout the migration process. As Regional Bureau of Asia and Pacifi c mobility within South Asian countries and migration UNDP Asia-Pacifi c Regional Center within the region and abroad continues to grow, care must be made to ensure that migrants’ rights are protected; from rights to movement, rights to access health and HIV services; and, rights to work with dignity that benefi ts the lives of their communities and families. Governments of the SAARC member states, as well as international and local NGOs throughout the region, have all expressed concerns on these issue. Vulnerability to HIV is often not the result of any individual choices or actions, but rather the outcome of multiple external factors, including: language barriers; prejudice; discrimination; exploitation; lack of access to health-care facilities, information, social networks, and support mechanisms. While this study highlights many such challenges faced by migrants with regards to HIV, it also illustrates a number of opportunities and examples of best practice from the region. In this regard, there are a number of initiatives already working to reduce the health vulnerabilities of migrants and mobile populations: from the Royal Government of Bhutan’s policy of providing “Health for All” – not just Bhutanese residents but also migrants; the decision by the Government of Sri Lanka to include HIV prevention and protection issues in pre-departure sessions for female migrants; and, the initiation of regional and intersectoral consultative processes such as the SAARC conventions and the Colombo process. This study provides a synthesis of current migration trends and the HIV situation in seven countries of South Asia, examining the HIV situation of migrants within the context of gender, national and international migration patterns, policies and legislation. It is our hope that it provides a comprehensive reference tool for future policy, programmes and advocacy, and ultimately, contributes to the protection of migrants’ rights throughout the whole migration cycle. CONTENTS Overview 2 Country Profi les Bangladesh 26 Bhutan 44 India 58 Maldives 82 Nepal 94 Pakistan 112 Sri Lanka 128 OVERVIEW vi Photo by Pattanoot Pongpanit OVERVIEW 1 Photo by Pattanoot Pongpanit OVERVIEW Acronyms & Abbreviations Introduction ART Anti-Retroviral Therapy CARAM Asia Coordination of Action Research on AIDS South Asia is home to 23 percent of the world’s and Mobility population and is the most densely populated region CSW Commercial Sex Worker in the world, accounting for about 40 percent of the CWA Community Welfare Attaché population of Asia – as well as 40 percent of the global FCA Federal Committee on AIDS poor.1 The eight countries of the region (Afghanistan, FIA Federal Investigation Agency Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, FSW Female Sex Worker/s and Sri Lanka) are members of the South Asian GAMCA Gulf Cooperation Council Approved Association for Regional Cooperation (SAARC), Medical Centres Association established in 1985. GATS General Agreement on Trade in Services GDP Gross Domestic Product Mobility within each country and migration within the HSS HIV Sentinel Surveillance region and abroad continues to grow. Migration is an IDU Injecting Drug User/s increasingly attractive option for the millions who seek ILO International Labour Organization greater employment and economic opportunities. IOM International Organization for Migration Migrants are an essential component of the workforce MoU Memorandum/Memoranda of in more economically developed countries and are Understanding MSM Men who have Sex with Men signifi cant contributors to the national economies of MSW Male Sex Worker/s their home countries. NACP National AIDS Control Programme In a highly mobile world, migration has become an (Pakistan) increasingly complex area of governance, inextricably NGO Non-governmental Organization interlinked with other key policy areas, including PLHIV People Living with HIV economic and social development, national security, RCP Regional Consultative Process SAARC South Asian Association for Regional human rights, public health, regional stability, and Cooperation interstate cooperation. Whether national, regional, STI/STD Sexually Transmitted Infection/Disease or international, migration
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