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Migrants and HIV, a wake up call for the Caribbean

By Marvin Hokstam, Panos Caribbean Fellow

Toronto, August 17 2006 (Panos). Policymakers are being warned to be mindful of the health implications of the increasing movement of people. from the poorer to the richer countries of the Caribbean.

And although no studies have been conducted on the issue, the high prevalence of HIV in the region and particularly among the poorer countries is cause for concern, experts say.

“Countries with high per capita income need a higher degree of prevention (against HIV), because people tend to move to these countries in search of opportunities. You can’t tell an undocumented worker that he is not allowed to engage in sexual activities with your local population,” Dr. Edward Greene, Assistant Secretary General of the Caribbean Community said.

Dr. Greene, whose responsibilities include overseeing the Pan Caribbean Partnership Against AIDS (PANCAP) said that during PANCAP’s satellite presentation today, attention will be drawn to the migration issue.

The movement of workers has led to calls for Caribbean countries to discuss strategies that would jointly address areas of potential problems such as discrimination and treatment. The Caribbean is home to an estimated 330,000 people living with HIV.

“It is a huge problem that has concerned me, because a lot of countries in Latin America and the Caribbean do not work towards solutions,” said Professor Brendan Bain, Coordinator of he University of the West Indies’ HIV/AIDS Response Programme. The programme trains Caribbean health workers to be HIV/AIDS caregivers.

Dr. Bain said the issue is a difficult one because there is limited control over movement, while that very movement helps to shape the disease.

“But I have a problem with countries that decide to close their borders to people who are infected. The best way to deal with this is through international cooperation,” he said.

In Dutch St. Maarten, a small island in the north eastern Caribbean, more than 70 per cent or 330 of the 472 people living with HIV were not born in the Netherlands Antilles. They are a mixture of legal and illegal migrants. With an estimated population of 41,000, St. Maarten, like several other Overseas Territories and Countries (OCT’s) in the Caribbean, is considered a high-income country. This characterization creates a great problem for the island concerning treatment.

As a territory of the Netherlands, St. Maarten does not get any special allowances with regard to ARVs. It neither receives money under the Global Fund to fight HIV/AIDS, Tuberculosis and Malaria as it is not considered a poor country. St. Maarten however is seeking help to provide treatment for its infected population.

“In other Caribbean countries, it costs between US$800 and US$1,200 a year to treat an HIV positive person. But because of our constitutional reality it costs anywhere between US$13,000 and US$18,000 to treat a patient here,” said Dr. Gerard van Osch, a physician who treats PLHIV.

The St. Maarten government used to provide ARVs free of cost to people living with HIV, regardless of immigration status. But budget shortages made it impossible to continue paying for those who are illegally in the country. The illegal immigrants are now being treated by NGOs. Dr. Van Osch fears though that these privately undertaken and NGO-driven activities could run out of steam, which could compound the issue on the island.

Dr. van Osch has sought the help of PANCAP to deal with the provision of drugs for the St. Maarten residents.

“Most of the migrant PLWHAs hail from other Caribbean countries. They moved here not for the possibility of HIV/AIDS treatment, but for clear economical reasons. But we have welcomed these persons to our shores -be it legal or illegal- so we still owe them some sort of responsibility,” he said.

Netherlands Antilles HIV/AIDS coordinator Sherlyne Eisden regrets the classification of the country as “mid-income”.

“Our relationship with The Netherlands means that we can’t have access to funding. Thousands of people from the lower income countries migrated to the Netherlands Antilles and we have been able to give treatment and care, but now it’s time to get assistance. The funding agencies have to reconsider their criteria,” she said.

In the Dominican Republic, approximately five per cent of the 700,000 Dominicans of Haitian descent are believed to be living with HIV. There are an estimated 88,000 people living with HIV in the Dominican Republic. Unlike St. Maarten, it is reported that the Haitians undergo significant discrimination and ARVs are not readily available to them.

A 2004 study by the International Organization for Migration (IOM) says that given the high level of population movement and the high prevalence of HIV infection in the region, the link between mobility and the spread of HIV/AIDS is an important dimension of the Caribbean epidemic, though poorly understood.

“The Joint United Nations Programme on HIV/AIDS (UNAIDS) has recognized the urgent need to develop and implement more effective responses to HIV/AIDS for migrants and mobile populations,” the report stated.

In the meantime, Dr. George Alleyne, the UN’s Special Envoy on HIV/AIDS in the Caribbean, is confident that the region will be able to manage the complexities that migration present.

“The Caribbean is one of the first regions in the world that devised a regional strategic plan against the disease. We agreed to the formation of PANCAP and we have a long tradition of corporation in health efforts. I am confident that we will be able to put our heads together to improve this situation as well. Don’t forget that in the UNAIDS report of 2005 our region was cited for its progress in battling the disease. That doesn’t make us cocky or overconfident, but it does make take away the need for extreme alarm,” said Dr. Alleyne.

He cautioned against inciting stigmatization of migrant PLHIV’s, as that would only drive the disease underground and out of reach. It is a view supported by Dr. Robert Carr, Board Member of the Caribbean Vulnerable Communities.

“Their marginalization drives them away from information and from being able to access the kind of support that would allow them to address their vulnerability,” he stated.

According to Dr. Carr, stigmatizing immigrants and refugees is an old tactic, which has been consistently misleading in terms of understanding how the epidemic works.

“The epidemic is not controlled by repressing groups, stigmatizing them or labelling them. It is controlled by providing support programmes to reach groups who are more infected or affected. To exclude immigrants is not an effective prevention policy. It is not going to stop HIV from spreading among the local population. HIV is spread through multiple dynamics amongst people, which include sexual contact and needle sharing,” Dr. Carr explained.

Andrea Downer contributed to this article.