Washington D.C., USA, 22-27 July 2012www.aids2012.org

Living with HIV as a Migrant Woman in the Diaspora

Navigating Multiple Spaces

Presented by:Marvelous Muchenje

Women’s Health in Women’s Hands CHCToronto, Canada

Washington D.C., USA, 22-27 July 2012www.aids2012.org

Introduction

Once Migrant women are diagnosed with HIV, they enter an environment which is highly technical dominated by western medical

models of service provision that leaves many of them feeling alienated and vulnerable without an in-depth understanding of HIV

disease, its treatment modalities, and impact on overall wellbeing.

Washington D.C., USA, 22-27 July 2012www.aids2012.org

Migration Journey

• (UNAIDS 2009)

Washington D.C., USA, 22-27 July 2012www.aids2012.org

Pre-departure Conditions•Prior access to health care

• Most migrants originate from countries where basic resources required for health are scarce

• Some have poor access to health care prior to arriving in host country, due to

• Breakdown of health services• Countries have limited capacity

to treat acute health concerns • Likely to have limited mental

health support

Washington D.C., USA, 22-27 July 2012www.aids2012.org

Transition Conditions

Trauma and torture-Immigrants are exposed to traumatic experience• Periods of deprivation• Human rights abuse• Loss of loved ones• Rape – HIV infection• Physical and psychological torture• Limited social and family support• Loss of place, identity & culture

Washington D.C., USA, 22-27 July 2012www.aids2012.org

Host Country Conditions

HEALTH CARE

Is the least of the migrant’s concern

Washington D.C., USA, 22-27 July 2012www.aids2012.org

Resettlement - Issues

• The settlement period is an enormous adjustment period for a migrant woman– Learning new culture, acquiring new language, learning how to

use public transport, negotiating new and complex education system, negotiating income support and health care system

• Dealing with people in authority may be a great challenge, impacting a woman’s efficacy and self-determination

• Unemployment/under employment/poverty

Washington D.C., USA, 22-27 July 2012www.aids2012.org

Resettlement - Issues• Multifaceted, intersecting dimensions of stigma

and discrimination:– (HIV status, – race/racism, – Gender discrimination, – sexual orientation/homophobia– immigration status

• Impacts actions at the individual, community and systems levels– exclusion and marginalization – limits access to health and social support

• Gender based violence and vulnerabilities associated with sponsorship by an abuse spouse/partner

Washington D.C., USA, 22-27 July 2012www.aids2012.org

Organizing Locally to support a broader global movement

Women’s Health in Women’s Hands CommunityHealth Centre in collaboration with Black Coalition for

AIDS Prevention (Black CAP) and Africans In Partnership Against AIDS (APAA) started the Health Promotion and Skills Development project to:

organize information sessions facilitate discussions between women and service providers to increase

access to services simplify highly technical information provided in the field of HIV/AIDS

treatment and care.

Washington D.C., USA, 22-27 July 2012www.aids2012.org

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Washington D.C., USA, 22-27 July 2012www.aids2012.org

Programs and Services related issues • Lack of an in-depth understanding of the underlying

factors from a gender/rights-based approach• Lack of long-term support strategies and limited

skills development opportunities • Lack of linkages between relevant departments• Lack of disclosure to “other” relevant health

providers limits access to effective and coordinated services.

• Failure to incorporate trauma experienced during the migration process as part of service delivery

Washington D.C., USA, 22-27 July 2012www.aids2012.org

Programs and Services related issues • Linguistically and culturally inappropriate

Programs and resources

• Limited effective psychological support system to deal with mental health and other HIV/AIDS related issues

• Cultural norms, values, practices and understanding of health, illness, death and dying differ from those of providers

Washington D.C., USA, 22-27 July 2012www.aids2012.org

Access to health care - Issues• Difficulties in accessing and

making the best use of health services (e.g. transportation costs; childcare)

• Numerous medical investigations & follow-up appointments that don’t make sense to women

• Anxiety associated with physical examination, invasive procedures particularly for women with FGM

• Revisiting of traumatic experiences

Washington D.C., USA, 22-27 July 2012www.aids2012.org

Recommendations• Develop programs and services based on the

realities of migrant women’s lives• Programs should address:

– Socio-cultural factors– Economic factors e.g. poverty, unemployment– Gender-based violence – Harmful cultural beliefs, values, norms and practices– Intersections of stigma and discrimination - racism, sexism, homophobia,

HIV-related stigma and other types of discrimination– Stigma reduction activities

• Involvement of migrant women in the development, implementation, and evaluation of HIV/AIDS programs and services

Washington D.C., USA, 22-27 July 2012www.aids2012.org

Recommendations• Address women’s lack of knowledge on their rights to access

treatment and care regardless of immigration status

• Utilizing a service delivery framework that recognizes impacts of HIV pre-migration, settlement and post migration

• Understanding of impacts of long distant relationships on HIV acquisition, transmission and coping

• More multi-disciplinary research to understand– Impact of intersectional stigma and discrimination– Migration, HIV and their impacts post settlement– Immigration policies, entry, stay and access for migrant women

living with HIV

Washington D.C., USA, 22-27 July 2012www.aids2012.org

Thank You