the diaspora declaration: development of a global hiv and aids framework for change

www.whiwh.comwww.abdgn.orgwww.aids2014.org

The Diaspora Declaration: Development of a Global HIV and AIDS

Framework for Change

Wangari Tharao Women's Health in Women's Hands Community Health Centre

African and Black Diaspora Global Network on HIV and AIDS

Toronto, Canada


Conflict of Interest Statement

• This presentation is supported through a research grant from the Canadian Institutes for Health Research (CIHR).

• I have no other actual or potential conflict of interest to declare.


Overview

• Who are we?

• Where are we now?

• Promising Frameworks for a Coordinated Response

• The Diaspora Declaration


Who are we?

• The African and Black Diaspora (ABD) are populations of Black Africans and their descendants who are dispersed through a mix of forced and willing migration and who may or may not maintain strong ties to their African origin.

• The ABD broadly encompasses populations of: – Recent migrants; – Second generation and multi-generational populations;– Refugee and asylum seekers; and– Mobile populations (e.g. temporary migrant workers).


Growing Recognition of ABD Communities as a Key Population

• Australia (2002-2012): 8.2% of all HIV diagnoses were in people born in Africa, although Africans are only about 1.4% of the total population (Kirby Institute, 2013).

• Canada (2008): ABD populations had an estimated HIV infection rate 8.5 times higher than other Canadians (PHAC, 2012).

• United States (2007-2010): Black populations were 62% of new HIV infections amongst women; 64% of transmission via heterosexual contact; and 66% of infections among children under 13 (CDC, 2010). In 2011, African Americans had the largest estimated percentage of HIV diagnoses among gay and bisexual men (11,805 or 39%) (CDC, 2012).

• Caribbean Region (2009): 53% of people with HIV were female. This is the only other region, besides sub-Saharan Africa, where women and girls outnumber men and boys among people living with HIV (UNAIDS, 2010).

• EU/EEA (2007-2011): Migrants represented 39% of reported HIV cases, most were from sub-Saharan Africa (ECDC, 2014).


Some Gains at the International Level

• 2011 UN Political Declaration on HIV and AIDS: Intensifying our Efforts to Eliminate HIV and AIDS1

• Para. 84. “Commit to address, according to national legislation, the vulnerabilities to HIV experienced by migrant and mobile populations and support their access to HIV prevention, treatment, care and support.”

• 2013 UN Secretary-General Report - A life of dignity for all: accelerating progress towards the Millennium Development Goals and advancing the United Nations development agenda beyond 2015

• Post-2015 discussions recognize diasporas as key contributors to development.

• Migrants’ contributions are undermined by experiences of discrimination and denial of their human rights at various stages of the migration process.

1General Assembly resolution 65/277 adopted June 2011


Promising Frameworks for a Coordinated Response

ABD Typology

(Fenton, 2010)

HIV/AIDS

Program & Policy Frameworks

(CDC, 2012)

Migrant Integration Frameworks

(Ager & Strang, 2008)

Global Health & Migration

Frameworks

(WHO, 2010)


Frameworks

(Zimmerman et. al., 2011)


Global Health & Migration Frameworks

Source: WHO (2010). Health of migrants: the way forward - report of a global consultation, Madrid, Spain, 3-5 March 2010. http://www.who.int/hac/events/consultation_report_health_migrants_colour_web.pdf

http://www.who.int/hac/events/consultation_report_health_migrants_colour_web.pdf

http://www.who.int/hac/events/consultation_report_health_migrants_colour_web.pdf


Global Health & Migration Frameworks

Source: Zimmerman C, Kiss L, Hossain M. (2011) Migration and Health: A Framework for 21st Century Policy-Making. PLoS Med 8(5): e1001034. doi:10.1371/journal.pmed.1001034http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001034

Figure 1. Migration phases framework

http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001034



• Health framed as a marker of successful integration

• Common barriers: language, access to health services, lack of information, cultural perceptions of health care

• Fragmented roles and responsibilities between levels of government hinder development of comprehensive migrant health policies

Source: Ager, A. & Strang, A. (2008). Understanding Integration: A Conceptual Framework. Journal of Refugee Studies, 21(2), 166-191.


HIV/AIDS Policy and Program Frameworks

• Demonstrates health inequities in diagnosis, treatment, and care• Tendency to focus on behavioral interventions • Does not reflect transnational nature of migration (relies on static

geographic location)

Source: CDC Fact Sheet (July 2012). http://www.cdc.gov/hiv/pdf/research_mmp_stagesofcare.pdf

http://www.cdc.gov/hiv/pdf/research_mmp_stagesofcare.pdf

http://www.cdc.gov/hiv/pdf/research_mmp_stagesofcare.pdf

ABD Typology

TYPE I:Post-Slavery Black

Majorities

TYPE II:Post slavery, Black

Minorities

TYPE III:Post-

Colonialization Black Minorities

TYPE IV: Recent economic

and social migrants

Caribbean region

Populace mainly of African descent

Political, social power structures and networks largely governed by those of African descent

Social and economic trajectories heterogeneous and determined by economic, political and social

North, Central and South America

Populace mainly of European or Mixed descent with varied proportion of blacks

Political, social power structures and networks largely governed by ethnic majority

Civil rights heterogeneous

Western Europe

Populace almost entirely of European descent

Black migration in mid-late 20th Century


Civil rights influence minimal and heterogeneous

Western Europe, Canada, United States, Intra-Africa

Level of integration into society heterogeneous

Display general characteristics of economic migrants


Historic New

Source: Fenton, K. (July 2010). Ties that Bind-HIV/AIDS in the African Diaspora. [PowerPoint Slides] Retrieved from African and Black Diaspora Global Network on HIV/AIDS website: http://abdgn.org/files/pdfs/Presentations/KEVIN%20FENTON%20ABDGN-PRESENTATION-HLM-JULY18-2010.pdf

http://abdgn.org/files/pdfs/Presentations/KEVIN%20FENTON%20ABDGN-PRESENTATION-HLM-JULY18-2010.pdf

The Diaspora Declaration: One Framework for Global Action


Frameworks

(WHO, 2010)


Frameworks

(Zimmerman et. al., 2011)

ABD Typology

(Fenton, 2010)


(Ager & Strang, 2008)

HIV/AIDS Program & Policy

Frameworks

(CDC, 2012)

Diaspora Declaration


How do we get there?

• Literature review – Review and synthesize available

evidence

• Global consultations

– Including ABD people living with HIV, government and health surveillance representatives, service providers, advocates and academics

• Leverage web-based platforms to mobilize communities and disseminate results

Get involved - follow us on Twitter (@kwakuABDGN) & visit www.abdgn.org

Visit us at the African Diaspora Networking Zone at AIDS 2014: Twitter (@BaobabAIDS2014) or facebook (Under the Baobab at AIDS 2014)

https://twitter.com/kwakuABDGN

https://twitter.com/kwakuABDGN

http://www.abdgn.org/

https://twitter.com/BaobabAIDS2014

https://twitter.com/BaobabAIDS2014

https://www.facebook.com/baobabaids2014




The Diaspora Declaration: One Framework for Global Action

The Diaspora Declaration will provide:

• Evidence-informed recommendations for a coordinated global response to ABD migration, HIV/AIDS, and health inequities.

• Actions across policy, advocacy, research, and service delivery.

• An advocacy tool that links grassroots efforts to national and international action.


Acknowledgements

ABDGN Governing Council Member Organizations

The Diaspora Declaration is funded by: The Robert Carr Fund through:

the diaspora declaration: development of a global hiv and aids framework for change

Health & Medicine