The living conditions of migrants, the intention to migrate to a previously established country of destination and the timing and logistics of migratory dynamics have been severely affected by COVID-19. The health emergency has implied not only the closure of borders, and the consequent restrictions on mobility, but also an increase in the health vulnerabilities of the migrant population, which on numerous occasions has been stranded in shelters in border areas. Such is the case of Haitian, and to a lesser extent Cuban, African and Asian migrants, whose migratory projects have been momentarily interrupted by the pandemic and who are now sheltering in Panama, near the border with Colombia, as their itinerary was obstructed by the border closures.
However, a United Nations report on the conditions of migrant shelters in North America indicates that these centers often lack the tools to offer adequate care to migrants and effectively implement health measures against the pandemic. These health deficits translate into precarious access to health services, and this not only exposes migrants to a greater risk of not being able to counteract COVID-19, but also deteriorates the health status of people who already live with another disease: HIV.
HIV, acronym for Human Immunodeficiency Virus, is a retrovirus that infects the cells of the immune system, causing their gradual debilitation. This term is frequently associated with another acronym, AIDS or Acquired Immune Deficiency Syndrome, which refers in particular to the symptoms and physical consequences generated by the virus. Although HIV is only spread through unprotected sexual contact, exposure to infected blood, or in some cases from a sick mother and her child during pregnancy, it is important to maintain high standards of protection and information in migrant reception centres to protect people who already suffer from this disease and prevent transmission.
As an IOM information sheet highlights, although migratory processes per se do not mean that the migrant population is more vulnerable to HIV, other factors such as lack of access to health services and information, lack of access to preventive measures or the high risk of facing threats such as being forced to have sexual relations in exchange for money or shelter, are a challenge for the physical integrity of the migrant population. Likewise, unsafe living conditions, discrimination in access to social services, and the lack of social capital exacerbate the exposure of migrants to HIV disease.
In this sense, the pandemic may have worsened these circumstances, increasing the precariousness of people on the move living with HIV and deteriorating their health status. In this regard, according to an analysis by the World Health Organization, due to the pandemic, and in particular due to the closure of land and air transport services and the weakening of health services, 73 countries are at risk of antiretroviral (ARV) drug shortages, while 24 countries reported low ARV stocks.
How can the personnel of shelter assist people living with HIV during the pandemic?
The report published by UNAIDS “Guide for the management of people on the move living with HIV in reception centers during the COVID-19 emergency” provide some recommendations addressed to the staff of shelters, reception centres and those who hold decisive positions in the strategic and technical levels, in order to guarantee adequate care for people living with HIV in migratory contexts. Some of the recommendations are:
• Prevent HIV transmission: Providing rapid tests for the identification of people living with HIV; guaranteeing access to water and sanitation; disseminating information on protection measures against COVID-19 and HIV and supplying condoms, ensuring their availability and accessibility of information on the correct use.
• Prevent mother-to-child transmission of HIV: Prioritizing the availability of rapid HIV and COVID-19 tests for pregnant women; providing specific care to newborns in shelters; disseminating notions about supplementary nutrition to breastfeeding mothers living with HIV and preventing newborns from coming into contact with breast milk, providing infant formulas.
• Defend and respect human rights: Ensuring that everyone can access emergency and health services, regardless of sex, age, ethnicity, gender and immigration status; documenting and denouncing the situations of violation of human rights in shelters, emergency centres and reception areas.
COVID-19 may be further aggravating the health conditions of migrants living with HIV. Although the two viruses are transmitted in different ways, maintaining high standards of health care and protection, along with sharing disseminated and accessible information are crucial prerequisites to prevent the spread of both. Taking into account the multiple and intertwined vulnerabilities of migrants living with HIV means fostering the development of new capacities and attention focused on their needs.