HIV risk and vulnerability for migrant populations is complex, probably too complex to be covered in a newspaper article. Migrants include expatriates, exiles, emigres, and refugees and all of these groups may be at increased or decreased risk. Migrants to India, Bangladesh, China, northern Thailand, western Thailand, and beyond face diverse host environments ...
The source for some of the figures used below has already pointed out in another forum that the “numbers for Shan and Kachin appear to be the IDU prevalence from earlier studies, not general population estimates as stated.”
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HIV/AIDS-refugees and migrants at high risk
Christopher Smith
Mizzima News
www.mizzima.com
October 20, 2006- Fringe populations, including refugees, estranged ethnic minority groups and migratory workers, comprise a high risk group vulnerable to HIV/AIDS. Their degree of human security is incredibly low. Burma represents a source for every one of these groups.
Refugee and migrant populations from Burma is by and large a product of political and economic crisis in Burma, often in combination with a direct threat to the physical security of the people concerned. Fleeing from danger, these populations are then exposed to a new array of risks in their new lives. One such risk is that of contracting HIV and suffering from AIDS.
Reliable estimates and projections regarding refugee populations and the prevalence of HIV/AIDS are no less difficult to come by than the corresponding numbers for Burma as a whole. Aid organizations working with refugee and migrant populations along Burma's borders caution that no statistics can be referenced with any degree of certainty. Subsequently, analysis of quantitative data must be made with caution.
However, for reasons that will be outlined below, most concur that these populations are confronted with an increased risk of infection and often cannot receive medicines needed. A study in the late 1990s by Sudthichitt Chintayananda found that the highest incidence of HIV/AIDS infection in Thailand occurred at cross-border points along the Burmese border.
As of August 2006, the Thailand Burma Border Consortium lists 151,391 persons living in refugee camps along the Thai/Burmese border. Of this figure, 62 percent are listed as originating from Karen state in Burma. Additionally, estimates on the number of illegal migrants in Thailand from Burma typically range from 750,000 to one million.
Other significant refugee and/or migrant Burmese populations exist along Burma's borders with both India and China.
In an interview with Burma Issues in July 2004, Doctors Without Borders personnel stated that they feared an epidemic in Karen camps, but that no data was available with which to substantiate the severity of the crisis. Through voluntary testing they found 50 cases of HIV/AIDS in the Mae La, a camp with a population of around 50,000. However, they hesitate to make a claim on the prevalence of the disease throughout Mae La or Karen refugee camps in general.
Aid workers have reported occasional resistance to HIV/AIDS education among many Karen refugees due to the high prevalence of Christian and Baptist followers residing in the camps. This religious obstacle makes educational training, especially when espousing the preventative benefits of condoms, difficult to undertake. There are reports detailing the burning of condom supplies in protest.
Women are at particular risk as a result of the, often economically determined, migratory status of the men – who venture in and out of the camps and regional urban areas in search of work. Upon returning or visiting home, the men then occasionally carry with them the HIV/AIDS virus.
Additionally, a growing number of girls end up working in the sex industry, which puts them in a situation of obvious enhanced risk to infection.
In Ruili, China, opposite Muse, Burma, a majority of women working in the sex industry are from Burma. Due to a combination of a lack of education and economic necessity, as many as 65 percent of those working in the trade claim to not regularly using a condom.
And for those that remain in refugee camps, the typical nature of a refugee's life within a camp environment serves only to further exacerbate the issue. As Doug Webb of Save the Children writes, "Furthermore, young refugees are often left days on end without anything to do. Without proper recreation, livelihood and vocational support, young displaced people and refugees are extremely vulnerable to exploitation and abuse."
A 1997 survey by Mahidol University of migrant women seeking medical assistance at the Mae Sot hospital (Mae Sot being a major population centre of migrant Karen and in proximity to many of the refugee camps), found that 3.1 percent of women tested positive for HIV/AIDS. The prevalence of HIV/AIDS for Burma as a whole, as measured by the Central Intelligence Agency, is estimated to be around 1.2 percent.
A 1999 Parental Clinic Screening undertaken by Dr. Cynthia Maung at the Mao Tao Clinic outside Mae Sot, revealed an infection rate of 0.8 percent. Additionally, Dr. Maung reported an average of two to three persons a month crossing over the border from Burma, afflicted with AIDS and unable to find any medical treatment inside of the country.
The Mae Tao Clinic reported in their 2005 Annual Report that 0.9 percent of new admissions were found to be living with HIV/AIDS. Additionally, the report sited that 2.2 percent of women receiving antenatal care through the Clinic suffer from HIV. Five years earlier the incidence was less than one percent.
But Karen ethnic, refugee and migrant populations are not the only ones faced with an increased risk.
Dr. Chris Beyrer of Johns Hopkins, who gave the alarmingly high estimate of upwards to seven percent for the overall population of Burma, in the same 2000 study estimated the incidence of HIV/AIDS in Shan state – inclusive of internally displaced people and migrants – at 10 percent.
In a follow-up 2004 study, Dr. Beyrer concluded that in northern Shan state, around Lashio, the prevalence of HIV/AIDS stood at a staggering 74 percent. Additionally, he found that along the Chinese border almost 93 percent of people were believed to be HIV positive or suffering from AIDS. His numbers for Shan state as a whole stood at 42 percent.
However, a 1999 study by the French National Centre for Scientific Research found that among Shan migrant workers in Chiang Mai Province, the prevalence of HIV/AIDS stood at 4.9 percent – still a figure that would merit the label of an epidemic.
Probably not of coincidence, both the Karen and the Shan have been waging a protracted struggle against the ruling junta.
Additionally, due to the legal status of many Burmese migrants outside Burma, they are hesitant to seek medical attention due to the potential negative side effects, for example deportation and of being confronted by government officials.
The classification of this population as economic and illegal migrants, as opposed to the political refugees that can be found in the camps, in addition to preventing the delivery of services available to legal residents of Thailand, makes it prohibitively difficult for international agencies and aid workers to be able to secure funds and work with the migrant population.
As Dr. Maung points out, "If migrants are continually prevented from seeking health care and counseling, their vulnerability will continue."
A Physicians for Human Rights report urges the government of Thailand to crack down on crimes against migrants, including human trafficking, while providing HIV/AIDS health services and programmes for Burmese migrants. The organisation stresses that anti-retroviral therapy should be made available to foreign resident migrants on an equal basis with the Thais.
Though estimates on the incidence of HIV/AIDS among the Burmese migrant community are not available, UNAIDS has calculated a figure of ten percent for the migrant community of Nepal. Nepalese migrants are confronted with most of the same factors contributing to the high risk of contraction within the Burmese migrant community.
If this figure in any way resembles the prevalence of HIV/AIDS among Burmese migrants, then over a 100,000 Burmese migrants would be projected as living with HIV/AIDS.
Yet, human rights discourse also stands as an obstacle to accurate statistics regarding the magnitude of the epidemic, who in fact is infected and how best to direct resources available.
Following an agreement by the governments of Burma and Thailand to enact mandatory testing of migrants returning to Burma from Thailand and the subsequent hospitalization of those who tested positive, Human Rights Watch protested that the enforcement of such mandatory testing and measures was a violation of rights and "in basic disagreement with international standards."
In agreement with this position, Refugees International and the Open Society Institute has referred to mandatory testing as "a human rights abuse and against the UN HIV Principles and Guidelines adopted by member states (including Thailand and Burma)."
However, Viroj Wiwanitkit and Weerachit Waenlor of Chulalongkorn University in Bangkok disagree. They argue that the negligence of not screening Burmese migrants in Thailand, whether they are repatriated or not, puts the Thai population at unnecessary risk to exposure.
Clearly refugee and migrant populations stand at an increased risk to HIV/AIDS due to the facts of their day to day lives. The reality of their existence and the dangers they then face are compounded by limited educational and economic opportunities, thereby often forcing or dictating what lifestyle is led and what chances are taken.
While it is possible to at least try and direct attention and assistance to these at risk groups, the cessation of refugee and migrant emigration, and thus an overall improvement in their human security, can only be realized with substantive change, politically and economically, inside Burma itself.
