Preliminary Results of Study on Mandatory HIV Testing for Employment of Migrant Workers in 8 countries of SE Asia: An analysis of National Law & International Practice: Preliminary Results of Study on Mandatory HIV Testing for Employment of Migrant Workers in 8 countries of SE Asia: An analysis of National Law & International Practice Dr. Nenette Motus, Regional Migration Health Manager, IOM Ema Naito, Technical Officer, HIV/AIDS, ILO SRO-Bangkok Joint WHO/UNICEF/UNAIDS consultation on scaling up HIV testing & counselling in Asia & the Pacific 2 June 2007, Phnom Penh


Migration & HIV/AIDS  International Migration Trends : Migration & HIV/AIDS International Migration Trends 190.6 M migrants worldwide (2005 estimate, UN Population Division) 90 M of whom are estimated to be economically active (ILO) Represents approximately 3% of world population (IOM WMR 2005) 48-50% are women Almost all countries today are influenced by international migration


Migration & HIV/AIDS  Regional Migration Trends: Migration & HIV/AIDS Regional Migration Trends Driven by disparities in development, demographics & globalization Increased disparity in levels of development between countries Labour & social-economic disparities


Migration & HIV/AIDS Key challenges: Migration & HIV/AIDS Key challenges Migrant workers when separated from spouses/family  more vulnerable to risky behaviour  higher risk of STIs, incl. HIV, & in the case of women, rape & unwanted pregnancies (Estrella-Gust, 2001) Low priority given to personal health/safety Lack of access to information/prevention, RH services, care, treatment & support


Migration & HIV/AIDS Key challenges (cont’d): Migration & HIV/AIDS Key challenges (cont’d) Uncertain legal status  lack of legal protection & more vulnerable to abuse & exploitation Marginalization, stigma & discrimination Migrants are unaware of legal & human rights and/or may not be able to enforce them Conflict between labour & health policies


Migration & HIV/AIDS : Migration & HIV/AIDS HIV-related travel restriction is imposed by certain states to: Protect public health Avoid excessive demands on health care/social services However, mandatory testing has no public health value (WHO, UNAIDS) Costly Discriminatory Can undermine PH efforts at HIV prevention/care


Migration & HIV/AIDS: Migration & HIV/AIDS Migrants contribute to national revenue, labour supply, cultural diversity Increased longevity with improved treatment  increasingly difficult to be certain that migrants with HIV & AIDS are a “burden” Yet, practice of HIV testing for migrant workers is wide-spread (limited data available)


ILO Code of Practice on HIV/AIDS : An ILO code of practice on HIV/AIDS and the world of work Adopted by ILO Governing Body, June 2001 ILO Code of Practice on HIV/AIDS


HIV Testing for Recruitment And Employment: HIV Testing for Recruitment And Employment 8.1 Prohibition in recruitment and employment “HIV testing should not be required at any time of recruitment or as a condition of continued employment. Any routine medical testing, such as testing for fitness carried out prior to the commencement of employment or on a regular basis for workers, should not include mandatory HIV testing.” * Source: An ILO Code of Practice on HIV/AIDS and the World of Work (25)


Scope of ILO Code of Practice: Scope of ILO Code of Practice 3.1 This code applies to: All employers and workers (including applicants for work) in public & private sectors All aspects of work, formal & informal


The study…: The study… Process 2006 review of national labour & migration laws & policies on… HIV testing & discrimination in workplace HIV testing for sending/receiving migrant labour Countries Cambodia, Indonesia, Malaysia, Myanmar, Philippines, Singapore, Thailand, Viet Nam Aim To encourage social dialogue & promote understanding on HIV testing of migrant workers


Methodology: Methodology Sources Desk review of published laws & policies Questionnaire sent to Workers’ & Employers’ Organizations & Ministries of Labour Unpublished data from IOM, documentation by CARAM Limitations / scope Not focused on actual practices In 1 country: unofficial translation of national laws & policies Limited data on migrants affected by mandatory HIV testing


Some Initial Findings: Some Initial Findings * In a 3rd country, government officials note that their policy does not support compulsory HIV testing in the workplace, nor exclusion from work on the grounds of HIV infection. However, as copies of the relevant policies could not be obtained, this 3rd country was not included in this current count.


Some Initial Findings: Some Initial Findings * For 1 country: HIV test is included in the health check required to obtain work permits. Work permits, however, are required for only certain sectors. † This is based on data from 6 countries. No data available for 2 countries ‡This is based on data from 6 countries. No data available for 2 countries


Additional Insights: Additional Insights Countries requiring HIV tests for incoming migrant workers did not have national laws prohibiting mandatory testing & HIV-based discrimination 4 countries had national laws prohibiting mandatory testing & discrimination; all 4 still facilitated testing of migrant workers going to work abroad, according to receiving countries’ requirements


Responses from Workers’, Employers’ & Government Representatives:Do Not Presuppose Other’s Positions: Responses from Workers’, Employers’ & Government Representatives: Do Not Presuppose Other’s Positions “For those…working in the health industry, [HIV testing] may be justifiable, but for other sectors such test is most likely irrelevant…. HIV is a personal matter & a test should only be conducted if it is relevant to ensure safety & health of people at work. No other reason can justify such a test.” (Employers’ organization, Country A) “[Our trade union] supports…regulation requiring migrant workers coming to [Country A] to undergo medical examination & certification. We therefore have no objection to HIV test requirement imposed on [migrants from A] seeking to work in other countries.” (Trade union, Country A)


Responses from Workers’, Employers’ & Government Representatives:What Kind of Testing Is It?: Responses from Workers’, Employers’ & Government Representatives: What Kind of Testing Is It? “It is always good to be aware of own physical condition, especially when leaving family & going to place where there could be no support group. I see going thru medical exams, including HIV test, as a positive thing.” (Government, Country B) “In my opinion, testing HIV is not a problem. The problem is that after HIV test, if a worker is HIV positive & he/she is not allowed to work abroad, that is a problem.” (Employer’s Organization, Country C)


Responses from Workers’, Employers’ & Government Representatives:Are Partners Investigating the Issue?: Responses from Workers’, Employers’ & Government Representatives: Are Partners Investigating the Issue? Has never handled a case involving migrant workers from Country D and HIV, although formal data shows that there have been people sent back due to their HIV status. (Gov’t, Country D) “I have never handled a case involving a [worker from Country D] going abroad & HIV testing. But I think it should be the right of any worker to work, even though he is tested HIV positive.” (Employer’s organization, Country D)


Guiding Lessons in Dialogue: Guiding Lessons in Dialogue Do not presuppose that one partner or country has certain position on mandatory testing: ASK THEM Be clear about what we mean by “mandatory HIV testing” Confusion re: positive benefits of VCT vs. negative practice of mandatory testing Mandatory HIV testing identified as important issue by many partners  BUT: few have taken up cases of migrant workers affected by practice


Discussion QuestionsMigrants & PITC: Discussion Questions Migrants & PITC Would an uptake of PITC affect migrant workers? What are possible positive impacts of PITC on migrant workers? What are possible negative impacts of PITC on migrant workers?


Concluding thoughts…: Concluding thoughts… Principle of no HIV-based discrimination & compulsory HIV testing applies to non-migrant & migrant workers (ILO Code of Practice) No public health or economic justification for mandatory testing of migrant workers Outright prohibition of mandatory HIV testing should be pursued


Concluding thoughts…: Concluding thoughts… In meantime: current situation of migrants should be improved Offer HIV testing & counseling well before migration  mainstream HIV/AIDS services to general population, including migrants Protect confidentiality Link to related services/referrals Strengthen counseling Ensure safety/reliability of test