Migrants with HIV of concern in COVID-19 era

COVID-19 is affecting all of us, but it holds particular dangers for migrants who are forced to live and work "illegally" because they are living with HIV and are in a country where their HIV status is a grounds for deportation.

For these migrants their irregular status means they are forced to use informal networks to access antiretroviral therapy (ART) or rely on their families to send them medicine. Others may try to share medicines or buy them locally.

Now, another factor is compounding the problems facing HIV-positive migrants: COVID-19, quarantine measures and the impact on economies worldwide have left large numbers of migrants stranded and without jobs, making it even harder for those with HIV to access necessary treatment.

Double bind

Among those at increased risk are thousands of migrants from Tajikistan in Central Asia. The UN migration agency, IOM, reports that over half a million Tajiks left their home to work abroad in 2019. Of these labor migrants, close to 20% (18.8% in 2018) are estimated to be living with HIV.

In the current pandemic, they are of particular concern, says Rukhshona Qurbonova, the IOM's Sub-Regional Coordinator on Migration Health for Central Asia. "Some ... will have to interrupt their treatment, weakening their immune status and making them more vulnerable to COVID-19."

Migrants living with HIV in the UK may also be facing increased risks from coronavirus, says Tamara Manuel, from the National AIDS Trust. Some who are in precarious employment situations and who have no recourse to public funds will not be eligible for special COVID-19 financial employment assistance.

Others may feel unable to tell their employer that they have HIV due to the stigma surrounding the condition and will therefore continue to work, putting themselves and others at risk, Manuel says.

She adds that lockdown conditions may be making it harder for migrants with HIV to access services that they relied on before, and some are unlikely to be provided with suitable housing in which to isolate. 

Migrants more vulnerable to HIV

Migrants' health is important for both countries of origin and destination, yet they are often left out when it comes to health programming, says Rukhshona Qurbonova. She says most Tajik migrants work in low-skilled jobs, even if they have a good education. But even for low-skilled jobs, good health is an important pre-requisite.

However, migrants can be stressed by facing a new environment and the challenges of a different culture and language, Qurbonova says. They are often exposed to poor working and living conditions that can affect their health.

For migrants from Tajikistan, most of whom are young men from rural areas, a major reason that they become more vulnerable to HIV is a change in sexual behavior, Qurbonova says. "A difference in social control, little knowledge about prevention of STIs and HIV, alcohol consumption and drug use, and casual sex all play into migrants' vulnerability."HIV and COVID-19

The general advice for people with HIV is to take the same precautions against COVID-19 as the general population, such as hand washing, cough etiquette and physical distancing.

Those with HIV who are receiving treatment with antiretroviral drugs are advised to make sure that they have at 30-days supply, plus enough medicines to treat other illnesses or addictions.

According to the World Health Organization, there is no evidence that HIV-positive people who are receiving treatment (ART) are at greater risk from COVID-19. However, people with advanced or poorly controlled HIV (low CD4 and high viral load) do have an increased risk of infections and related complications in general, and therefore face an increased risk from coronavirus.

Globally, millions are in this category. Last year, in the eastern and southern Africa region there were 6.8 million people living with HIV who did not have access to ARTs.

Also read from UNAIDS: What people living with HIV need to know about HIV and COVID-19