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Between 120 and 150 million people will remain for an extended stay outside their country of citizenship this year and most of us know someone who has relocated to new country or area. But what exactly is migration? And who are migrants? What motivates people to leave their country of birth, how many are moving to the UK, and what problems are they bringing with them? This article aims to answer these questions and give an overview of the issues surrounding Immigrants, Immigration and HIV. Theoretically, migration can be seen as a simple process that consists of three phases: where a person comes from, where they are going, and where they end up. 1 2. Migration is also about the how a person travels; the length of time they are away; why they left in the first place; the relationships they maintain with home while they are away and how far they are from home. Migration is often cyclical or seasonal, as people return home for periods of time. When a person is deciding on whether leave their country of origin a combination of "push" and "pull" factors determine where to go, how to go and for how long. Push Factors, such as political unrest, war, persecution, famine, social upheaval, lack of opportunities and lack of infrastructure are what encourage people to leave. Pull Factors, such as economic prosperity, political stability, professional opportunities and labour shortages are what encourage people to come to a country. A migrant is someone who moves from one place or country to another. An emigrant is someone who leaves his or her own country to settle in another, and an immigrant is someone who comes as a resident to a new country. In terms of the UK, emigrants are people who leave the UK to live elsewhere, and immigrants are people who come from other countries to live in the UK. "Migrants may be defined by their legal status or ethnicity�. If we exclude short term visitors (tourists for example) the most important categories [for the UK] are labour migration, refugee migration, resettlement migration, internal migration and commuting"3 The UK tends to define immigrants in terms of the extent to which they mesh with the native culture, socially, ethnically and linguistically. However, it is a person's legal status which determines whether they are allowed to stay in the UK. If a person wishes to come to the UK for longer than a short visit there are only a limited number of legal avenues. People from EU countries are allowed to stay in the UK for as long as they like. People from non-EU countries must fit into one of several legal categories, and must satisfy certain criteria if they are to be permitted to enter and remain in the UK. The criteria they must satisfy varies depending on their country of origin, and the amount of time they are permitted to remain in the UK depends upon which legal category they are in. Asylum seekers Students People wishing to work in the UK Other work-related categories include : the working holidaymaker scheme where individuals aged 17 -27 from commonwealth countries are allowed to take non-professional jobs as part of their holiday (e.g. working in bars and restaurants); approximately 15,000 people allowed to enter the UK to work under the Seasonal Agricultural Workers Scheme and Commonwealth Citizens with a UK-born grandparent who are allowed to seek employment. The 'Family Resettlement' system The rules and exemptions for people wishing to access free NHS treatment are covered on our NHS guidelines page. Being a migrant, in and of itself, is not a risk factor for sexual ill health. Indeed migrants (especially economic migrants) from many countries are more likely to be healthier, younger and more economically active than those who remain. There are, however, many factors that put migrants at a high risk of poor health in general and HIV infection in particular.
Individual factors A persons health beliefs often impact on their health seeking behaviour. Many migrants do not access health services unless they have symptoms of an illness. Additionally migrants, such as asylum seekers, may not feel entitled to access healthcare facilities in a new country, may be unaware of their entitlements or may have linguistic barriers. The majority of migrants travel alone. Being separated from family or regular partners, loneliness, depression, poverty and anonymity may cause a person to take risks they would not take at home. Misconceptions about host country norms and the pressure to 'fit in' may also lead to increased risk taking, both as regards sexual behaviour and drug use. Migrants are often subject to exploitation and those who find themselves in need of money or services, may turn to selling or trading unprotected sex in order to survive. Infectious Agents At present 42 million people in the world are living with HIV, 95% of which are in developing countries and 30 million in Sub-Saharan Africa alone. In Africa only 50,000 individuals with HIV are currently accessing treatment. Coming from a country with a high prevalence of HIV may increase the likelihood of having been infected with that disease. Migrants may not be aware of a high prevalence of sexually transmitted infections in their host country and therefore put themselves at risk. Although less applicable to HIV and STIs, migrants may become more susceptible to infectious agents on arrival in a new country. This is often seen with respiratory and gastrointestinal 'bugs'. Gradual acclimatisation to the new environment takes place over time. Social and Environmental Factors Migrants who are fleeing poverty may well find themselves in similar situations when they arrive at their destination. As well as putting a person at risk of exploitation, problems such as poor housing and lack of food are likely to be far more pressing than poor sexual health. These factors may also push migrants into risky situations or behaviours (e.g. commercial sex work). Migrants, such as asylum seekers, may not feel entitled to access healthcare facilities in a new country. Some people may not be entitled to free health care. Language barriers, isolation and culturally inappropriate health facilities may also limit migrant access to and use of curative services. Along with the sigma and discrimination that goes with STI, people may well have to cope with stigma and discrimination attached to migrants from particular regions. This often leads to a delay in seeking treatment resulting in poorer health outcomes. Information on HIV/AIDS and migrants comes from a number of sources. One of these is the Health Protection Agency, which analyses and disseminates data on HIV trends in the UK. This information can be seen here. Although no data is collected about the legal status of people with HIV, some information is collected about the proportion of infections acquired overseas and the distribution of HIV infection across Britain's ethnic minority communities. For people born outside the UK, data are collected about their country of origin and date of arrival in the UK. A recently published report by the All-Party Parliamentary Group on AIDS entitled Migration and HIV: Improving lives in Britain aimed to examine these issues in detail and to communicate the actual experience of migrant living with HIV in the UK through written and verbal testimony. This report found that people coming to the UK from higher HIV prevalence countries may come to the NHS in late-stages of HIV requiring complex treatment for opportunistic infections as well as the on-set of AIDS. Some of those diagnosed with HIV may need a significant initial period of assessment and treatment and some will require follow-up care and treatment either for infections or to begin Anti-retroviral (AR) therapy. For anyone learning that one has HIV can be a life-shattering event, but for an individual coming from a high prevalence country, this news can seem like a "death sentence". They may not know that treatment is now available to people with HIV. Recently the media has been focused on the issue of HIV and migration, with many stories appearing in the press about the burden migrants with HIV have placed on the National Health Service (NHS). Misinformation about asylum seekers and illegal immigrants has lead to discrimination and stigmatisation of many migrant groups. Stories about "Treatment tourism", suggesting people are coming to the UK purely for free treatment, have lead calls for the mandatory HIV testing of visitors to the UK. From a public heath point of view, according to UNAIDS (Joint United Nations Programme on HIV/AIDS), "there is no public health rationale for restricting liberty of movement or choice of residence on the ground of HIV status". With regard to the burden migrants place on the health system, HIV treatment represents less than 0.1% of the total NHS budget. The NHS spends �3.8 billion per year on alcohol related illnesses as opposed to �279 million on HIV treatment and prevention. Indeed the NHS expenditure on heart disease is �7 billion a year. The UK government has responded to the debate on HIV and asylum seekers in various ways. An example is the recent changes to immigration and asylum law. Visa regimes have also been put in place in certain countries, such as Zimbabwe, in order to restrict migration. The discussion is ongoing. For more information about health tourism and about the effects of migration on HIV in the UK, see our UK FAQs page. Prepared by: Reference List 1 Haour-Knipe M. Migration and HIV/AIDS in Europe. AIDS Infotheque 2000;4-14. 2 Haour-Knipe M. Migration and HIV/AIDS in Europe. AIDS Infotheque 2000;4-14. 3 Decosas J,.Adrien A. Migration and HIV. AIDS 1997;11 Suppl A:S77-S84. 4 Glover, s, Gott, C, Loizillon, A, Portes, J, Price, C, Spencer, S, Srinivasan, V, and Willis, C. Migration: an economic and social analysis. RDS Occasional Paper No 67. 2001. Research, Development and Statistics Directorate. 5 Mallourides, E and Turner, G. Control of Immigration: Statistics Uniteed Kingdom, 2001. 11/02. 2002.
Last updated September 2, 2004 |