42 MEMBERS IN 18 COUNTRIES ACROSS ASIA, AND MIDDLE EAST, AND EMPOWERS MIGRANT WORKERS AGAINST HIV AND AIDS
incorporates a rights based
approach in promoting
and protecting migrants’ health
and labour rights with focus on HIV,
Srhr, and violence against
CARAM Asia is a regional network of 42 migrant and migrant support organizations in eighteen countries across Asia, including Middle East. CARAM Asia is a non-profit and non-governmental organisation (NGO), that educates, promotes and protects migrants’ labour and health rights with a focus on HIV&AIDS and SRHR issues since its establishment in 1997. Based in Kuala Lumpur, Malaysia, the CARAM Asia Secretariat works with its member organizations at regional level to work for advancement of migrant worker’s labour and health rights.
On the occasion of World AIDS Day 2023, CARAM Asia urges governments in both sending and receiving countries to cease the criminalization of migrant workers (MWs) based on their HIV positive status. Recognizing HIV as a significant global public health concern that impacts millions worldwide, CARAM Asia emphasizes that the persistence of HIV as a global health crisis can be linked, in part, to failures such as division, disparity, and a disregard for human rights, as highlighted by the World Health Organization (WHO)i. In order to successfully eradicate HIV, it is absolutely essential to recognize the vulnerability of MWs to HIV & AIDS and Sexual and Reproductive Health and Rights (SRHR). Furthermore, governments in receiving countries must stop the unfair practice of criminalizing MWs based solely on their HIV-positive status and other health conditions, such as by arresting, detaining, and deporting them. It is important to understand the various risk factors for HIV and (SRHR) that MWs face during migration. It is important to note that the majority of MWs are of reproductive age and sexually active. Therefore, governments must emphasize evidence-based HIV prevention programs for MWs and give them full access to public health services. The objective of the Sustainable Development Goals (SDGs) target 3.8 is to attain universal health coverage (UHC) for everyone ii. UHC entails ensuring that all individuals can access the necessary health services wherever and whenever required, without facing financial difficulties. Despite this, MWs not only encounter significant obstacles in accessing health services, but also face criminalization when infected with HIV and other treatable diseases. As we observe World AIDS Day, it is critical to consider the evolving landscape of HIV statistics among MWs in Asia. The HIV prevalence data for migrant communities before and after the COVID pandemic reveals their heightened vulnerability. In Nepal, the number of HIV infections has been on the rise. Before the COVID-19 pandemic, the count was 3,768, and after the pandemic, 4,576 MW's have been identified as HIV-positive as reported in the National HIV Strategic Plan 2021-2026iii. In the Philippines, the number of migrants has increased from 6,905 before the pandemic to 9,340 now as stated on the Philippine’s Department of Health Website iv. This shows that targeted actions are needed to address the vulnerabilities faced by migrant communities. CARAM Asia appreciate and congratulates the governments who have underscored the importance of inclusivity, aligning with the global commitment to leave no one behind in country statements during the recent Seventh Asian and Pacific Population Conference in Bangkok (November 15-17, 2023). While governments took a positive stride in addressing critical issues like inclusion of marginalized groups, a sobering reality persists for migrants. There is a pressing need for comprehensive policies that ensure the protection of MW's health rights and access to healthcare services regardless of their HIV-positive and documentation status. MW's who test positive for HIV still face a stark reality in a number of countries - immediate detention and deportation without adequate time to settle financial affairs or retrieve personal belongings. For instance, in Jordan, the Residence and Foreign Affairs Law of 1973 has been employed to expel numerous migrants living with HIV, aligning with Jordan's stringent policy to deport any non-national diagnosed with HIV. The government's strict stance dictates that all MW's must undergo a set of medical evaluations upon entering the Kingdom before their applications for residence and work permits can be approved. Numerous countries receiving MW's, including Bahrain, UAE, Hong Kong, Malaysia, and Singapore, all enforce laws requiring mandatory HIV testing and related deportation for MWs. The UAE imposes HIV/AIDS-related travel restrictions, requiring a test for work or residence permits, leading to denial of healthcare, and quarantine and deportation for HIV positive MWs. Meanwhile, CARAM Asia applauds Lebanon's 2019 labor law exempting MWs from mandatory HIV/AIDS testing for work and residency permits. While a positive step, the risk of repatriation due to HIV-positive results persists, necessitating robust law implementation and increased employer awareness. In the context of sending countries, certain nations have implemented specific policies to address the vulnerabilities of MW's concerning HIV, notably, the Philippines and Sri Lanka. In the Philippines, the HIV and AIDS Policy Act, also known as the Republic Act (RA) 11166, has provisions that aim to protect migrant workers. These provisions include education to prevent HIV infection before they go abroad, access to HIV services and treatment, a program to reintegrate them into society without stigma, protection from HIV related discrimination, and representation of civil society organizations working for migrants’ rights in the Philippines National Aids Council. Despite the existence of policies that underscore the country's commitment, such as representation in the Philippines National AIDS Council, the practical implementation of these measures remains a challenge. Similarly, while Sri Lanka's policies take a holistic approach, encompassing voluntary screening, health databases, systematic reintegration into the national health system, dissemination of pre-departure health information, promotion of informed choices, health protection through bilateral agreements, and the implementation of comprehensive health assessments for outbound migrant populations, effective execution is lacking. Thus, on the occasion of World AIDS Day 2023 CARAM Asia with its 42 member organizations in 18 countries across Asia and Middle East: • Call on governments in MW’s receiving countries to reform the discriminatory health policies and practices, remove mandatory HIV testing and stop criminalizing MWs due to HIV positive status in order to achieve 2030 SDGs. • Urge leaders in the field of HIV, including organizations like UNAIDS and WHO, to acknowledge the vulnerability of migrant workers to HIV, the criminalization of MWs based on HIV positive status, and the broader violation of their health rights. • Encourage all governments, both in the sending and receiving countries, to actively work towards reducing stigma and discrimination against HIV-positive MW's. • Promote the health and human rights of this vulnerable group through comprehensive efforts. • Call for governments in both sending and receiving countries to allocate health budgets for MW's and provide them with access to quality health services, encompassing prevention, treatment, counseling, and care for those who are HIV positive. • Emphasize the need to enhance MW's access to public health services by promoting Universal Health Care (UHC) through improving accessibility to health insurance, eliminating discrimination in costs compared to nationals, and reforming policies that restrict access, such as limitations on mobility and the arrest of undocumented MW's. • Urge countries receiving support from the Global Fund to recognize MWs as a Key Population and to allocate a special budget line for testing, treatment and care of MW's living with HIV/AIDS in national health budgets. CARAM Asia (Coordination of Action Research on AIDS and Mobility) is a regional network of 42 member organizations in 18 countries across Asia including Middle East. Statement issued by: CARAM Asia Task Force on Migration Health and HIV (MHH)
All people have the right to stay or move and live and work in dignity with equal rights in a society, where their quality of life is ensured.
To empower migrants, their families and communities throughout the migration process and build capacities of Community Based Organisations (CBOs) and Non-Governmental Organisations (NGOs) working for the promotion and protection of migrants’ labour and health rights with focus on HIV & AIDS including sexual and reproductive health rights (SRHR).
Utilise Participatory Action Research (PAR) to ensure inclusion of migrant’s voices and perspectives on HIV vulnerabilities, migrant worker’s health status and give potential policy recommendations for effective national and regional advocacy.
Use the rights-based approach in promoting and protecting migrants’ labour and health rights through interventions to reduce all vulnerabilities and improve social determinants of health throughout the migration process.
CARAM Asia's task forces are prioritised in line with four key thematic areas:
CARAM Asia endeavours to institutionalise and incorporate a rights based framework from which to address migrants’ health concerns. Two other frameworks used in developing and implementing programmes are the Greater Involvement of People Living with HIV (GIPA) principles as well as gender and sexuality frameworks.
Four key thrusts and pillars which provide momentum to CARAM Asia programmes are Participatory Action Research (PAR), national and regional advocacy, coalition building and capacity building for CBOs and NGOs working with migrant communities.
These approaches provide an impetus for the development of research, publications, campaigns and policy prescriptions for CARAM Asia programmes.
PAR has assisted migrants in developing information tools which empowers them to understand, provide solutions and better manage their own situations. The real strength in PAR is that it is conducted by local communities for local communities.
Outputs from PAR are used for key regional advocacy and capacity building activities aimed at creating a regional response to improving the health and well-being of Asian migrant workers.
CARAM Asia works for promotion and protection of migrant worker’s health rights with focus on HIV & AIDS and SRHR issues in the region. The network is presently working on the regional project titled "Prevention & Advocacy on Migrant's HIV Issues, Enhancing Access to Health Services and Promoting HIV Positive Migrant's Rights in Asia". This project is comprised of three years funding cycle from 2022 to 2024, funded by the Robert Carr Fund (RCF) for Civil Society Networks, aiming to address stigma and discrimination against HIV-positive migrant workers (MWs), enhance MW’s access to health services, conduct advocacy with key stakeholders for the protection of MWs’ health rights and address laws, policies and practices issues related to HIV, MW’s criminalization based on HIV-positive status and other health conditions. The project also covers the areas of awareness-raising on HIV prevention, conducting capacity building of the project partners, community-based organizations (CBOs), non-governmental organizations (NGOs), migrant community leaders, MWs etc.
The significant collaboration with CARAM Asia's project partners in three Asian sub-regions— South Asia, comprising the Ovibashi Karmi Unnayan Programme (OKUP) in Bangladesh, SPEAK Trust in Pakistan, Community Development Services (CDS) in Sri Lanka, and POURAKHI in Nepal, Southeast Asia includes the North South Initiative (NSI) in Malaysia and Action for Health Initiatives (ACHIEVE) in the Philippines and Middle East features Migration Services and Development (MSD) in Lebanon—is leading to various activities being implemented by the project partners, which hold corresponding purposes.
The Robert Carr Fund (RCF) for Civil Society Networks has been instrumental in providing CARAM Asia with the ongoing financial support as it implements the current regional project for 2022 to 2024 funding cycle. The tremendous support from RCF in the past years and for the current project implementation makes it possible for CARAM Asia to work extensively with the project partners at national, international, and regional levels for advocacy and at community levels among MWs in sending and receiving countries by executing its overarching strategies. To learn more about RCF, please click this link here.
PAR, which is identified as a core initiative of CARAM Asia, is designed to integrate migrants' perspectives and points of view on HIV & AIDS, MW’s vulnerabilities to HIV, SRHR issues and other health conditions, and develop potential policy recommendations. Currently, a few research studies are being conducted under this project such as “Health of Bangladeshi Migrant Workers: A Cost Analysis from Social and Economic Perspective” and “Research on Workers’ Understanding about HIV and Barriers in Accessing Health Services in Malaysia” to give attention to unaddressed issues of MWs especially on health’s rights.
Recently, completed research studies under this project are “Identify the Risk Factors that make MigrantWorkers More Vulnerable to Contracting HIV and What Interventions could be Taken to Reduce this Risk” in Sri Lanka and “Identify the Percentage of Migrants among Registered People Living with HIV (PLHIV)” in Pakistan produced fruitful key findings such as data acquisition on number of MWs with HIV and risk factors for HIV. These research outcomes are potentially being used for advocacy activities such as policy recommendations and to come up with insightful and research-based evidence on MWs and their current needs. For example, CDS has submitted research outcomes to important policy makers in Sri Lanka for further actions.
Built on the PAR, this strategy involves program policies and resource advocacy such as engagements between civil society organizations (CSOs) and relevant stakeholders. Within this strategy, CARAM Asia and its project partners are implementing well-established advocacy plans using the evidence-based from the PARs. These activities demonstrate that CARAM Asia strongly advocates for the recognition of MW’s vulnerability to HIV & AIDS, and SRHR due to various factors involved in the migration process. CARAM Asia also advocates for the removal of discriminatory health policies which criminalize MWs based on HIV-positive status. Many of these project activities are designed to address these issues at various levels.
For instance, advocacy meetings are being conducted with stakeholders including government officials, political representatives, NGOs, embassies, consulates, foreign service providers and others to advocate them on MWs’ needs. These are to achieve several outcomes; creating referral mechanisms for MWs at the airports in Pakistan, streamlining deportation process of MWs in Pakistan, sharing the research outcomes for the purpose of educating stakeholders with MWs’ needs in Pakistan, demanding the government for MWs’ health protection in Bangladesh, creating standard operating procedures (SOPs) for MWs’ protections in Lebanon, reforming the policies and laws for HIV-positive MWs in Nepal, addressing health issues and ensuring that HIV and AIDS-related activities and services are created based on the current needs of MWs in the Philippines.
Strengthening the skills and capacity of CARAM Asia’s project partners is one of the influential elements in determining the success of CARAM Asia in achieving its goals. For that reason, CARAM Asia is capacitating the project partners with the monitoring and evaluation (M&E) training to empower them to have a better evaluation on the outcomes of project activities. Together, project partners are taking various initiatives including provision of training such as training of trainers (TOTs) workshop and orientation to officers, building on knowledge on HIV/AIDS and life skills training to different groups such as MWs and families, migrant leaders, government officers, commercial sex workers and staff members of various civil society organizations, to fully equipped them with relevant capacities.
Knowledge was boosted and skills were made available via the capacity builds that cover a variety of topics. For instance, roll-out training is introducing migrant leaders with HIV and STI related information, M&E training is providing project partners with the necessary tools to understand the M&E processes and orientation training are providing educational opportunities for foreign service officers to learn about HIV policies in relation to MW’s rights. The implementation of these activities follows from the fact that it improved their capacity to manage activities they engaged in their organizations.
Crucial aspect of HIV prevention among MWs is awareness raising and increasing knowledge on HIV & AIDS related topics. HIV information generation and dissemination implemented by CARAM Asia’s project partners is not limited to MWs, but include hospital staffs, nursing students, potential MWs, youth, CSOs/NGOs, government officials, political representatives and other important stakeholders. Onsite HIV/AIDS awareness raising sessions such as in hospital, health care, nursing school, detention centers, via forums theaters and other online social media campaigns and materials dissemination on HIV/AIDS are combining together to reach the above-mentioned targeted populations to the greatest extent.
Moreover, the annual World AIDS Day celebration and HIV/AIDS prevention forum theater are part of this project initiative for the mass-awareness raising. This is an essential part of developing new knowledge and enhancing awareness of MWs' health rights, notably in HIV prevention, for having equal protection under laws, and accessibility to assistance and health services without stigma and discrimination by hospital staff and health care providers.
To ensure health rights of MWs regardless of their status, CARAM Asia and its project partners are making services more accessible and available to MWs and their families. In spite of MWs' rising needs for healthcare services, illness prevention and treatment, and other services, the national health programmes are frequently neglecting them. With that, provision of services such as counseling sessions, referral services, self-support groups, service mechanism reconstruction, online psycho-social supports and medical assistance are being implemented as a part of the CARAM Asia’ regional project activities with the means to tackle such issues. Additionally, the RESQ team has been formed to increase accessibility and outreach services for MWs with lack of access to HIV services in Malaysia. Increased health access was proven to empower MWs living with HIV and enhance general mental and physical well-being.
To conclude, this project showed remarkable outcomes in the previous year. Notably, ACHIEVE’s representation as a CSO to the Philippine National AIDS Council (PNAC) and the 7th AIDS Medium Term Plan (AMTP 7) influenced changes in policy formulations to include MWs in HIV prevention programs. The development of 11-point action plans for the key affected population (KAP) on HIV/AIDS in Bangladesh resulted from collaboration of OKUP with UNAIDS and Community Forum Bangladesh. The creation of the technical working group (TWG) through SPEAK Trust’s stakeholder’s sensitization marked the progress towards the implementation of an HIV testing and referral system at international airports in Pakistan. POURAKHI's status as the voice of MWs was also strengthened with the formation of a coalition with CSOs addressing MW issues in Nepal.
Other noteworthy accomplishments include large number of beneficiaries/recipients of services who were directly benefited from services delivery, education and awareness campaigns on HIV prevention which conducted by CARAM Asia's project partners, MSD, CDS and SPEAK Trust, include the provision of medical support to MWs who are detained, HIV screening of deportees and returnees and their access to health services, and HIV awareness training for migrant prisoners, potential MWs, and other Key Affected Populations. NSI has also created the first-ever training module to build capacity and educate the community leaders who are MWs about risk behaviors for HIV infection, prevention, and the availability of HIV- and STI-related health services. The 2022 activities' outcomes, notably in treating the HIV issues among MWs, were crucial to assess the effectiveness and its impacts they had on positively improving MWs' lives.
Board of Directors
Migrant Assistance Program (MAP Foundation), Thailand
DAWN (Development Action for Women Network)
MSD (Migrant Services and Development), Lebanon
Development Alternatives for Wider Network (DAWN), India
OKUP (Ovibashi Karmi Unnayan Program), Bangladesh
The CARAM Asia Secretariat operates from Kuala Lumpur, Malaysia. The core team members are:
Musarrat Perveen (Regional Coordinator)
Elizabeth Deveraj (Finance Manager)