When migrant workers leave their home, many encounter abuse and violence on their journey and discrimination once they arrive. This can be because of their status as migrants but also because of their ethnicity, sex, religion, and HIV status.

They often struggle to find decent work, which means they can end up in poor living and working conditions, which in turn affects their health. Female migrants are more likely to be vulnerable to exploitation and violence, which exposes them to the risk of HIV and other health issues.

Research has shown that migrant workers – particularly those who are in an irregular situation – often fail to access health services because of poverty, language and cultural barriers, lack of health insurance, as well as fear of job loss and deportation. It means that by the time they see a doctor, their illness has become all too serious.

Against this background, a newly launched ILO publication looks at the interplay between migration policies and those relating to broader health goals in countries of origin, transit and destination. Its key recommendation is that HIV and health policies should be integrated into the entire labour migration process.

So what can be done to ensure that migrant workers have better access to decent work, health and HIV services? The report recommends a three-pronged approach.

1) End discriminatory practices

Migrants face obstacles in accessing decent work, health as well as social protection. Whenever migrants are denied their rights, they tend to live and work in the shadows.  They become vulnerable to discrimination, exploitation and marginalization.

Discriminatory practices such as mandatory HIV testing of migrants for employment have proved to be ineffective. On the contrary, it is a violation of their rights. It disrupts access to health care and increases migrants’ vulnerability to HIV infection.

2) Set up an integrated response

It is essential to develop a response that does not just pile up ad-hoc policies one after another. Instead there needs to be an integrated and coordinated response that leads to decent work and health outcomes for migrants, including more effective HIV responses.

Right to entry does not mean the right to work for women in many countries. In such cases, women are left with no option but irregular migration which further exposes them to various forms of abuse, exploitation and risks such as HIV.

Gender-responsive migration policies would help address existing inequalities between men and women migrants, while at the same time improve their health.

3) Focus on migrant workers’ rights

There are no quick-fix solutions but discrimination and inequalities relating to HIV and health can be reduced if we focus on migrants’ rights and if we take a global approach. The report especially insists on the following priorities:

• There is a need to target different groups of migrant workers for HIV prevention, care and treatment, depending on the specific risks that they face. For example, risks are different depending on whether they are low skilled or high skilled workers.
• Effective responses to HIV for migrant workers should be integrated into fair recruitment initiatives, encouraging fair business practices to reduce HIV-related stigma and discrimination, and equal access to health services.
• Health programmes and HIV prevention for migrants must be disassociated from immigration enforcement.
• Inclusion, participation and freedom of association among migrant workers are essential pillars for effective actions on migration, health and HIV.
• Migration and health policies and practices, in particular those relating to HIV and AIDS, should address inequalities between women and men. A gender analysis is needed from the start for all policies and practices relevant to migration and health.