PEAH is pleased to republish an article by AFEW partner organization. AFEW is dedicated to improving the health of key populations in society. With a focus on Eastern Europe and Central Asia, AFEW strives to promote health and increase access to prevention, treatment and care for major public health concerns such as HIV, TB, viral hepatitis, and sexual and reproductive health

First published August 25, 2020

AFEW International intern

Barriers For Migrants

The main reason why labour migrants from Tajikistan, Moldova, Belarus and Uzbekistan come to Russia is that there is no work for them in their home countries. Often labour migrants have big families; parents, brothers, sisters, wives and children, and they have to take care of them. Working in Russia is often the only way for them to help their families to survive.

Margarita Abramyan, manager at KOVCHEG Anti-AIDS in Rostov-on-Don, a partner of AFEW International in Russia, has been implementing a project called ”HIV and migrant workers in southern districts” in the framework of the regional approach of the “Bridging the Gaps: health and right for key populations” program. She told us what influences migrants’ access to health services in Russia and how to improve this difficult situation.

How would you describe the access to health services for labour migrants in Russia?

So it really depends on whether you are in Russia legally or illegally. If a migrant comes to Russia legally, he/she receives a residence and work permit with medical insurance. If the migrant is in Russia illegally, this person can stay here up to 90 days. They don´t need to undertake all the documentation procedures and therefore don´t have a medical insurance. To get a legal residence permit or a medical card in Russia, you need to be tested for HIV, viral hepatitis and TB. But the thing is that you have to pay for all these tests yourself, and many migrants cannot afford this.

Under the migrant medical policy, emergency ambulance assistance and emergency operations are free. If you need an operation that is not absolutely necessary, then you need to pay for this operation yourself.

What are the consequences if labour migrants do not have access to health services?

There are a lot of consequences of the lack of access to health services for labour migrants in Russia. Migrants who come to Russia often work at construction sites, the kind of jobs that are really dangerous and where it´s common to have serious accidents. When a migrant has a serious accident at a construction site and they do not have access to healthcare, they can become an invalid for life.

The big problem is that migrants are actually afraid to get medical help, because medical workers ask for their documents and check if their papers are valid. If medical workers find out that migrants are illegal, then basically they can be thrown out of the country. Another big problem is that HIV positive migrants who come to Russia cannot get Russian citizenship. However, many of those HIV positive migrants come to Russia anyway. They stay in the country illegally and do not have access to healthcare. They often don´t know the condition of their health and cannot get any ART.

What these migrants sometimes do is that they connect or communicate with the non-profit-organizations from Ukraine or Uzbekistan, with countries that have borders with Russia, and then they can get therapy from there. So they could register in Ukraine, for example, and get therapy there and then go back to Russia. We are in contact with these organizations to support migrants. Of course, now with the coronavirus situation it´s a lot more difficult because the borders are closed. So the migrants can´t go back to their own countries and get treatment there.

What are other factors that influence migrants’ access to health services, besides their legal or illegal status?

So other factors include societal denial and ignorance . Russian people and people who come from post-Soviet countries have a very particular mentality – they believe that HIV will never touch them. They think they will never get sick and if they get something, like a flu, then they just drink some herbs, and everything will be fine.

The other thing is that there is a widespread belief left over from the 90s that only sex workers, LGBTQ+ people and drug users can get HIV, so if you don´t live a “wild life”, you live a so-called a ´normal life´ that is not connected to drugs or sex work, then you definitely will never get HIV. Another thing is that people still have a lot of unprotected sex. Moreover, most of the migrants that come to Russia send their money to their families back home. All the money that migrants earn is sent back to their home countries and they do not want to spend this money on healthcare.

Are culture and language also a barrier for migrants to access health services?

Yes, it’s a very big barrier. Together with my organization we went to one of the detention centres for illegal migrants in February and there is no official interpreter for them there. Migrants are communicating with through signs. Even though there is a lot of medical information about HIV and how to access medical services, there are no interpreters for migrants. For example, of the four people who came from Uzbekistan, only one spoke Russian. The people who cannot speak Russian are trying to figure it out for themselves.

Is there a governmental programme that tries to help migrants integrate into Russian society?

There is no governmental programme like this, these kinds of activities are mostly done by NGOs. These activities include language training, consultations, cultural trainings and workshops, and it´s mostly just NGOs doing that, as volunteers.

Which services does your organization provide for labour migrants?

We provide peer-to-peer consultations for migrants. We also have lawyers, virologists, and psychologists who support migrants. We are also supporting migrants in getting their Russian citizenship and filling out the documents for work and residence permits. If there are funds, we also try to support migrants financially. We also have rehabilitation centres for drug HIV positive users. Also, we often organize information events for labour migrants where we tell them about access to health services and about treatment and testing for HIV. We also have a lot of contact with local organizations and job centres. If a migrant is looking for a job, we can refer them to our other contacts.

What do you think should be done to improve the access to health services?

On the governmental level, first of all the medical insurance for labour migrants should cover all the medical services that are also available for Russian citizens. On the local level it would be great if NGOs get financial support from the government to pay for HIV treatment and testing for migrants.

There is always hope that things will change. If the government provides enough support, treatment and care to migrants then communicable diseases will not be transmitted. There are migrants who take their health and the health of their families very seriously, but they do not have the same access to health services as Russian citizens.