HIV/AIDS case in Indonesia is growing fast. The Ministry of Health reported the cumulative AIDS case up to Dec 2010 is 24.131 cases. Indonesia classified as a low concentrated epidemic country, focusing the intervention to the key populations (sex workers, homosexual, injection drug user and client of sex workers) whereas the migrant worker as vulnerable group is not prioritized to be targeted. In the last five years, due to the type of transmission, HIV transmission type in Indonesia changes from injection drug to sexual transmission. It is showed by the increment of HIV AIDS cases among women and child including migrant workers. Even though there is no comprehensive reported data available on HIV and AIDS cases among migrant workers, it is reported by Caring for Migrant Workers, a local NGO which handling AIDS cases of deported migrant workers, 50 cases of AIDS cases from deported migrant workers have been handled in the last 2 years.
Migration its self is not a risk factor to HIV, the unsafe conditions under which people migrate and work tend to make migrants vulnerable or put them at risk. Separated from families, communities and social support systems, migrants and mobile populations are more likely to be exploited and victimized, or engage in risk behavior that can result in HIV infection. Unsafe migration which caused by lack of protection afforded to migrant workers during the course of the migratory cycle, as a consequence, migrant workers are often subjected to multiple violations that occur in the context of the recruitment procedures, precarious employment abroad as well as upon return to their countries of origin. Exploitation, discrimination and abuse, combined with low awareness of HIV/AIDS among migrant workers put migrant workers under increased risk of becoming infected.
As sending country, the mandatory HIV-testing is followed to avoid the refusal entry to the country of destination or deportation to the home country. This is a fact that migrant workers are subjected to at various stages of the migration process. HIV testing practices tend to be highly discriminatory and violate the rights of migrant workers in several ways. In most cases migrant workers have no knowledge of the purpose of the test. Feeling obliged to sign whatever papers required in order to be allowed abroad, they are tested for HIV without giving consent to it. There is also no counseling offered, neither before taking the test nor after. Testing HIV-positive is generally followed, often without the migrant workers being made aware of his or her health condition. It also happened when the migrant workers in destination country. Once it is found the migrant workers are HIV positive, they have to be deported to the home country without any health treatment provided in the destination country.
Moreover, assistance for returning HIV-positive migrants to reintegrate in their countries of origin is extremely lacking. Upon return migrant workers are usually neither referred to medical services nor counseling, the result being delayed treatment and the potential of unknowingly infecting others.
International commitments on Rights for Migrant Workers, Health and HIV/AIDS have been addressed to protect migrant workers from HIV/AIDS. ILO recommendation no 200 stated that migrant workers as one of target group that should be concerning for the VCT, care and support both in home country and destination countries. The ASEAN Declaration on the Protection and Promotion of the Rights of Migrant Workers and the families recognizes migrant workers as a vulnerable group whose rights require protection, the latter identifies the need to provide prevention and treatment for such vulnerable groups battling HIV/AIDS related stigma and discrimination.
- To improve the knowledge on Migration and HIV vulnerabilities of migrant workers;
- To improve the understanding of the rights-based on HIV testing procedure and the health referral system for people living with HIV;
- To reduce stigma and discrimination in providing the health services among migrant workers; and
- To improve the commitment in creating enabling environment to implement the health referral system for HIV-positive migrant workers.
- The HIV knowledge and HIV vulnerabilities among migrant workers in all migration cycle improved;
- The understanding of right- based HIV testing procedure and the health referral system improved; and
- The commitment among health service providers and recruitment agencies in improving the HIV health access and service among migrant workers improved.