Within but without: human rights and access to HIV

Refugees and Internally displaced persons

Within but without: human rights and access to HIV prevention and treatment for internal migrants.

Worldwide, far more people migrate within than across borders, and although internal migrants do not risk a loss of citizenship, they frequently confront significant social, financial and health consequences, as well as a loss of rights. The recent global financial crisis has exacerbated the vulnerability internal migrants face in realizing their rights to health care generally and to antiretroviral therapy in particular. For example, in countries such as China and Russia, internal migrants who lack official residence status are often ineligible to receive public health services and may be increasingly unable to afford private care. In India, internal migrants face substantial logistical, cultural and linguistic barriers to HIV prevention and care, and have difficulty accessing treatment when returning to poorly served rural areas. Resulting interruptions in HIV services may lead to a wide range of negative consequences, including: individual vulnerability to infection and risk of death; an undermining of state efforts to curb the HIV epidemic and provide universal access to treatment; and the emergence of drug-resistant disease strains. International human rights law guarantees individuals lawfully within a territory the right to free movement within the borders of that state. This guarantee, combined with the right to the highest attainable standard of health set out in international human rights treaties, and the fundamental principle of non-discrimination, creates a duty on states to provide a core minimum of health care services to internal migrants on a non-discriminatory basis. Targeted HIV prevention programs and the elimination of restrictive residence-based eligibility criteria for access to health services are necessary to ensure that internal migrants are able to realize their equal rights to HIV prevention and treatment.

Far more people migrate within their country than out of it. China has more than 140 million and India more than 250 million internal migrants. Internal migrants change residence from one civil division to another in their country of origin for social, political, or financial reasons or in the wake of natural disaster. This article highlights the negative health consequences of internal registration systems, such as hukuo (China) and propiska (Russia) or state-specific government ration cards (India), which are compounded by deepening health and social inequalities in the wake of the global financial crisis. The lack of access to and lack of continuity in antiretroviral treatment services for internal migrants, who are often doubly stigmatised, along with gaps in HIV prevention programmes, are creating the conditions for failure to reach national goals of reduced HIV incidence and disease burden. The right to the highest attainable standard of health, the principle of non-discrimination, and the right to free movement within state borders are all international human rights law guarantees to which signatory countries are legally bound. Immediate steps to end discrimination in health care provision for internal migrants should be high on every country’s agenda.