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'I always imagined my future only here' - How the HIV residence ban affects international migrants in the Russian Federation

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BACKGROUND: Russia has the highest HIV incidence in Eastern Europe and Central Asia.It is also one of only 19 countries that deports migrants living with HIV. In 2008, the United Nations announced that such discriminatory policies are unacceptable'they serve no public health interest and instead only make migrants living with HIV more vulnerable and less likely to access life-saving HIV care and other medical treatment. This study examines the effects of Russia's HIV deportation policy on HIV+ migrants, especially undocumented migrants, to better understand how this policy is being implemented and how migrants cope with the challenges it creates in the Russian context.
METHODS: Our analysis draws on in-depth interviews with 15 HIV-positive migrants, supplemented by 13 in-depth interviews with experts and caregivers providing HIV prevention and treatment services to migrants in Russia.
RESULTS: Undocumented HIV+ migrants describe being doubly stigmatized for their migration status and their HIV status, both in Russia and in their home countries. This is especially exacerbating for migrants from key populations who endure the most serious stigma. The also describe facing doubles sets of barriers in Russia and their home countries. In Russia, migrants describe facing significant barriers to accessing prevention information and HIV testing and treatment services, as well as general medical services, contributing to high vulnerability. On the other hand, migrants sometime fear to return home because of fear of stigma and uncertainty about availability of free HIV care back home. They also fear being placed on a ban list and being unable to return to Russia, where they have better economic opportunities than in their home countries. As a result, after learning their HIV status, many migrants prefer to remain in Russia undocumented, trying to obtain treatment using grassroots transnational networks or remain without treatment.
CONCLUSIONS: Twin fears of deportation and discrimination leave undocumented HIV+ migrants in Russia without any good choices. Consequently, many of them reside in limbo for years with little chance of obtaining ART. Our principal recommendations are decriminalizing migrants with HIV in Russia and creating transborder agreements between migrants' sending countries and Russia to aid migrants in receiving treatment.