AIDS at 25

I had been meaning to post on the topic of HIV in migrant and mobile populations much, much earlier, but was unable to get to a session until today. My interest was piqued on Saturday as I stood in line for my press pass and media bag, and struck up a conversation with a press officer from the French AIDS and hepatitis research agency (ANRS). In France, and many other countries, inequity, social exclusion and language barriers--not to mention fear of the authorities--make migrant individuals particularly susceptible to HIV and limit their access to testing and treatment.

Earlier sessions spoke of the numbers and the risks associated with migration--whether voluntary or forced--whereas today's session focused on the challenges to those who were trying to provide information, prevention, testing and treatment. It was food for thought.

Paul Farmer, a medical anthropologist and physician at Brigham and Women's hospital in Boston, MA and the founder of Partners in Health, pointed out that the consequences of conflicts don't vanish as soon as accords are signed and troops pull out. In Rwanda, for example, a 2003 survey found that among 1,000 women who were raped during the genocide, 66 percent were HIV positive.

There are also those who are left behind and forgotten, the "invisible ones" David Mosca, an emergency surgeon in Nairobi, called them. The wives, mothers and children who don't leave or, perhaps, don't continue to the second or third country, and are left to fend for themselves. If we don't know who they are, how can we find them and provide them with the healthcare services they need? And how to make sure that a recent migrant, or one who routinely crosses borders continues to get their regular course of antiretrovirals? Difficult to do and maintain confidentiality.

A member of the audience stood up and brought attention to the situation in Darfur, where lately aid workers have been unable to provide proper care in the HIV setting. No condoms, no post-exposure prophylaxis, no therapy. As Farmer indicated: there are many consequences to Darfur, that we won't see for years.