Presentation given by Wangari Tharao, from Women's Health in Women's Hands Community Health Centre African and Black Diaspora Global Network on HIV and AIDS, at the Under the Baobab African Diaspora Networking Zone at the International AIDS Conference, AIDS 2014.
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Conflict of Interest Statement
• This presentation is supported through a research grant from the
Canadian Institutes for Health Research (CIHR).
• I have no other actual or potential conflict of interest to declare.
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Who are we?
• The African and Black Diaspora (ABD) are populations of Black
Africans and their descendants who are dispersed through a mix
of forced and willing migration and who may or may not maintain
strong ties to their African origin.
• The ABD broadly encompasses populations of:
– Recent migrants;
– Second generation and multi-generational populations;
– Refugee and asylum seekers; and
– Mobile populations (e.g. temporary migrant workers).
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Growing Recognition of ABD Communities as a
Key Population
• Australia (2002-2012): 8.2% of all HIV diagnoses were in people born in
Africa, although Africans are only about 1.4% of the total population (Kirby
Institute, 2013).
• Canada (2008): ABD populations had an estimated HIV infection rate 8.5
times higher than other Canadians (PHAC, 2012).
• United States (2007-2010): Black populations were 62% of new HIV
infections amongst women; 64% of transmission via heterosexual contact; and
66% of infections among children under 13 (CDC, 2010). In 2011, African
Americans had the largest estimated percentage of HIV diagnoses among gay
and bisexual men (11,805 or 39%) (CDC, 2012).
• Caribbean Region (2009): 53% of people with HIV were female. This is the
only other region, besides sub-Saharan Africa, where women and girls
outnumber men and boys among people living with HIV (UNAIDS, 2010).
• EU/EEA (2007-2011): Migrants represented 39% of reported HIV cases, most
were from sub-Saharan Africa (ECDC, 2014).
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Some Gains at the International Level
• 2011 UN Political Declaration on HIV and AIDS: Intensifying our Efforts
to Eliminate HIV and AIDS1
• Para. 84. “Commit to address, according to national legislation, the
vulnerabilities to HIV experienced by migrant and mobile populations
and support their access to HIV prevention, treatment, care and support.”
• 2013 UN Secretary-General Report - A life of dignity for all: accelerating
progress towards the Millennium Development Goals and advancing the
United Nations development agenda beyond 2015
• Post-2015 discussions recognize diasporas as key contributors to
development.
• Migrants’ contributions are undermined by experiences of discrimination
and denial of their human rights at various stages of the migration
process.
1General Assembly resolution 65/277 adopted June 2011
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Promising Frameworks for a Coordinated Response
ABD Typology
(Fenton, 2010)
HIV/AIDS
Program & Policy
Frameworks
(CDC, 2012)
Migrant Integration
Frameworks
(Ager & Strang,
2008)
Global Health &
Migration
Frameworks
(WHO, 2010)
Global Health &
Migration
Frameworks
(Zimmerman et. al.,
2011)
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Global Health & Migration Frameworks
Source: WHO (2010). Health of migrants: the way forward - report of a global consultation, Madrid, Spain, 3-5
March 2010. http://www.who.int/hac/events/consultation_report_health_migrants_colour_web.pdf
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Global Health & Migration Frameworks
Source: Zimmerman C, Kiss L, Hossain M. (2011) Migration and Health: A Framework for 21st Century Policy-Making.
PLoS Med 8(5): e1001034. doi:10.1371/journal.pmed.1001034
http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001034
Figure 1. Migration phases framework
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Migrant Integration Frameworks
• Health framed as a marker
of successful integration
• Common barriers:
language, access to
health services, lack of
information, cultural
perceptions of health care
• Fragmented roles and
responsibilities between
levels of government
hinder development of
comprehensive migrant
health policies
Source: Ager, A. & Strang, A. (2008). Understanding Integration: A Conceptual Framework. Journal of Refugee Studies,
21(2), 166-191.
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HIV/AIDS Policy and Program Frameworks
• Demonstrates health inequities in diagnosis, treatment, and care
• Tendency to focus on behavioral interventions
• Does not reflect transnational nature of migration (relies on static
geographic location)
Source: CDC Fact Sheet (July 2012). http://www.cdc.gov/hiv/pdf/research_mmp_stagesofcare.pdf
12. ABD Typology
TYPE I:
Post-Slavery Black
Majorities
TYPE II:
Post slavery, Black
Minorities
TYPE III:
Post-
Colonialization
Black Minorities
TYPE IV:
Recent economic
and social
migrants
Caribbean region
Populace mainly of African
descent
Political, social power
structures and networks
largely governed by those
of African descent
Social and economic
trajectories heterogeneous
and determined by
economic, political and
social
North, Central and
South America
Populace mainly of
European or Mixed
descent with varied
proportion of blacks
Political, social power
structures and networks
largely governed by ethnic
majority
Civil rights heterogeneous
Western Europe
Populace almost entirely
of European descent
Black migration in mid-late
20th Century
Political, social power
structures and networks
largely governed by ethnic
majority
Civil rights influence
minimal and
heterogeneous
Western Europe,
Canada, United States,
Intra-Africa
Level of integration into
society heterogeneous
Display general
characteristics of
economic migrants
Political, social power
structures and networks
largely governed by
ethnic majority
Source: Fenton, K. (July 2010). Ties that Bind-HIV/AIDS in the African Diaspora. [PowerPoint Slides] Retrieved from African
and Black Diaspora Global Network on HIV/AIDS website:
http://abdgn.org/files/pdfs/Presentations/KEVIN%20FENTON%20ABDGN-PRESENTATION-HLM-JULY18-2010.pdf
13. The Diaspora Declaration:
One Framework for Global Action
Global Health &
Migration
Frameworks
(WHO, 2010)
Global Health &
Migration
Frameworks
(Zimmerman et. al.,
2011)
ABD Typology
(Fenton, 2010)
Migrant Integration
Frameworks
(Ager & Strang,
2008)
HIV/AIDS
Program & Policy
Frameworks
(CDC, 2012)
Diaspora
Declaration
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How do we get there?
• Literature review
– Review and synthesize available
evidence
• Global consultations
– Including ABD people living with HIV,
government and health surveillance
representatives, service providers,
advocates and academics
• Leverage web-based platforms to
mobilize communities and disseminate
results
Get involved - follow
us on Twitter
(@kwakuABDGN) &
visit www.abdgn.org
Visit us at the
African Diaspora
Networking Zone at
AIDS 2014: Twitter
(@BaobabAIDS2014)
or facebook (Under
the Baobab at AIDS
2014)
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The Diaspora Declaration:
One Framework for Global Action
The Diaspora Declaration will provide:
• Evidence-informed recommendations for a coordinated
global response to ABD migration, HIV/AIDS, and health
inequities.
• Actions across policy, advocacy, research, and service
delivery.
• An advocacy tool that links grassroots efforts to national and
international action.
The ABD includes the largest forced migration in recent history, the transatlantic slave trade, which has resulted in the populations of African descendants now living in the Caribbean, the Americas, Western Europe, the Middle East, and other regions around the world.
The diverse social histories linked to the movement and establishment of ABD populations globally highlights the tremendous heterogeneity among these populations.
Language, faith-practices, established community infrastructure, cultural and economic ties to country of origin, gender norms, and access to health services are just some of the factors that contribute to the divergent, yet interconnected, experiences of ABD populations.
The number of people of African descent that live outside the continent is estimated at almost 140 million, most of them in the Western Hemisphere. (Shinn, 2008 as referenced in World Bank, Leveraging Migration for Africa: Remittances, Skills, and Investments, 2011 )
It is still a struggle to collect ethnicity-based data.
These statistics cut across traditional key populations (whether heterosexual transmission, women, MSM, migrants) and across regions.
ABD populations have not traditionally been discussed as part of the dialogue on these key populations.
2011 UN Political Declaration on HIV and AIDS: Intensifying our Efforts to Eliminate HIV and AIDS
ABDGN’s advocacy helped ensure migrants were recognized as a vulnerable population that must be targeted for HIV prevention, treatment, and care.
The Declaration’s potential effectiveness is not being effectively maximized to link, leverage, or empower communities, organizations, ABD networks or member states to engage with high level national/global health and migration stakeholders.
Since the resolution was adopted, UNAIDS (which is mandated to support countries to report on the commitments in the Political Declaration), has released a set of indicators to track progress on key commitments in the Political Declaration.
ABD and migrant populations are missing in the targets and related indicators, unlike other key populations such as sex workers, MSM, and youth. Some information on migrants/mobile population and ethnic minorities will be tracked through the National Commitments & Policy Instrument (which measures progress in the development and implementation of national HIV policies, strategies and laws), but this won’t address information gaps and inadequate access to resources ABD communities experience on the ground.
2. 2013 UN Secretary-General Report - A life of dignity for all: accelerating progress towards the Millennium Development Goals and advancing the United Nations development agenda beyond 2015
An annual report to the UN General Assembly on progress in the implementation of the Millennium Development Goals until 2015 and to make recommendations for further steps to advance the UN development agenda beyond 2015.
Post-2015 discussions on the role of migrants in development have tended to focus on their role as labourers/workers and the impact of their financial contributions as opposed to discussions on a health and human rights agenda to sustain their vital economic and social contributions ‘back home’
These frameworks are relevant to our work to support ABD populations. They were chosen to represent the broad domains of thought impacting services and polices that impact HIV among ABD communities. Some of the frameworks are peer reviewed, some are global in nature, some are supported by UN member states and have buy-in from a policy standpoint, or international organizations or governments have participated in their development.
ABD Typology:
Kevin Fenton presented a descriptive typology of the black Diaspora at AIDS 2012 in a presentation entitled: Ties that Bind-HIV/AIDS in the African Diaspora. The typology highlights the diversity among ABD populations around the world based on their experiences of colonialism and migration. It makes the connection between this variability and a range of factors, including experiences of discrimination, migrant rights, individual and community characteristics, culture and the social determinants of health, and how they impact the HIV epidemics among ABD populations.
Global Health Framework: WHO (2010). Health of migrants: the way forward - report of a global consultation, Madrid, Spain, 3-5 March 2010
The 2008 World Health Assembly Resolution on the Health of Migrants asks Member States to take action on migrant health policies and practices, and directs WHO to promote migrant health on the international agenda. As part of this work, WHO and IOM held a Global Consultation on Migrant Health in Madrid in 2010, and one of the key outcomes was an outline for an operational framework to further action on migrant health. The key priorities of the framework are: monitoring migrant health, policy and legal frameworks to protect migrants’ rights globally, building migrant-sensitive health systems, and partnerships, networks and multi country frameworks that recognize the transnational nature of migration.
Global Health Framework: Zimmerman C, Kiss L, Hossain M. (2011) Migration and Health: A Framework for 21st Century Policy-Making. PLoS Med 8(5)
Zimmerman, Kiss and Hossain published a PLoS Medicine series on migration and health that provides a nuanced picture of the impact of migration on health during the five stages of migration (pre-departure, travel, interception, destination, and return). The framework recognizes the special vulnerability of migrants during complex migration processes and argues for interventions at each stage of the migration process to promote health and well-being.
4. Migrant Integration Frameworks: Ager, A. & Strang, A. (2008). Understanding Integration: A Conceptual Framework. Journal of Refugee Studies, 21(2)
Ager and Strang conducted a review of definitions of integration to develop a comprehensive conceptual framework of immigrant integration and the key factors needed for success. Health is identified as one of the markers of successful integration, but like many migrant settlement and integration frameworks, the unique migration experiences of ABD populations are not reflected and HIV is not addressed (although briefly mentioned as an issue for migrant communities).
5. HIV/AIDS Program and Policy Frameworks: Treatment Cascade
Although the treatment cascade has been published in peer reviewed journals, the CDC has done some interesting data analysis comparing outcomes at various stages of the cascade across race/ethnicity. The treatment cascade has important implications for our HIV program and policy work, but needs to be connected to our discussions on health inequities and social determinants of health.
Recognizes unique health needs of migrants and intersections with legal status
Promotes coordination across policy and program domains and levels of government
Highlights lack of standardization in migrant health data
Migration process as a multistage cycle
Links stage of migration and status to social determinants of health approach
Promotes policy coordination across policy sectors and borders
Does not reflect the unique settlement needs of HIV positive migrants or make the connection between migration, integration, and risk of HIV infection
Graph Legend (from dark to light bars):
Diagnosed
Linked to Care
Retained in Care
Prescribed ART
Virally Suppressed
At AIDS 2012, Kevin Fenton presented a descriptive typology of the Black Diaspora
It acknowledges historical context of migration and legacies of colonialism in various regional contexts that contribute to the ongoing economic and social marginalization of ABD communities in the global north.
It links the ABD experience to a social determinants of health framework
The typology reflects the diversity among ABD populations
Factors driving heterogeneity among diasporas (Cohen, 1997):
Historical experience, driver and context for migration
“Victim minorities” – “host societies” power dynamics
Migratory phase within same communities
Type, quality and structure of social relations, networks and institutions
Role of socio-economic or political institutions
Cultural knowledge – identify, value systems, rules of behavior which guide the actions and choices of individuals in the community
Degree of internal cohesion and organization
Openness to the surrounding socio-economic system
Each framework addresses an aspect of ABD communities: as forced and willing migrants, as people living with HIV, and ethnic minorities
The Diaspora Declaration is an attempt to bring all these frameworks together:
Integrating ABD communities in countries where they are;
Incorporating a historical perspective and recognizing its impact on the HIV response;
Improving policies nad programs as a component of effective service delivery; and
Making the link to cyclical migration processes and frameworks.
The Diaspora Declaration will be informed by a literature review, global consultations, and the use of web-based platforms to build and strengthen partnerships across regions and disciplines
The literature review will consider questions such as:
What are the most effective strategies for collecting and monitoring HIV/AIDS health indicators for ABD populations?
What national/regional health policies include recommendations specifically for ABD populations?
What advocacy-based strategies to reduce HIV/AIDS disparities amongst ABD populations have been used/evaluated?
What strategies can support integration of ABD population needs in the delivery of existing HIV/AIDS services and programs?
Global consultations will build capacity among grassroots advocates to make connections to and between national and global policies and programs.
The web-based platform supports knowledge translation and strengthened partnerships within the ABD and across stakeholder groups.