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The Diaspora Declaration: Development of a Global HIV and AIDS Framework for Change

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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 …

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.

Published in: Health & Medicine

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  • 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.
  • Transcript

    • 1. www.whiwh.com www.abdgn.org www.aids2014.org The Diaspora Declaration: Development of a Global HIV and AIDS Framework for Change Wangari Tharao Women's Health in Women's Hands Community Health Centre African and Black Diaspora Global Network on HIV and AIDS Toronto, Canada
    • 2. www.whiwh.com www.abdgn.org www.aids2014.org 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.
    • 3. www.whiwh.com www.abdgn.org www.aids2014.org Overview • Who are we? • Where are we now? • Promising Frameworks for a Coordinated Response • The Diaspora Declaration
    • 4. www.whiwh.com www.abdgn.org www.aids2014.org 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).
    • 5. www.whiwh.com www.abdgn.org www.aids2014.org 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).
    • 6. www.whiwh.com www.abdgn.org www.aids2014.org 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
    • 7. www.whiwh.com www.abdgn.org www.aids2014.org 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)
    • 8. www.whiwh.com www.abdgn.org www.aids2014.org 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
    • 9. www.whiwh.com www.abdgn.org www.aids2014.org 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
    • 10. www.whiwh.com www.abdgn.org www.aids2014.org 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.
    • 11. www.whiwh.com www.abdgn.org www.aids2014.org 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
    • 14. www.whiwh.com www.abdgn.org www.aids2014.org 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)
    • 15. www.whiwh.com www.abdgn.org www.aids2014.org 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.
    • 16. www.whiwh.com www.abdgn.org www.aids2014.org Acknowledgements ABDGN Governing Council Member Organizations The Diaspora Declaration is funded by: The Robert Carr Fund through: