Component 4: Setting-up sub-regional alliances for the improvement of HIV gender and age specific service delivery to the migrant population, and promotion of best practice.
Indicator: The number of organizations offering HIV/AIDS services tailored to the specific needs of male, female, and adolescent migrants.

Activities

•    Analysis of existing HIV-services for migrants and mapping of migrants in the catchment area of service providers
•    Identification, documentation and publication of evidence-based best practices of HIV-related services for migrants in the region.
•    Establishing of sub-regional partnerships to support the implementation of the identified best practices in other countries.
•    Testing of sub-regional reference systems.
•    Identification and punctual support of regionally organised training for personnel providing HIV&AIDS services.

Milestones  

•    Existing HIV-services for migrants within reach of selected HIV-services analysed.
•    Evidence-based best practice approaches to HIV-services to be provided to migrants identified, documented and published.
•    Sub-regional partnerships and alliances for the transfer of best practices to other countries of the region supported.
•    Sub-regional reference systems tested
•    Targeted regional training possibilities for personnel of HIV-services identified and selectively supported.
Deliverables
•    Analytical review of HIV-services for migrants.
•     Definition of the basic package of services for prevention, counseling, testing and treatment with division of responsibilities among different levels and types of providers.
•     Mapping of migrants within reach of selected HIV-services.
•     Publications of Best Practice on HIVservices for migrants.
•    Agreements on sub-regional partnerships for the transfer of best practices.
•    Evaluation report on sub-regional reference system test.
•    Training needs assessment for HIV service providers with regards to migrants as client group.
•     Analytical review of regional training institutes which offer targeted training

Key Challenges

Legal restrictions: Public hospitals and health centers are bound by legislative frameworks, which often prevent them from offering HIV/AIDS services to migrant populations. These restrictions are not only related to the immigration status of the respective individual, but also relate to the fact that mobile populations often work undocumented (both in the formal and the informal sector), which aggravates their opportunities to access healthcare services.
Stigmatization of HIV/AIDS: stirmatisation of HIV/AIDS is pervasive in the region, so people living with HIV&AIDS face strong discrimination from policy makers, health service providers, and the wider public alike. This does not only aggravate access to healthcare access of people living with HIV/AIDS (including migrants), it also motivates people living with HIV/AIDS to seek treatment abroad in order to conceal their HIV status within their domestic environment, thus fueling migration.
Discrimination against commercial sex workers and MSM by medical providers: A considerable percentage of male and female migrants work as commercial sex workers, and face stark discrimination throughout the region - not only by the general public, but also by medical service providers. Sex workers and other vulnerable groups such as MSM and drug users, do not only confront the problem of restricted access to HIV services, but also suffer from discrimination by medical staff, which tends to approach patients from migrant and vulnerable groups with preconceived attitudes concerning both
the legal status of the patients and/or their right to receive treatment. Given the resistance from healthcare workers, members of vulnerable migrant groups often decide against medical advice or seek services from non-profit and trusted private providers, to avoid discrimination.
Lack of sensitisation and training for public and private healthcare providers: Public and private healthcare providers alike lack the specific skills which are necessary to provide targeted, gender specific HIV/AIDS services for male, female, and adolescent migrant populations This is particularly important with regards to vulnerable migrant groups, such as commercial sex workers and MSM, whose needs cannot be met through standard HIV/AIDS service packages.
At present, sub-regional reference systems do not exist in the region. This implies that a patient who seeks treatment in country A today, and in country B in three months time, faces the problem that his/her doctor in country B has no insight into the patient’s record of country A, and vice versa. Even at the national level, referral systems are weak. This leads to important information deficiencies, as patients benefiting from prevention and screening services do not always receive information on further support and treatment services. This entails, that once these patients identify another service provider, the latter might not be able to trace the patient’s record even at national level.

Intervention Logic
This component focuses on enhancing the quality of HIV/AIDS services for migrant populations through the establishment of sub-regional alliances which will be able to provide basic package of services for migrant population wherever they are. The work under this component will be focused on three main issues: definition of the package of services, training of the providers and strengthening of the cooperation and knowledge sharing mechanisms to allow regional and sub-regional alliances to secure cross-country service provision. It has been made very clear in this proposal and shall be re-emphasized at this point, that migrants in the Caribbean region must be regarded as a heterogeneous group of people, differing by nationality, mother tongue, age, and gender, type of economic activity. In this respect, a specific focus was placed on vulnerable groups, such as commercial sex workers and MSM.

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