Migrants in Switzerland are in a situation of greater intersectional vulnerability to HIV

The authors of a study advise that specific preventive interventions be carried out that take into account the needs of this population.

Migrants in Europe are at much higher risk of acquiring HIV – and also developing AIDS – due to numerous social factors that place them in a vulnerable position. On the other hand, these vulnerabilities are enhanced by sexism, cisgenderism and racism, according to a Swiss study published in Culture, Health and Sexuality. All this is reflected in the fact that a significant number of these people are infected with HIV in their host country, so it is necessary to carry out specific preventive interventions for this population, which address the identified risk factors.

The conclusions of previous studies indicated that migrants faced not only particular legal and socioeconomic factors that put them in a situation of vulnerability, but that there were also other more specific aspects that also influenced that risk, such as not being a cis person, not being heterosexual or being a sex worker.

Intersectional inequality is produced by the interaction of several axes of inequality and oppression such as age, class, sex, sexual diversity, religious beliefs or national or ethnic origin, among others. The intersection of social vulnerabilities increases the risk that migrants will acquire HIV or develop advanced HIV disease due to lack of adequate care.

As a result, the Swiss public health authorities decided to collect data to inform HIV/STI prevention policies in the migrant population. To this end, a sociological, participatory and qualitative study was launched by a team of social researchers from the University of Freiburg. Special attention was paid to people coming from countries with high HIV prevalence, sex workers, gay men, bisexuals and other men who have sex with men (GBHSH), injecting drug users, trans and undocumented people or with temporary residence status in Switzerland.

All participants were over 18 years of age who were subjected to in-depth interviews. It was attended by prevention specialists working in the field of migration and HIV.

The results of the study reveal that the biographical, interactional and contextual dimensions are intertwined and create social vulnerabilities that affect this population. Thus, the team of researchers reports that, by not allowing irregular migrants to work, Swiss laws lead them to undeclared and poorly paid jobs. This exposes them to exploitation and deprives them of housing, social protection and health insurance. Lack of health care is very common among these people, who live with the constant fear of being reported or deported.

The link between the three dimensions and social vulnerabilities is also observed in relation to work. All these limitations can translate into both a precarious housing situation and the need to practice transactional sex in exchange for economic, housing and other resources.

That is, the difficulties faced by migrants in a host country condition their behaviours and sexual relations, and increase their vulnerability to HIV, especially due to an increase in transactional relationships. On the other hand, limitations to access antiretroviral treatment increase their risk of developing advanced HIV disease.

The structural conditions in which interactions with sexual partners occur may increase the vulnerability of these people to HIV. Thus, they can be seen in situations where they cannot negotiate safe practices. Added to this, in the case of needing post-exposure prophylaxis against HIV (PEP), you may find stigmatizing attitudes towards sex work.

In their conclusions, the study authors indicate that these findings have important implications for HIV prevention and HIV treatment in the context of migration. For example, they highlight the need for a structural shift towards greater equity in health care and universal access to it. In addition, if migrants had greater economic and legal security (for example, thanks to economic benefits and long-term residence permits) they would be less likely to enter into intimate relationships with an unequal balance of power. They also suggest that HIV and AIDS prevention among the migrant population requires a review of social and cultural structures and power systems, such as sexism, cisgenderism and racism.

These conclusions are in line with those from the aMASE study (Expanding access to health services for immigrants in Europe), carried out in 10 European countries. The study not only reflected that a large proportion of migrants were infected in their host country (agent the preconceived idea that they had been infected in their home country), but also advocated that migrant communities be considered more actively in HIV prevention campaigns.