Migrations and HIV/AIDS vulnerability in South East Asia

Paper presented at the12th World AIDS Conference - Geneva - July 1998
by Irene Fernandez
Chairperson of CARAM-Asia and Director of Tenaganita

There is a rush to globalize. Governments are racing to negotiating tables eager to sign away their national sovereignty for pieces of the economic miracle that globalization promises. The supposed miracle is indeed tempting - rapid economic growth with rapid development and rapid profits… the gateway to a good life. Globalization maybe the most fundamental redesign of the world’s economic, political and cultural systems ever to take place.

Through free trade blocks, modern communications, multilateral agreements through the World Trade Organization and global financial systems and institutions like the World Bank and the IMF, we have been sucked into a global system that has produced massive integration into the global economy. Money, as we in South East Asia have come to realize and understand clearly with the bust and collapse of our economies, can travel the world in seconds. And in seconds drastically change our economies too.

Behind the promises of unlimited growth and prosperity there exists a grim reality; the disintegration of the social order, increasing inequality and squalor, displacement and landlessness, violence and homelessness, alienation and growing fear of the future. And one major form of disintegration is the migration of people for economic reasons that is becoming a visible phenomena globally but more so in Asia.

The proponents of globalization look beyond the current reality. They speak about how all will eventually rise with the tide of economic growth. In the meantime they acknowledge that some people will suffer and shoulder risks. These people are not the rich and the famous who can afford imported food and privatized health care and services. They are farmers forced out of their lands. Workers who have lost their jobs to machines and corporate flight. They are women forced to sell their bodies in the tourism and sex industries. They are indigenous people who have no right to their own lands. And as globalization grips us, these people continue to lose their rights and democratic space.

Globalization, Development and Patterns and Trends in Migration

Recognizing the devastating ramifications globalization as it is directed tody can bring to majority of our people, it is indeed vital that we look and evaluate the HIV/AIDS pandemic beyond the bio-medical concerns. Vulnerability to the disease is in fact the fundamental question confronting us. Within the whole process of globalization, migration of peoples is major consequence. The mass migration of peoples will be further facilitated by explosive regional developments. It is understood there are over 2 billion people are on the move globally. This is a phenomenal number that has various implications on the lives of people.

The migrant worker torn from his loved ones , forced by poverty, resourcelessness and maldevelopment moves to countries with booming economies. In Asia, most countries are labor exporters while there exists a relatively small number of labor importers who are popularly know to be the tiger economies of Asia. During the last 15 years in particular, Asia has not only been a continent for great opportunities for the market but also for investment. This intensive growth has been experienced especially in South East Asia. The growth has brought about restructuring of economies that has necessitated movement of people both at intra and international levels.

The emergence of sub-regional economic zones like SIJORI comprising of Singapore, Johor in Malaysia and Batam and Bitan of Indonesia or EAGA - the Eastern growth traingle consisting of the Borneo Island, Mindanao of Philippines and Irian jaya of Indonesia have also brought about migration within these zones. The management of migration flows, generated by these sub-regional economic zones presents a number of challenges. Even small wage differentials appear to generate strong incentives for international migration especially when distances are short and cultural ties are strong. It may also be difficult to prevent illegal migration of dependents especially when contracts are for a long duration.

Recent ILO studies done in some Asian countries show that the possibility of people to emigrate increases rather than declines with the improvement in per capita income. The emigration flows as stated by Manolo Abella in the ILO study recognises emigration pressures to come from unemployment, large reserves of labor, landlessness, poverty, income inequalities, environmental degradation , reforms through economic transactions and political conflicts. All these pressures are in fact the very same consequences brought about by an economic model pushed through by the current globalization processes. This economic model only concerns itself with profit and capital accumulation. The human person is only secondary to the agenda.

In recent time in fact the state has diligently taken on the role of motivating and organization outward migration of its citizens. The Philippines, Sri Lanka, Indonesia and Bangladesh governments involve themselves directly to ensure outward migration is brought through. They see this means as one of the better ways to earn foreign exchange and pay their external debts. The external debts accrued have been created by structural adjustment programs of the IMF and borrowing from the World Bank for economic restructuring .

The tiger economies that became labor importers enjoyed the cheap and flexible migrant labor. In 1996, the Republic of Korea had more than 250,000 foreign citizens with 61,000 being trainees and over 150,000 overstaying. Now with the economic downturn Korea is rapidly sending back the foreign workers. Singapore has about 600,000 out of which 200,000 are Malaysian workers and the rest foreign workers. Singapore is coming hard on illegal workers. It has introduced mandatory caning for workers who overstay or are undocumented.

Malaysia, when it was booming economy, prior to July 1997, had 3 million migrant workers with a working population of 5 million . Half of the migrant workers are undocumented for various reasons. Some of the common ones have been where the employer or agent has not registered and obtained the work permits of the workers. Since the economic downturn, Malaysian authorities have taken a hard position on migrants being repatriated. The government stated that it would send back one million migrant workers by the end of 1998. In August 1998, it will not renew the work permits of migrants in the services sector. Migrant workers will only be maintained in the plantations and in specific export oriented manufacturing industries.

Under Ops Nyah or Operation Go Away, the authorities have intensively hunted down undocumented workers, and have detained thousands of migrant workers. It has forcefully repatriated thousands to Indonesia. Many more are languishing in the detention camps. On the other hand migrant workers who have overstayed or have become undocumented find it impossible to return home. They have to pay a compound of RM30 per day or a maximum of RM 3000 ( US$800 ) . The workers do not have the money. Thus they go into hiding to escape arrest. The Indonesian workers are not motivated at all to return. With the collapse of their economy and with a record of 20 million unemployed, the Indonesians believe they are better off in Malaysia. Therefore they try their level best to remain in Malaysia. Anyway they have nothing that is economically viable for survival back home.

With the economic crisis, Malaysia has made a number of changes to its policy. It now refuses to renew or recruit Filipinas as maids. Incidently, the Filipino housemaid is paid at least RM500 or more. Malaysia now has decided to recruit from Cambodia and Sri Lanka where the maids will only be paid RM350. In Cambodia, after the coup in July 1997, the economic dropped very drastically. Many major investors left the country. Confronted with political turmoil and poverty, the Cambodian government was only too willing to sign an agreement with Malaysia to send women to work as maids. For the first time in decades, Cambodia opened up to the global world in the export of unskilled workers. However as the business of labor export grows, the government does not have the capacity nor the resources to provide appropriate training prior to the departure of the workers tp prevent migrant workers from STDs/HIV/AIDS . The private sector was only interested in training the maids in the skills of housekeeping. For the women it was a golden opportunity.

Caram-Asia’s partner in Cambodia, Caram - Cambodia involved itself in the project . It now conducts a three day pre-departure program for the Cambodian maids on the reproductive system, understanding our bodies and on STDs/HIV/AIDS and how to prevent infection.

In Vietnam a phenomena of enormous influence on the spread of HIV virus is that of migration. But it is still an undiscussed issue. The borders of Vietnam between Cambodia, Laos and China are fluid in many parts. Vietnam also has a very long sleek coastline with some nineteen ports that brings about high movement of people. As the country opened itself to foreign investment to boost its economy, one sees the growth of the sex industry as foreign business men look for pleasure while they are temporarily in Vietnam. Many businessmen keep a Amistress who quite often is a sex worker. Large international companies bring in men, single, for work in the projects like oil exploration or construction. The men who come in single seek for pleasures and it has brought about a growth in the sex industry. This has also brought about women moving into the urban centres where they become sex workers. These two forms of migration have created the vulnerability for HIV/STDs.

Caram-Asia’s partner, Care-Vietnam in their research has found condom usage to be low. The cultural factors that determine women’s low status especially in negotiating for safe sex, have left the onus to the men. The men believe that Vietnam is free of the HIV virus. And coupled with the myths in condom usage, do not at most times practise safe sex. The virus has thus a good environment. The women are thus put at high risk of being infected.

While the economy was booming in Cambodia, a similar situation developed. With UNTAC men and foreign businessmen presence, brothels, lounges and various forms of entertainment centers mushroomed to provide commercial sex. Men from Vietnam also moved in droves to become construction workers in Cambodia. There was an influx of both rural Khmer women and Vietnamese women, wanted for their fair skin to the brothels and entertainment centers. The vast majority of these women had no or very little knowledge of STDs/HIV/AIDS. I is not a surprise that today, Cambodia is recognised as an AIDS explosive center in South East Asia.

For the one million Burmese who live in Thailand the majority are not political dissidents. They are grassroots people, pushed out by the oppressive SLORC regime. These migrants live through hard labor to support their loved ones back home. The continued effects of the political instability of the SLORC, economic chaos, forced labor and forced relocation are not only factors for migration and movement of people but also causes of increasing the risk of HIV infection. The large projects like the gas pipeline at the Gulf of Martaban is one such project that has displaced large communities of both Burmese and Thais.

Feminization of Migration

Within these forms or flows of migration in South East Asia, it is increasingly clear that women in many cases tend to dominate migration flows. In the Philippines women account for 60% of legal migrant workers, excluding seafarers. In Indonesia, of documented migrant workers, for every one male migrant, there are two female migrant workers. In Thailand while women account only 25% of recorded workers leaving the country, but clandestine female migration is known to be significant. The large droves of women being trafficked into Europe, Canada, Japan for forced prostitution is a well established fact now. In Sri Lanka an airport survey showed that 84% of the migrant workers were women and of them 94% were domestic helps. In the Gulf alone there is an estimated number of over 100,000 Indian women working and as Bangladesh has lifted the ban on women leaving the country for work, we see an increase of such women in Malaysia working in the textile and garment industries or as domestics in northern India, in Pakistan, Hong Kong and the Middle East.

The receiving countries do not allow the women to come with their families and so the women emigrate in their own right. They are contractual. The women cannot marry nor become pregnant. If they do, then they are deported. The women have to go for annual medical tests to ensure they are not pregnant nor infected with HIV or STDs. These migrant women of course leave home to become income earners for their families and to pay for the debts of their countries.. The jobs that the women are provided with are in fact at the bottom of the occupation hierarchy, generally shunned by the local women.

From the increasing number of cases being reported and campaigns carried out by women’s groups, the migrant women is indeed in a very vulnerable position. Domestic helps, entertainers or those in the sex industry are particularly vulnerable as they go into individualized work situation involving greater isolation and lower level of social support network. The women are open to abuse especially sexually, regularly confronted with sexual harassment , discrimination and exploitation. All these make them vulnerable to HIV.

Migration and Its relation To The HIV/AIDS Pandemic

It is evident from various reports of countries and of the WHO that the region is an explosive area for the AIDS pandemic. HIV/AIDS is spreading rapidly. But yet people are puzzled by the combination of HIV/AIDS and migration. Governments are concerned but quite often paralyzed in their actions. We search for reasons and causes to arrest the problem. But we tend not to be able to define the problem in its correct perspective and thus deal with it effectively. In fact in many instances we have failed to make the connections and linkages. Many Asian governments in theri strategies to combat and control the spread of HIV/AIDS have focused on specific groups called high risk groups like IVD Users or Sex workers.

A number of the receiving countries of migrant labor believe that migrants bring the virus across borders to other countries . Thus the problem is addressed by policies like mandatory testing and immediate deportation if found to be infected with the HIV virus. But this policy only applies to the semi-skilled and unskilled workers. Professionals and skilled workers need not go through such a testing. In fact this policy only goes to create a false sense of security for the local population. The policy is also very discriminatory and creates a believe that expatriates or skilled workers can never be infected by the virus. This mandatory testing tends to create abuse in testing for HIV virus as migrants who have spent huge sums of money to get recruited as a worker would want to have a clean medical report. However such a policy is indeed futile when a country like Malaysia, has 50% out of the 3 million foreign workers undocumented or illegal.

The relation between HIV/AIDS and migration has to do with the fact that the conditions of migration produce risks for migrants. The migrant workers come as singles. Rarely whole families migrate. If they do want, policies do not allow this choice. The majority of te migrants are mostly in their reproductive ages. Though countries tend to see them purely as economic tools, we in no way can deny that migrants are social beings who have their sexual needs and who will create social networks. In new conditions, without their traditional social networks and cultural values, migrants try to cope and develop a happy life. Undoubtedly they develop new relationships.

Confronted by these realities, CARAM-Asia ( Coordination Action Research on Aids and Mobility) is involved in a eight country participatory research program in South east Asian. One of our main goals is to produce information and knowledge about the living conditions , policies, accessibility to health care and the vulnerability of migrants to HIV/AIDS . We want to create data in such a way that the information derived is from the perspective of migrants themselves. We are very often bombarded with the point of view of politicians on how can we control the flow of migrants or from public health officials who care only on how to control infections brought by mobile groups like foreign workers. In analyzing the strategies undertaken by governments and even international agencies, very often the point of view of migrant workers themselves is under represented and not forthcoming. In order to ensure the migrant perspective is recognized and to strengthen the advocacy on effective strategies to reduce vulnerability, Caram - Asia uses the participatory action methodologies where the migrant is involved throughout the whole process and interventions take place concomitantly.

The research emphasized very much on identifying the social networks, relationships and sexual behavior and practices of migrant workers. Various strategies and methodologies were used. This was combined with outreach, programs and intervention actions. In order to discover networks and relationships with sexual practices, confidence and trust were prerequisites. But confidence cannot be achieved through rapid assessments. Confidence only grows when people understand and recognize you are on their side. It requires a long lasting commitment and the migrant is not the object but the subject in the research. What matters is not to find infected people but to influence behaviors in communities. One of the adverse consequences of policies that have kept people away or are unfriendly is that people will continue doing whatever they did, but now they do it secretly. To reverse this we need the active involvement of the communities themselves.

Spatial Mobility and Behavior - Social Networks and Relationships

The Caram-Asia research noticed that people alone and partly homesick in new surroundings often have increased sexual needs. Among male migrant workers there is increased visiting of sex workers, increased casual sex and less bargaining power. Among female migrant workers there is increased casual sex and little bargaining power, sexual abuse is increasing especially with domestic helps who have very little bargaining power. The job security question tends to override all other factors. Though the majority of migrant workers have heard about HIV/AIDS, they knew very little of how one got infected or how a person could prevent infection from the virus.

A study with 104 Filipina maids in Malaysia showed that over half of them were over 30 years of age and 55% of them were married. Out of those who were married at least 50% admitted they had a partner in Malaysia. More than half of those married also stated that their husbands back home in the Philippines had another partner. These facts indicate changing relationships. But the Malaysian government now has a policy stating that domestic helps who come to Malaysia should be above 25 years years old. This would reduce sexual abuse, marriages being broken up and new relationships will not occur. The new policy comes from the common belief that Filipina migrants who leave as domestics are very young, outgoing, single and have risk behaviour lifestyles. Migrants young or older, male or female, married or single being single in a new environment will create their own social networks and relationships.

The Filipina maids showed that they had high levels of knowledge on AIDS. They knew of prevention and of risky behaviour. Yet the decision to practise safe sex was left to the male partner. Thus the gender element and the general status of women in a relationship clouded with culture and its norms seems to determine sexual practices. The male is both the dominant partner and the decision maker on safe sex practices.

The research revealed that spatial movement led to not only creation of new relationships but change in behaviour. Bangladeshi women who were interviewed stated that they were experiencing a new form of freedom. They could wear clothes of their choice; they could now make their own friends with men without fear of repercussion. The women could mix freely and openly and even enter into sexual relationships or have casuals sex. The anonymity they experienced, changed their behavior. Thus migration patterns and movement have created a conducive environment for sexual encounters within migrants themselves and within the local population. The experiences for these women were exciting and the interactions with the men reduced their loneliness. In fact, the women, now out of the controls of their community and their social conditioning, were making their own decisions. This behavioral change is important for us to recognize as it contributes to the potential risk of HIV infection.

The group discussions held with the same women revealed that the women were more concerned in protecting themselves against pregnancy rather than HIV. They would request their friends to bring back the pill from Bangladesh. Back in Bangladesh, we know there has been a very aggressive campaign on family planning and how to prevent pregnancy. Moreover, the women find that it affects their body directly and they can take control of it. But for HIV/AIDS, the knowledge is low, methods of prevention unclear and the male partner is the dominant decision maker. The research in fact has strengthened the argument for a gender analysis and perspective so that the intervention strategies will ensure women’s involvement and build women’s capacity to make decisions within relationships to reduce vulnerability to HIV/AIDS.

It is increasingly evident that male migrant workers have created their own sexual and social networks. Most of the male migrant workers who were part of the research in Malaysia revealed that they frequented sex workers. Many of them visited the same sex workers regularly. They felt safe and were certain of the kind of services they would get from the sex worker without increase in costs. In fact in one case, the migrant workers took the researchers to meet with the sex workers in the brothels the workers frequented. The research team was able to discuss safe sex practices both with the sex workers and the brothel owners.

However, 61% of the male Bangladeshi workers in the Malaysian study thought they were not at risk of contracting AIDS and 78% were not worried about getting HIV/AIDS. However it is indeed interesting to note that the study also revealed that it was the young( 26 years mean age) single male Bangladeshi migrant worker who is more educated , had higher knowledge of HIV/AIDS that had a lower personal risk perception of acquiring the HIV infection and showed more risky behavior reflected in the low condom usage or lack in experience in using condoms. This in fact indicates that what is needed is change in behavior and understanding of the issues related to relationships and being infected to HIV/AIDS.

In Cambodia the influx of Vietnamese workers to the construction sector brought about the same phenomena of the men wanting to go to sex workers. There was a mushrooming of brothels to meet the demand. As stated earlier there was growing number of both Khmer and Vietnamese sex workers. However, after the attempted coup in July1997, the Cambodian government has taken a different position on brothels. The current crackdown on brothels ins unprecedented. Meanwhile the increasing pressure from the authorities is driving the sex workers underground and many are become free lance sex workers. Many of the sex workers have moved to other provinces and sex workers believe it is safer to be mobile. Thus it has become difficult for our partner in Cambodia to continue the research with the sex workers who have become invisible. The city of Phnom Penh may have succeeded in shutting down brothels. But they have not reduced the amount of prostitution nor lowered the spread of the HIV virus or sexually transmitted diseases. On the contrary, the current situation is a Acondition@ that puts migrant workers, here the sex workers at risk of HIV/STDS. From interviews done and informal discussions from the sex workers who are in the streets now, they state that their earning capacity has been drastically reduced, from 5000 reel to less than 3000 reel . Although the sex workers appear to be separated from the pimps or brothel owners, they appear to have lost access to regular and organized condom distribution and access to whatever limited medical care they had before.

Accessibility to Health Care Services and Treatment

Very often, the Malaysian leaders in their statements have blamed migrant workers for bringing in various communicable diseases and social ills. They create the impression that locals need to protect themselves from the migrant workers. Towards this end, the government has imposed mandatory testing for all migrant workers in order to obtain their work permits. However, there is a difference between communicable diseases like malaria and tuberculosis and HIV/AIDS. In HIV/AIDS the primary mode of transmission is through personal or intimate contact. Thus it goes beyond the classic exposure analysis to involve behavior factors. The statements by political leaders contribute to further stigmatization of migrant workers. In this context, migrant workers, already marginalized become the scapegoats for unwanted social ills and diseases.

In Malaysia, one of the questions to migrant workers asked in the research was ADid you know that you were tested for HIV/AIDS?@ Almost all of the respondents answered that they were not aware or did not know and that they did not get any form of counseling. This lack of information is a breach of international ethics. And when they are found positive, the migrant is immediately deported. According to recent statistics, at least 35 Bangladeshi migrant workers were tested positive and sent back. We do not know what has happened to them nor what support services and acre they get. This perpetuates discrimination and alienation. It benefits no one for at the end of the day, the citizens of the receiving country only have a false sense of security to potential risk.

Migrant workers pay for first class treatment, but receive third class treatment. The majority of migrants cannot afford. Consequently accessibility to health care is threatened and health is compromised. Employers are not willing to pay for high cost treatment. Workers therefore resort to self medication. Migrants also fear going to the panel of doctors determined by employers especially if they know they have STDs. They fear being deported. In Malaysia the Communicable diseases Act compels the doctor to inform the health Ministry. The worker then gets deported. No worker wants his job threatened. Thus accessibility is further undermined. In order to fight AIDS, a holistic approach to primary health care must be adopted. To be effective, w need to take a multi-sectoral approach and include housing and sanitation in intervention strategies. We also need to change the attitudes of health care providers in relation to migrants and marginalized communities. Globalization and privatization of health care gives sanction to a subtle but real commodification of basic human and health rights. Social integration and development is expected to remain a low priority in the agenda of governments. We need to reverse that trend.

Bridging the Gap

In bridging the gap to make the fight against HIV/AIDS and STDs, effective in the context of migration and mobility, there has to be openness, understanding and recognition that we are dealing with human persons who are wholesome at all times. It must challenge us to a holistic approach with a long term commitment, Therefore:

1. We need to recognize the gaps in our analysis and perspective. HIV/AIDS can no longer be understood from purely a bio-medical perspective. Even attempts to address the issue on the individual level and responsibility is limited and narrow. As CARAM-Asia=s participatory research has shown, the analysis needs to take on a macro analysis with its multilateral and multi sectoral implications. The current economic model which increases polarization of the rich and the poor, women and men, north and south, migrant and local, only facilitates the environment for the virus to multiply, infect and destroy lives.Thus any AIDS intervention strategy has to challenge the current economic strategies. In particular, one area that must be given focus is the whole question of privatization and commodification of health care services, its development and accessibility.As part of its bailout conditions, structural adjustment programs, the International Monetary Fund (IMF) has pushed through the whole concept of privatization and deflation of the state. The health sector has been a major target.Privatization of the health services has only brought about increased costs in medical care. A HIV positive person who gets combination therapy in Malaysia needs RM1555 for three weeks. On the other hand, a HIV+ who also needs alternative drugs for harm reduction needs RM6000 per month. The average income of a worker is only RM600 per month. How can an ordinary person afford treatment?

   It is well established that primary health care is fundamental to the well being of any community and health status of individuals. The universal goal is health for all by the year 2000. However, primary halth care is being sacrificed and undermined with the whole process of pirvatization.. This development will create conditions for greater potential risk to infections and to higher vulnerability to HIV/AIDS.

   My question to all of us is, @Has the IMF together with its current policies and conditions like privatization of various services especially Health become an HIV carrier? I believe it seems to be more and more true. Therefore in bridging the gap, we must confront IMF and World Bank policies and conditions, its structural adjustment programs in order to address issues of HIV vulnerability.

   Most of our resources are being used to change individual behavior while hardly little is done to ensure access to health care services and programs by all people and communities and to change the attitude of health care providers . A national public health plan must be evolved for all communities that guarantees accessibility and treatment.

2. To bridge the gap, equality of the human person must be recognised and practised . Equality needs to be reflected in all policies and intervention strategies. It is clear that migrant workers are discriminated and stigmatized. They are not given equal treatment and thus denied accessibility to health care services, education programs. There has to be strong political will, especially during this period of economic crisis in Asia for governments to ensure that migrant workers are treated like human beings with social and sexual needs. Migrant workers need health care. It must become the total responsibility of governments and employers.The creation of a blanket policy of mandatory testing and deportation for migrants found HIV+, will only bring about a false sense of security to the local population. This will in turn only create a backlash to the control of HIV/AIDS.The challenge is for countries to recognize the rights of both documented and undocumented workers. Governments need to very ardently facilitate interventions so that migrant workers become visible and accessible.
3. In evolving policies and action plans to control the further spread of the HIV virus, countries need to take into cognizance, the movement of large groups of people for economic benefit and therefore these migrants and their needs must be integrated . The migrant perspective has to be understood and recognised in all plans. In order to bridge the gap, the migrant workers have to be involved in planning, evolving and implementing strategies and actions for behavioral change and for the development of support networks and services to reduce the conditions that increase vulnerability to HIV/AIDS.
4. Unless and until gender analysis and perspective is developed and strengthened in our evaluation of conditions to HIV vulnerability, the gap will never be bridged. There has to be more interaction and involvement of women. In this case the migrant woman or the woman who has been trafficked. For too often and too long, we see the woman as the transmitter…. a sex worker who spreads the virus or a mother who gives the virus to her unborn child. We need to see the woman in her own right.More research has to be done to understand clearly the influence of cultural norms and values; the impact these have when a woman moves away from her community; the parallel lives of both partners when they migrate; factors that bring about spatial behavioral changes; dynamics of relationships within a woman=s subordinated position; and the woman=s capacities to determine safe sex practices.We need to become more and more critical of the religious and cultural factors that are patriarchal and which perpetuate women=s subordination. We need to critically relook our intervention strategies for women, in particular for sex workers and women who are trafficked.There is a need for preventive approaches that do not create fear, panic or false sense of security and safety of infection. While actions targeted at the males have been preventative and protective of them, actions targeted at women, like sex workers has been to prevent the spread of the virus from them. When this perspective is accepted, there is little expression given to a woman=s social, economic, health and cultural needs.

   HIV/AIDS action must look at AIDS within the whole gamut of health problems and services to ensure that women get access to health services and use them. Without a gender sensitive and gender centered health services, STDs or HIV/AIDS services will remain out of reach.

5. There needs to be bridging the gap in research itself. We have to relook at research itself, its focus, strategies and methodologies. Have we spent too much on searching for a cure that we have allowed the virus to overtake us? Or have we been too fast with our rapid assessment procedures with rapid intervention strategies especially on mobile populations that we have forgotten how a human person behaves and internalizes ideas and perceptions in relation to relationships and sexual networks. How effective have all these been. Or have we been caught up with immediate results for after all it is results that donors look for? Has research been donor driven or people driven? Has our research been migrant centered with objective of bringing about the migrant perspective. It is only with the migrant perspective can we determine positive results in behavior change. In order to reduce vulnerability to HIV, it requires more than just condom promotion. Behavioral change has to take place. This is a process that absorbs time, space and interaction. Rapid assessment procedures are only like entry points. With a migrant population, a longer term involvement and commitment is required .Participatory Action research methodologies have to be evolved, experimented and strengthened so that the community is empowered to take control of their lives.