Social policy and programme administration

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Social policy and programme administration considerations Immigration is often challenging and difficult in and of itself. Leaving one’s homeland and journeying to a new country can be stressful and complicated. Permission to cross borders and settle in a new land is a function of its national sovereignty, based on existing legisla gushulak/macpherson
1±± tive and regulatory frameworks. For the individual European country, the implications of international policy statements on HIV/AIDS travel restrictions (54) can be daunting and hard to resolve. New arrivals are frequently subject to relative poverty. They may have difficulties in obtaining adequate employment and housing, and can experience significant psychological and physiological stress. Lack of access to formal economies and employment can encour age new arrivals engage in informal or illegal economies, such as drug trafficking and the commercial sex trade, with their associated increases in HIV risk. All these factors can af fect general health and well-being. For refugees and asylum seekers, the nature of migra tion is even more difficult, especially when exacerbated by acculturation, stigmatization or discrimination. For the host nation, these issues invoke human rights and humanitarian considerations, creating strains on social and health policy development (55, 56) and the practical delivery of programmes (57) . Beyond life-preserving emergency care, however, most international conventions and agreements do not mention migrant health service needs – and certainly not the health promotion, disease prevention and public health efforts needed to address migration and globalization of HIV/AIDS. Health care and treatment services are frequently less available, accessible and afford able for migrants than for native residents. The legal or administrative residency status of a migrant can limit the availability of health services and insurance (58) . Migrants who are not legally residing in their host nation may avoid contact with the health care system for fear of administrative or legal repercussions. Unaddressed social stressors, particularly poverty, may exacerbate existing risk factors for HIV, encourage uptake of new ones and also con tribute to avoidance of essential health care services. Some migrants may not be entitled to health care or social services, including state-fund ed HIV/AIDS prevention and treatment programmes, depending on national policies and the migrants’ ability to make contributions to programme support. As a consequence, there may arise a very significant differential in the affordability of health care services and medica tions between some infected migrants and other infected individuals. It is clear that migration in Europe will continue to significantly influence its dynamic demographics. Expansion of the European Union, the ageing of several European popula tions and the continued impact of globalization will result in a growing influx of migrants to support population growth needs and manual and skilled labour requirements. The dynamics

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