Crossroads in Two Colombian Cities
Authors:   , Correa-Salazar Catalina , Martínez-Donate Ana P. 
Published: November 2022

Migrant and refugee women experience increased risks for HIV infection and gender-based violence (GBV) across migration phases. The Venezuelan humanitarian crisis has unleashed the largest exodus of migrants/refugees in the history of Latin America and the Caribbean (LAC). Women and girls have been forced to migrate to neighboring Colombia seeking treatment and care for health conditions such as HIV and AIDS, sexual and reproductive care, maternal and child services, and mental health counseling. Colombia, a post-conflict country, is the primary recipient of Venezuelan migrants and refugees. The Colombian post-armed conflict context imposes extremely high levels of violence on women, increasing exposure to HIV risk, GBV and trauma across migration phases. Evidence in the region is still lacking on the relationship between violence and HIV risk and how to approach the HIV response related to Venezuela's humanitarian crisis. There is a need for policies and interventions informed by culturally appropriate and gender-sensitive research that comprises women and girls' contexts and health needs. Additionally, there is a lack of evidence in Colombia and LAC on how migration and violence impact human rights of Venezuelan migrant and refugee women and girls (VMRWG). This dissertation sought to respond to these gaps in knowledge by aiming to: i) describe how violence impacts HIV risk in Colombian municipalities for women and explain how exposure to violence endured by VMRWG in Colombia impacts HIV risk and imposes barriers to HIV prevention and care among this particularly vulnerable female population; ii) answer how VMRWG perceived HIV risks and human rights violations and the strategies they implement to navigate them across migration phases to inform actionable solutions; and, iii) characterize VMRWG's access to healthcare systems, HIV services and violence prevention/protection mechanisms in Bogotá and Cúcuta. This dissertation's main goal was to study how GBV relates to HIV risk exposure and detrimental health outcomes for VMRWG to inform policies and programmatic efforts in Colombia and Latin America. We conducted a participatory-action study implementing a cross-sectional concurrent mixed-methods design in the two Colombian cities with the largest numbers of resettled migrants and refugees: Bogotá and Cúcuta. The quantitative part included negative binomial models to explore associations between social violence, proxied by homicide rates obtained from vital registrations, and newly reported HIV case rates obtained from the Colombian Ministry of Health. The qualitative part included 54 semi-structured interviews with Venezuelan migrant and refugee women (N=30/ n=15 per study site) and key informants (N=24/ n=12 per study site), social cartographies (n=16), and sexual and reproductive rights workshops (n=11) with VMRWG co-conducted by a local partner organization and community leaders in both cities. We found newly reported HIV cases in women were 25% higher for every increase of 18 homicides per 100,000 people after adjusting for covariates. Women and key informants described violence impacting HIV risk for Venezuelan women migrants related to armed actor violence and lack of government accountability, as well as to GBV and stigmatization of HIV upon resettlement. These factors impose barriers to HIV testing, treatment and care. Thus, social violence in Colombian municipalities is associated with an increase in newly reported HIV/AIDS case rates in women, which hinders VMRW's access and engagement in available HIV prevention and treatment interventions. Furthermore, we found pervasive GBV impacting HIV risk for VMRWG related to interpersonal, community and social factors. Across migration phases, perceived HIV and GBV risks relate to the presence of armed groups and lack of state accountability in border crossing and transit migration phases, whereas upon resettlement these relate to household violence, lack of social resources, gender expectations and scarce opportunities. Perceived risks differentially impact VMRWG according to their characteristics (i.e. gender identity, sexual orientation, socioeconomic status and race, among others). Protective factors for VMRWG relate to peer-led networks' support and a gender approach to health that comprises their specific needs and contextual limitations to health seeking behaviors. Needed actions include promoting HIV prevention across migration phases, capitalizing on community leaders for information dissemination and engagement in care, and holistic approaches to health that promote safe housing and job conditions upon resettlement. To address and tackle discrimination, violence and HIV risk factors in the personal, micro, meso, exo and macro levels across migration phases, programs and policies need to: i) implement strategies through community-NGO alliances, ii) prioritize local needs and build trust, iii) include a human rights, intersectional and gender-sensitive approach to health. These strategies could help protect human rights and inform local public health policies.