title: Exploitation, vulnerability to tuberculosis and access to treatment among Uzbek labor migrants in Kazakhstan.
abstract: In recent years, Kazakhstan has become an important destination for primarily undocumented seasonal workers from Uzbekistan. In a context of high tuberculosis (TB) incidence, TB treatment is provided free for all residents in Kazakhstan, but migrants rarely access these services. This paper reports findings from a qualitative study conducted with migrants, TB patients and health care workers between July and September 2008 to understand the mechanisms that impede migrants' access to care. Findings describe three structural contexts--the employment, legal and health care contexts - which act in concert to render migrants vulnerable to exploitative work conditions and cause a series of barriers to health care. These conditions contribute to increased exposure to TB, heightened risk of reactivation due to weakened immunity, treatment-seeking delays, and increased severity of disease. Seasonal migration patterns also contribute to treatment interruption, which constitutes a risk for the creation of drug resistance. Using the theory of structural violence coupled with the concept of cumulative vulnerability, this paper analyzes how illegality interacts with exploitation and social marginalization to produce vulnerability to TB and restrict access to treatment.
authors.affiliation: Global Fund to Fight AIDS, Tuberculosis and Malaria, Eastern Europe and Central Asia Team, 8 Chemin de Blandonnet, 1214 Geneva, Switzerland. shuffman@alum.emory.edu
authors.forename: Samantha A
authors.initials: SA
authors.lastname: Huffman
authors.forename: Jaap
authors.initials: J
authors.lastname: Veen
authors.forename: Monique M
authors.initials: MM
authors.lastname: Hennink
authors.forename: Deborah A
authors.initials: DA
authors.lastname: McFarland
mesh_terms: D003430:Cross-Sectional Studies; D006282:Health Personnel; D006297:Health Services Accessibility / Q000191:economics / Q000458:organization & administration*; D006801:Humans; D007623:Kazakhstan / Q000453:epidemiology; D036301:Qualitative Research; D012720:Severity of Illness Index; D012962:Sociology, Medical; D014171:Transients and Migrants / Q000706:statistics & numerical data; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000188:drug therapy / Q000208:ethnology*; D014610:Uzbekistan / Q000208:ethnology; D014754:Violence; D035862:Vulnerable Populations