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STATEMENT FROM THE GENERAL SECRETARY, STEPHEN COTTON | HIV/AIDS / CREW CHANGE CRISIS
The International Transport Workers’ Federation (ITF) and our global union family of affiliates represent what are likely to number hundreds of thousands of the world’s 37.9 million people living with HIV or AIDS.
These people are our mothers, our fathers, our sisters, our brothers, our children, our workmates. They are us.
In 2020, in most parts of the world, we have come a long way in reducing the stigma and shame associated with this disease, which left untreated, can still take the lives of those we care about too soon. And it still leaves countless more experiencing lifetimes of ill health and expensive medical bills.
I want to send a message to all those HIV-positive transport workers, who drive our buses, ticket our trains, pilot our ships, operate our port cranes, clean our planes, or catch our fish: we have unbreakable solidarity with you.
This isn’t just because the theme for this year’s World AIDS Day is ‘Global solidarity, shared responsibility’. It’s because solidarity, real solidarity – through our actions and our deeds – is a fundamental union value. It’s what makes us strong, and kind, and unbeatable.
I want to tell those transport workers – the ones battling to get the drugs they need, to get treatment, who still have to hide their status from their managers or their friends, who have been told that they will likely die sooner than the person they thought they would grow old with, who have ever believed the lie that they deserve their fate – that we have unbreakable solidarity with you.
We value your contribution to the world, however great or small you may believe it to be today. You are a transport worker. You keep the world moving. Without you, nothing can go forward.
There is a lot of work to do to ensure that every transport worker has free and equal access to the quality health care, and the social dignity, that they need to live long, happy, healthy lives.
Where some of the most pressing work to be done is in solidarity with HIV-positive seafarers who are right now facing a double crisis. The crew change crisis, where quarantine restrictions have triggered governments to close borders and ban seafarers from stepping ashore has led to a crisis in seafarers’ ability to access the HIV medicines and medical treatments that they need to be healthy, and for many – stay alive.
HIV-positive seafarers facing pandemic medication crisis
The global shipping industry is held up by its workforce, the seafarers who come from all over the world. They are the nearly two million people who operate the 65,000 ships securing the world’s supply chains. In fact, seafarers bringing you 90 per cent of all the things you wear, buy, drive and eat – of everything. And just prior to the pandemic, this included more than 300,000 seafarers in the incredibly diverse cruise industry.
Among this global workforce are seafarers from every country, including Filipino, Chinese, Indian, Indonesian, Russian, Ukrainian, Samoan, British, American Italian and Norwegian seafarers. They’re a cosmopolitan bunch, performing skilled work in what can be high-pressure and taxing environments, both physically and mentally.
Seafarers’ six-, or often seven-, day working weeks used to be broken up by short bursts of shore leave. It has to be said that the historical stereotype of pent-up navy sailors using their sparse occasions of time ashore for wild sexual escapades with local maidens is both outdated and quite offensive when characterising the modern, professional seafaring industry. However, like many other transport workers who cross national boundaries for work, seafarers have a relatively high rate of infection for HIV. More research is needed on exactly why this is the case, but attitudinal differences across cultures on prevention tools like condoms seem to be a factor. Access to these products when you need them, if you did want to use them, is also a problem.
In some countries, Pre-exposure Prophylaxis (PrEP) is now available and is subsidised by national health systems or private insurers. The medication can be extremely effective in reducing a person’s risk of HIV infection, but obtaining it over the counter can be difficult. This means prescriptions are often required, but obtaining internationally-valid prescriptions is not always an option.
For those seafarers who do become infected, in 2020 having HIV is not a death sentence. Modern medicine has provided us with medication and support that makes it is possible for those who are HIV-positive to lead long and relatively health lives. Post exposure medication can even remove the contagiousness of the virus – meaning there is almost zero risk of infecting future sexual partners. This removes some of the guilt and shame historically associated with the virus. Shame that has prevented some people from addressing their condition and its danger to their health.
Despite these advances in treatment, social stigma remains in some communities and prejudice in the minds of some individuals. I have sympathy for with those workers who would rather not disclose their status to their employer or workmates unless absolutely necessary. But keeping their status confidential on board can be challenging and stressful for seafarers living with HIV or AIDS. There’s little privacy on board what effectively becomes your floating home for months on end.
Even before the pandemic, accessing HIV medications was difficult and patchy for seafarers. Antiretroviral drugs to control viral loads for those with a positive status are either impossible to get over the counter in some countries, or banned by governments completely. Hard luck if your supply ran out just before docking into these places.
In 2020, this problem is actually getting worse. In response to Covid-19, most of the world’s governments closed their borders – including to seafarers working aboard ships. The crew change crisis that began in March has seen up to 400,000 seafarers trapped working aboard vessels around the world and unable to get home at the conclusion of their contracts. This border and shore access situation is undoubtedly making things even more complicated (and potentially dangerous) for seafarers living with HIV. In a recent survey conducted of seafarers caught up in the crew change crisis, almost one third of them said they had medical issues that they needed treatment for, but are not receiving.
Because HIV targets a person's immune system, it destroys and impairs the function of immune cells, making HIV-positive people more vulnerable to infections and some types of cancer. Even with medication, failing to get HIV-positive seafarers the care they need for even the most minor issue can have serious ramifications for their long-term health.
Through this pandemic, we have seen the often shameful ways that governments have closed their borders and closed access to medical treatment for this key workforce, regardless of the health impacts on them. Some governments sent ships with crew infected with Covid back out to sea. Others blocked stroke victims from coming ashore for treatment. Even though we’ve been living with Covid for eight months, most countries still prevent shore leave, making it impossible for seafarers with HIV to discretely restock their antiretrovirals or fill other prescriptions.
Despite the seafarers’ sacrifice, governments are happy to continue waiving through the goods that the world’s seafarers’ deliver day after day. The ‘essential goods’ are allowed ashore – but the ‘essential workers’ who bring them aren’t. I am sure the tragic irony is not lost on seafarers living with HIV who are presently unable to go ashore for medications that it is they, the seafarers, who will ultimately deliver the PPE, the medical supplies, and potentially even some of the Covid vaccines to the same shores in the months to come – just as they dutifully have delivered other health supplies through this pandemic.
Amongst the pandemic’s gloom for seafarers living with HIV, there are some bright spots, however. I want to share a couple of them with you.
In 2017, the ITF and our the Filipino seafarers union AMOSUP supported the launch of the first self-help and support network of HIV-positive seafarers, called Positibong Marino Philippines. The network provides support, advocacy, resources and education for HIV-positive seafarers and the wider community. Of particular importance is helping HIV-positive seafarers to understand their rights, including freedom from discrimination by employers on the basis of their HIV status.
Positibong has gone from strength to strength in the last three years, and I am incredibly proud of what they have achieved.
I am also proud that the ITF has produced a Seafarers Wellbeing App for iOS and Android devices, so that seafarers can learn more about HIV and find ways to get support – including from Positibong, and our the ITF’s Wellbeing Coordinator, who helps seafarers to access the treatment and help they need, wherever they are.
If you’re a seafarer reading this and you’re one of the hundreds of thousands still trapped working aboard ships: please reach out to the support channels available. The ITF, our union affiliates and our partners all want to help you find ways to meet your health needs through this crew change crisis. You are not alone.
Standing up for transport workers with HIV is a union’s responsibility
As unionists, we understand the notions of fairness and justice. It’s why we join unions, why we get involved in them. We want to be treated with fairness and justice – and believe our workmates deserve the same.
But securing that fairness and that justice requires all of us to recognise our shared responsibility to one another, when the time comes to fight for what is right. To demand a living wage. To refuse to work in unsafe conditions. To demand equal treatment for our workmates. And when that moment comes – to strike, to stare down a bully, to defend your sisters and brothers – it is make-or-break.
And, so too, is this moment for the trade union movement. Today I am reiterating the ITF’s long-standing call on all unions to be brave, to be strong and to take action:
- Raise the crew change crisis and seafarer access to HIV medications and treatment as a priority for your government and health authorities;
- Tell your governments that HIV and equitable treatment of those living with it is a workplace issue, including access to medications through workplace health cover;
- Develop workplace policies and awareness, education and treatment programs on HIV/AIDS in partnership with the employers and social partners to improve the lives of HIV-positive transport workers;
- Support and encourage your governments to back initiatives that to reduce the rate of new infections, such as by making sexual health products like condoms and treatment services free and accessible;
- Push for the subsidisation of preventative HIV medications like PrEP, and post-exposure medications for treating the virus in HIV-positive people;
- Educate your members about the modern reality of HIV – how it is transmitted, how to get treatment and help, and how HIV-positive people can now lead long and relatively healthy lives with the right medication and support;
- Challenge HIV- and AIDS-related stigma and discrimination in the industries you organise, within your membership and in the community. An injury to one is an injury to all – live it.
- Listen to your HIV-positive members. What do they need? What are the challenges they are facing – practical and social, at work or in their lives? Then take action to help tackle those problems, together.
On this World AIDS Day, let’s all renew our commitment to take action to stand with our HIV-positive sisters, brothers and others in this mighty global union family. Let’s show solidarity – real solidarity – by taking action.
Their struggle is our struggle. Their fight is our fight.
Together, our solidarity is unbreakable.
Stephen Cotton
ITF General Secretary