stigma, vulnerable population, social harm, substance use, HIV prevalence, qualitative interviews, pilot study, migrants
Southeast Asia is particularly vulnerable to human displacement caused by climate change disasters affecting sizable highly vulnerable impoverished populations.1 Millions of people live along coastlines, on deltas, and in other low-lying areas prone to flooding, salinization, and erosion, all of which are expected to become worse with continued effects of climate change. In 2023, 10.5 million people were newly displaced in the East Asia and Pacific region; 92% of these displacements were caused by severe storms and flooding.2 One Southeast Asian country is currently hosting more than 100,000 climate-induced migrants displaced by climate disasters over the past decade. The country has limited financial resources, a fragmented health care system, and politically motivated disdain for migrants.
There are limited substance use disorder treatment facilities in this country, and they mostly serve the domestic population and are not accessible to the climate-displaced migrants. HIV/AIDS is another health issue of concern, with most cases being diagnosed among men who have sex with men (MSM). Both health issues are highly stigmatized in this country.3 The prevalence of HIV/AIDS among the domestic population who use drugs is relatively low, but there are no published studies on the prevalence of HIV/AIDS among climate-induced migrants who use drugs. Most of the domestic population living with HIV/AIDS has access to treatment, but that is not the case for climate-induced migrants.
A researcher has received funding for a pilot study to investigate drug use among climate-induced migrants in this country. The researcher plans to survey 80 displaced migrants to provide preliminary data about substance use and risk of HIV and other blood-borne infections in this population. The rapid assessment and response methodology includes use of social maps created by people who live in neighborhoods of interest and use/buy drugs there. The research will also include semistructured interviews with people from displaced populations who use drugs and individual semistructured interviews with key informants/stakeholders (e.g., substance use service providers, refugee agencies, government health officials, and other researchers). The results of this pilot research are intended to inform policies and programs for substance use and HIV/AIDS as well as to serve as preliminary data for a larger research grant. However, information about substance use and HIV/AIDS among the migrant population could potentially be used for political purposes.
Questions
What are the key ethical issues raised by the proposed study with regard to vulnerable populations and participant privacy?
What are the potential risks and benefits of this study? Do the benefits sufficiently outweigh the risks, and can the risks be adequately prevented or minimized, or not?
Do you have any suggested modifications of the proposed study methodology for the study to be conducted ethically?
What are your thoughts about the ethics of sharing the study results, given the political climate in which negative information regarding climate-displaced migrants might be used for political purposes?
