Exploitation, vulnerability to tuberculosis and access to treatment among Uzbek labor migrants in Kazakhstan

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.

► This study is the first to examine access to TB treatment among labor migrants in Central Asia. ► Employs a qualitative approach to elucidating the complex pathways that link undocumented status and risk of TB. ► Demonstrates the accumulation of risk factors among undocumented migrants and differential patterning of risk. ► Analyzes how illegality interacts with exploitation and social marginalization to produce vulnerability to TB. ► Examines the role of the post-Soviet health system structure in influencing rationales of access to care for migrants.