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. © 2011 Elsevier Ltd.

Labor migration tuberculosis Undocumented migrants Uzbekistan Central Asia Access to care Access to TB treatment Kazakhstan

Vulnerable Populations vulnerable population Health Personnel postprimary tuberculosis health risk poverty disease treatment health care personnel construction work human violence health status qualitative research drug resistant tuberculosis Cross-Sectional Studies foreign worker migrant worker cross-sectional study Humans Severity of Illness Index male labor migration Tuberculosis, Pulmonary female Uzbekistan tuberculosis vulnerability Article health care help seeking behavior infection risk health care access disease severity Sociology, Medical Transients and Migrants disease incidence occupational hazard Kazakhstan employment illegal immigrant Health Services Accessibility