Tip of the iceberg

Entry restrictions generally affect people who want to stay in a country for a long period of time. Depending on the duration of the stay, a negative HIV test result must be presented to authorities for approval of the stay. HIV-positive test results generally lead to refusal of entry or to being forced to leave if one is already in the country. Such regulations limit PLHIV in the selection of educational opportunities and places of work. This discrimination cannot be accepted, particularly in view of the change in status of HIV from a fatal to a treatable chronic disease, since PLHIV – just like any other citizens today – need to plan their education and pursue a profession.

PLHIV are at constant risk of losing what they have built up: their job, their financial basis, access to health care, their home, their friends and family, and even their life. In this regard, some countries in Asia and the Middle East set particularly poor examples. We have anecdotal reports of people dying in deportation confinement, denied access to treatment while waiting to return to their homeland. This usually affects migrants who have been confined for deportation when their HIV status is discovered. The excuse of ‘legal problems’ between the authorities is often given. Authorities can even make it harder for their own citizens to return home if it becomes known that they are infected with HIV or have AIDS.

The true extent of the problem is unknown

The true scale of the daily discriminations experienced by PLHIV cannot be described, and the data compiled here can only provide a limited picture of the consequences of statutory regulations. There is currently no system and no organization which centrally collects relevant cases and reports on them. We only have individual, anecdotal reports. Further uncertainty about the true extent of these regulations is created by the fact that existing laws are sometimes not applied or only applied by some officials. The following information provides an overview of the extent of the problem:

• Approx. 40 million people worldwide are living with HIV. Most of the affected persons live in low and middle-income countries. Many of them have an urgent need for treatment options in order to survive.
• According to figures from the United Nations World Tourist Organisation (UNWTO), there were approx. 935 million international arrivals worldwide in 2010.
• Approx. 191 million migrant workers live outside their own countries, according to estimates by the IOM. The refugee commission of the United Nations (UNHCR) assesses the number of refugees and people seeking asylum at 20.8 million worldwide.
• With respect to the countries with discriminatory entry regulations, more reliable monitoring of actual conditions is required for the future. This is the only way we can show how PLHIV suffer disadvantages and discrimination on a global level.

A heavy burden for PLHIV

Application forms for entry visas often contain questions about general health, such as “Do you suffer from a communicable disease?” Those who decide to answer truthfully can expect entry to be refused. If HIV-positive travellers decide to answer this question untruthfully, they then encounter the subsequent problems of needing to hide any medication they are carrying and needing to give the healthiest possible impression to the border official(s). At border checks, it is the job of officials to look at luggage and/or check completed forms. The checks may also include checks of physical appearance.

If health certification is required when applying for the visa or for entry at the border, the required tests and examinations are frequently carried out by contractual doctors or other official bodies. Only those who subject themselves to these regulations have a chance of entering the chosen country – apart from the option of paying bribes, as anecdotal reports suggest.

Some countries require foreigners to have regular routine examinations which may include an HIV test. The costs for all these tests must naturally be covered by the individual, putting financially weaker groups of people at a disadvantage.

Other checks are performed by agencies whose task it is to hire workers in foreign countries. In applications for healthcare professions (physicians, nurses, etc.) a negative HIV test is a prerequisite for even being invited to an interview. In this manner, for instance, medical personnel is recruited from South Africa to work in the rich north. Other employers and other institutions such as universities also often openly require HIV tests as a prerequisite for employment, allocation of study places, and grants.

In principle, anyone entering a country may find themselves in the position of having to provide information about “suspicious” fellow travellers. An HIV-positive passenger from Japan on his way to China, when China still had its restrictions enforced, was sent back on the next airplane after a fellow passenger on the plane listened in on a conversation about HIV and reported him.

There is a particularly significant strain when a traveller’s physical appearance makes it impossible to hide or deny illness. It is then often at the discretion of the border official to order an examination. People who refuse to subject themselves to this will not have the option to enter the country, as examples from Malaysia and other countries show.

Positive examples are rare

Positive examples are rare, but should give us courage that cooperative commitment can bring about change. There are some countries which have eased or removed their restrictions in recent years. The examples of the USA and China are an important victory in the fight against the global discrimination against PLHIV.

Canadian HIV and human rights activists did good work in advance of the World AIDS Conference in Toronto 2006 and obtained changes in the entry regulations for short-term visas. This made it possible for PLHIV to participate in the conference and of course had longer-term benefits as well.

Following this, in 2007 the International AIDS Society (IAS) re-stated that it would not hold an international AIDS conference in any country which refuses entry to PLHIV.

Pressure by the Global Fund to cancel a working meeting in China, if the Chinese government did not remove questions about HIV from the entry application form, shows that this subject has reached the global HIV community.

The creation of an International Task Team by UNAIDS is another positive sign that the situation regarding entry regulations for PLHIV is changing. Last but not least, the request of the UN general secretary Ban Ki-Moon in June 2008 to end this form of stigmatization has met with worldwide resonance. Let us hope that Ban Ki-Moon’s authority paves the way for the elimination of the harsh restrictions in South Korea, his home country.

A prerequisite for these positive developments was and is that the scope of the problem must be pointed out again and again. We are glad to see that our data collection has proved to be an extraordinarily strong political instrument in these processes. The examples given above encourage us to keep combating the negative perception of PLHIV (cost factor, virus carriers, source of danger) which are the background of such discriminatory regulations. Clarifying how HIV has changed in recent years and the contribution which PLHIV make to society is an important step against the policy of exclusion.

Even after the legislative changes in the USA, the world at present is still not a very open place for PLHIV. In order to change the situation we need to fight for fundamental human rights, closely connected with the lifesaving ability to secure financial survival and access to treatment and care. To reach these goals, we require your support.