HIV Travel Restrictions - Fright & prejudice

A couple of years ago, someone contacted me through this blog, because her friend, a 21yr old young man, was admitted to hospital for HIV-related complications. She was trying desperately to get help to save his life, but there was little to be done by that late stage. She told me he had not sought help early, despite KNOWing he was HIV positive, because he was Malaysian, and he needed to keep his job as a hairdresser in singapore . He didn’t want authorities to know his status and get deported back home, where he wouldn’t be able to face his family, and so he had refused to go to any doctors. Until he collapsed and had to be admitted into hospital, that is. 2 weeks later, he died.

Very recently, my friend told me about a friend of his, who got stopped at the immigration when he was trying to enter Singapore. This person had businesses and friends and family here, but he was a foreigner. So he cannot even come back to settle all this business. This made my friend very afraid, because my friend is a Malaysian who has been staying in Singapore for very long, with his job and friends and life here. He is afraid to go back to Malaysia to visit family, in case he cannot return. And he has planned, in the event he has to go to Malaysia to visit, to take enough money and be prepared for a scenario where he gets stopped at the immigration and is never allowed to return. The prospect of losing my friend and never seeing him again this way, saddens me. The fact that he has to live his life in fear this way, saddens me more.

 

 

In Singapore, the Immigration Act Subsection 8 includes in its list of prohibited immigrants, “any person suffering from Acquired Immune Deficiency Syndrome or infected with the Human Immunodeficiency Virus”. Apparently “authorities justified the policy as being necessary to “safeguard the public health of Singaporeans” and to “prevent the import of cases of AIDS and HIV infection into Singapore where it can”.”(
http://www.afa.org.sg/act/23/frame_keepingfamily.html
)

Someone ignorant, fearful and prejudiced can quite easily believe that we have no choice, but to let some HIV positive non-citizens suffer, for the sake of the greater good. After all, in the early days of the HIV epidemic, many countries reacted the same way, and enacted travel restrictions against immigrants with HIV. However, over the years, evidence has showed that travel restrictions do NOT protect the local population at all. In fact, it can be counter-productive, when migrant workers fear to go for HIV tests , or fear to go for treatment after an anonymous HIV test (as with the young man who died from lack of treatment). This increases the population’s risk, because someone who is unaware of his/her HIV status, or untreated, may not take precautions with their partner (eg to prevent their wife from becoming “suspicious”). Their higher viral load makes them more likely to spread the infection to their partner.

Articles in medical journals have denounced travel restrictions, with headlines such as “Border restrictions and HIV / AIDS: a public health policy disaster.” ,and concluding that “border restrictions based on HIV testing are counter productive and impede efforts to contain the pandemic”. Way back in 1990, the Lancet declared “HIV and travel, no rationale for restrictions.”  Seldom do scientists and medical journals use such strong words, but in this case, they have chosen to. (
http://www.ncbi.nlm.nih.gov/pubmed/1978061
,
http://www.ncbi.nlm.nih.gov/pubmed/12286989
)

Such evidence led countries like the USA and even China, to remove their travel restrictions against people who were HIV positive (
http://abcnews.go.com/Politics/united-states-ends-22-year-hiv-travel-ban/story?id=9482817#.ULYmmSpXvhI
,
http://www.aidsmap.com/China-repeals-its-HIV-travel-ban/page/1438602/
). The UNAIDS has listed “Eliminate travel restrictions” as one of its key 2011 Political Declaration commitments.

 

 

A strategy that’s gaining support for its effectiveness is the “test and treat” strategy, where regular testing and early detection is encouraged, so that HIV infections can be treated aggressively before symptoms appear. Data showing that it slows or reverses the HIV infection rates, have been encouraging. (
http://www.nature.com/news/2010/100224/full/4631006a.html
).  Both HIV testing and affordable, accessible treatment is important for this strategy to work.

In Singapore, we too have embraced HIV testing.  As World AIDS Day approaches, we have set for ourselves a goal of “walking towards zero infections, zero deaths, zero stigma and discrimination” (
http://www.aidswalk.sg/
), modelled after the global goal set out by the UNAIDS.

The Action For AIDS Be Positive video is very supportive and a good step toward eliminating stigma. It also encourages HIV testing, presumably for early treatment, so that people with HIV can live healthy, productive, happy lives, like anyone who has a well-managed chronic disease, so that we can move towards zero deaths.

Unfortunately, with the travel restrictions still enforced, not on the basis of evidence, compassion or effectiveness, but on the basis of ignorance, the truth is that many will be tested, not for treatment, but for deportation, or for a life of hiding and fear.

 

With a prejudice-driven policy of not subsidising HIV medications the way medications for other chronic diseases are subsidised, treatment after testing becomes compromised.

As long as such policies remain, AFA’s call to HIV testing and early treatment, no matter how compassionately done, will sadly continue to be seen as opportunities to pin the scarlet letter onto people living with HIV.