Tuesday, February 10, 2009

US Travel Ban on HIV-infected Individuals

Welcome to this installment of The AIDS pandemic, a podcast hosted by Dr. David Wessner from the Department of Biology at Davidson College. I’m Middleton Chang.

Since 1987, the United States Department of Health and Human Services has imposed a travel ban on HIV-infected individuals, under the premise that HIV falls into their list of “dangerous and contagious” diseases which present a public health risk. The law specifically prohibited foreigners from immigrating or obtaining a travel visa to the United States. Activists had long decried the ban for several reasons, until this past summer. On July 30, 2008, President Bush signed into law a five-year, $48 billion bill to fight AIDS, malaria and tuberculosis around the world as well as lift the ban on HIV positive travelers. Yet the ban has still not actually been lifted. HIV/AIDS activists, at first praising the current administration are becoming impatient for an actual removal of the ban.

HIV/AIDS activists originally declared the ban to be unnecessary and unfair. The ban was not codified into law however until 1993 during the Clinton Administration, much to the chagrin of activists. This legislation made HIV the only specific medical condition mentioned as grounds for inadmissibility to the United States. Activists argue that the ban was just another in a long string on US inconsistencies on HIV/AIDS policy. Helene Gayle, president of CARE, stated that the ban was not consistent with the international leadership role the United States has taken with PEPFAR (President’s Emergency Plan for AIDS relief). Experts at the International AIDS conference this past fall were full of praise for the new legislation lifting the travel ban. However, little has been done to actually lift the ban. In order to do so, the Department of Health and Human Services must write a new rule, submit it for public comment, and finalize it. The Bush Administration has moved with the speed of a rolling stone gathering moss on this issue. Last week 58 house Democrats submitted a letter to President Bush urging “swift action” on the issue.
Due to the ban, no major AIDS conference has been held on US soil since 1993 as no activists or researchers infected with the virus may enter the country without embarking on a complicated waiver process. In 1991, 40,000 Haitian political refugees fled to the United States. Of these refugees, 158 were detained in Guantanamo Bay, Cuba due to the ban. For nearly twenty months, Guantanamo Bay hosted these 158 political refugees, due to either being HIV-positive, or a relative of one of the positive refugees. A court order was needed to force the Clinton Administration to close down the razor-wire encircled refugee camp setup in 1991 by the Bush Administration.

Despite the fact President Bush has signed the bill mandating removal of the ban into law, HIV remains on the list of “dangerous and contagious” diseases that may prevent entry into the United States. Recently, the Department of Homeland Security released a revised and “streamlined” process for obtaining a waiver, making it easier to obtain the necessary paperwork. However, the Department of Heath and Human Services has still not removed HIV from the list of medical conditions which are grounds for exclusion from entering the United States.

A study conducted in 2006 showed that of 1113 HIV positive survey respondents. 349 (31%) had traveled to the United States. Of those 349 that had traveled to the US, only 14.3% traveled with the mandatory waiver to obtain a travel visa. Many simply did not disclose their status. This study not only shows the inefficacy of the travel ban, but shows the harm presented to HIV positive individuals who desire to visit the United States. The study showed that patients on anti-retroviral therapy (212 patients) were more likely to go off their medication, increasing their chances of developing drug-resistant HIV strains or developing AIDS. The study concluded that people do so “with insufficient planning and advice.”

Only about a dozen countries around the world maintain a travel ban on people living with HIV. These countries are: Iraq, China, Saudi Arabia, Libya, Sudan, Qatar, Brunei, Oman, Moldova, Russia, Armenia, and South Korea. Should the United States still include itself amongst these countries in discriminating against people living with HIV?

Thanks for listening, until next time I’m Middleton Chang.

For more information:
Mahto M, Ponnusamy K, Schuhwerk M, Richens J, Lambert N, Wilkins E, Churchill DR, Miller RF, Behrens RH. “Knowledge, attitudes and health outcomes in HIV-infected travellers to the USA”. HIV Medicine 2006; 7: 201–204.


"Give me your tired, your poor,
Your huddled masses yearning to breathe free,
The wretched refuse of your teeming shore.
Send these, the homeless, tempest-tost to me,
I lift my lamp beside the golden door!"
-An excerpt from The New Colossus, which hangs within the Statue’s Pedestal.

8 comments:

www.plwha.org said...

http://plwha.com/usa.html

Entry restrictionsUpdate: October 2008


The Congressional entry restriction had been lifted, but that a second entry restriction remained - contained in administrative law (regulations) published by the United States Department of Health and Human Services (DHHS).

There have been two developments since then:

In the media it was mentioned a process announced by George W. Bush on World AIDS Day 2006 to extend the four categories under which an HIV entry waiver is easily available (business, medical treatment, conferences and visiting friends/family) to include a fifth streamlined category for pleasure travellers.

A year and ten months later, DHHS finally announced this process has been completed and HIV-positive tourists can now access the streamlined process by contacting the US Embassy in Australia.

For details, please visit:
http://www.dhs.gov/xnews/releases/pr_1222704743103.shtm

It was also reported it was likely the DHHS would remove the second entry restriction contained in regulations listing HIV as an 'inadmissible condition'. This has been confirmed by the Director of the Centres for Disease Control and Prevention, Dr Julie L. Gerberding, in a letter to the Washington Post on Mon 6 Oct 2008. However, just as changing the waiver process took about 22 months, it will take some time for the rule change to be drafted, published for public comment, and finalised.

For a copy of the letter please visit:
http://www.washingtonpost.com/wp-dyn/content/article/2008/10/05/AR2008100501854.html




Update: August 2008


In August, an Act of Congress containing a provision lifting the HIV entry restriction was passed by Congress and signed into law by the president. The provision was inserted by Democrat Senator Barbara Lee into a bill authorising continued American international aid for HIV prevention (including abstinence education) and treatment programmes in developing countries. This was a fairly clever move on Lee's part because the President was hardly going to veto (block) an Act providing funding for a programme he initiated himself.

However it has since been discovered there is ANOTHER entry restriction, imposed by the US Department of Health and Human Services in administrative law, which has not been removed yet. There is reason to believe it may be removed soon, because the DHHS is also the home of the Centers for Disease Control, which has advocated strongly against the entry restriction, and also because the removal of the congressional entry restriction means the departmental restriction is no longer required by law.

Continue to take care if you are travelling to the States!

Special Waiver

The United States of America is one of the countries that prohibit HIV-positive foreigners to enter its borders. HIV-positive people must request a “special waiver” to be granted entrance to the US. This waiver, pictured above and referred to as “Waiver of 212(A)(1)”, is stamped into an HIV-positive person’s passport as a permanent record of his or her HIV status.

We believe that people living with HIV/AIDS have the right to full enjoyment of their human rights, including the right to privacy, confidentiality and protection from stigma and discrimination. Short-term travel policies of any country, in which disclosure of HIV status is required for prospective visitors, treat HIV-positive people seeking entry on short term visas differently on the basis of their HIV-positive status. These are not only discriminatory, but also contribute to fuelling national and international stigma against people living with HIV/AIDS.

Anonymous said...

I do believe that China lifted it's ban as of last year in quite a speedy process - you may want to check this out and revise the list of countries that ban HIV positive individuals.

David Wessner said...

Thanks for the update on China. We appreciate your input.

JACK said...

the best way 2 stop the spread of H.I.V/AIDS is awreness people,even the school going students.

tk>
awreness

JACK said...

Never hate an AIDS infected person,Maybe our love gives him courare & hope to face the SOCIETY.

TK>
takecare

Anonymous said...

You forgot to mention that Singapore is still banning visitors with HIV to enter Singapore

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Anonymous said...

Many countries have HIV tests for migrants or those applying for work permits, even Australia. For visitors, either tourist or for business this does not apply. Saudi Arabia does not require an HIV test for a visitor, neither is it asked on your visa application form or on your arrival card. Likewise Singapore, such as one comment suggests.