Russia: The deportation of people living with HIV is outdated, bad for public health and economically ineffective

“He sees his children only by video link.” How the law to deport migrants with HIV turns foreigners into illegal immigrants and destroys families

Automatic Google translation, for original article in Russian, please scroll down.

Author: Ekaterina Ivaschenko

Russia is one of 19 countries in the world where HIV is the basis for deportation. In practice, when migrants find out about their positive status, they do not leave, but turn into illegal immigrants and are afraid to seek treatment. Those who report themselves can be expelled even if they have a family in Russia – although this has been banned since 2015.

We will tell you why the law on deportation harms not only the migrants themselves, but also the economy of Russia, as well as the health of all its inhabitants, regardless of citizenship.

Sardor is 24 years old. He came to work in Russia from Kyrgyzstan nine years ago, at the age of 15. His mother was the first to leave for Russia – after her husband and her three children were abandoned. Sardor did not get along with his father and stepmother, so after the eighth grade he came to his mother. The teenager was sent by bus through Kazakhstan, leaving the driver with a power of attorney.

“I dreamed of getting a good education, becoming a doctor, but in the end, when I came to Russia, I did not speak a word of Russian,” Sardor says. Until the age of 16, he worked at a brick factory in a village near Novosibirsk, then returned to his homeland, received a passport and returned to Russia.

Three years ago, Sardor moved to Moscow, where he worked in various fields, from a janitor to a cook. He found out about his HIV status last year when he got seriously ill in winter and was tested. A specialised NGO (nongovernmental organisation) helps him to receive antiretroviral therapy. The young man does not want to return to his homeland: he says that there is discrimination against HIV-infected people. He also does not tell his relatives about his status.

How deportation law turns migrants into illegal immigrants

For years, specialised NGOs and human rights activists have been fighting for the right of people like Sardor to live in Russia without the threat of deportation. But Russia remains one of 19 countries in the world from which HIV-positive foreigners are expelled . These restrictions are spelled out in the law “On Preventing the Spread of Disease Caused by the Human Immunodeficiency Virus in the Russian Federation”, adopted back in 1995 .

If a person takes an HIV test officially: for example, to obtain a patent or apply for citizenship, his data goes to Rospotrebnadzor, which makes a decision on the undesirability of a foreigner’s stay in Russia and sends the document to the Ministry of Internal Affairs. Since in such cases people have to leave the country on their own, they often remain in Russia illegally. Those who know about this norm in advance take the test anonymously. In case of a positive result, they can cross the border to receive treatment at home, but do not draw up documents.

The coordinator for academic relations of the Regional Expert Group on the Health of Migrants Daniil Kashnitsky explains that in practice the rule on the deportation of HIV-infected foreigners does not work, because deportation itself is expensive even for Russia, the richest state in the region: “After Rospotrebnadzor decides on Deportation of a person is sent to the Ministry of Internal Affairs for execution, but it is impossible to find a person, because he often does not live at the place of registration, plus the deportation itself costs money, to which is added the cost of keeping people in TsVSIGs . And people with HIV-positive status, realising that, for example, they cannot get a patent for work and it is better not to leave the country, because they will never be able to return, they go into illegality. ”

The hidden HIV epidemic: statistics and causes

In 2021, the Financial Research Institute of the Ministry of Finance of Russia published a socio-economic study of state policy on HIV , which also mentions migrants.

The document says that “one of the components of the problem of high levels of HIV incidence among the population of Russia may be the growing scale of the latent epidemic, formed mostly by migrants from Moldova, Tajikistan, Uzbekistan, Ukraine. status”.

“As of 2018, foreign citizens accounted for only 2.1% of new cases of HIV infection, but the Ministry of Internal Affairs data on the number of illegal migrants does not allow us to say that official statistics reflect the true picture of the incidence and prevalence of HIV infection among foreign citizens, “the study says.

The authors of the document say directly that the underlying epidemic is based on the current legal status of HIV-infected migrants: “Under the conditions of Russian legislation, which imposes restrictions on entry and stay on the territory of the country for HIV-infected people, foreign citizens are forced to hide their status, which is a significant threat for the development of a latent epidemic “.

“I read this report, and I was confused by this quote,” says Daniil Kashnitsky, explaining that he means the authors of the report assertion that “one of the components of the problem of high levels of HIV incidence among the Russian population may be the growing scale of a hidden epidemic formed mostly by migrants from Moldova, Tajikistan, Uzbekistan, Ukraine “.

“It is wrong to say that migrants are contributing to the epidemic. If migration is well organised, then this is an extremely positive process from all sides. Not migration is a risk factor, but the circumstances in which migrants find themselves and the laws that are in force in the receiving country, in our case, in Russia, “emphasises Kashnitsky.

The available figures for migrants are really low, especially in comparison with the general data for Russia, where 1.2% of the adult population is infected with HIV . According to Rospotrebnadzor, 2.5 million foreigners were tested for HIV in Russia in 2017. Among the citizens of the neighbouring countries, 32,885 HIV cases were detected, 70% of the detected infected were from Ukraine, Uzbekistan and Tajikistan. “In 2014-2015, 4000-4500 new cases of HIV infection were detected among foreign citizens, mainly from Ukraine, who traveled to Russia en masse. Now about 3500 cases are detected a year. But there are more migrants with HIV, because some of them are tested anonymously, and some avoid testing, knowing that they are infected, “the representative of Rospotrebnadzor said at the time.

An interesting situation is with Turkmenistan, which officially reported two cases of HIV infection in the country. At the same time, on the territory of Russia in 2017, Rospotrebnadzor recorded 136 cases of HIV infection among citizens of this country, although the flow of migrants from there is small.

A separate situation for the citizens of Kyrgyzstan. The fact is that the country is a member of the EAEU, therefore, unlike Uzbeks and Tajiks, its citizens do not receive a patent for which they need to take an HIV test.

Helping people with HIV is cheaper than treating AIDS. Who does it

The fact that foreigners with HIV remain in Russia is evidenced, for example, by the data of the Patient Control movement : “In 2020, thanks to the donations provided and the joint efforts of HIV activists, 449 people from 19 countries received ARVs on the territory of Russia, of them: Tajikistan – 88, Kyrgyzstan – 67, Uzbekistan – 33, Kazakhstan – 20 and Turkmenistan – 2 “.

Kirill Barskiy, program coordinator of the Steps Foundation, one of the few Russian nongovernmental organisations that helps HIV-positive migrants, says that foreigners have been turning to them for help since the foundation was founded in 2004. In 2020 alone, more than 2,000 people. People who contacted the fund wanted to anonymously take a test for HIV, hepatitis and even coronavirus, get advice on their health, and also sought help in finding therapy.

36-year-old Kemal is one of those who “Steps” literally helped to get back on their feet. Kemal ended up in Russia 10 years ago. I came from Turkmenistan to earn money under the pretext of studying – otherwise it was impossible to get here because of the visa regime between the countries. The young man really studied at the university, and at night he worked as a loader, cook, waiter to pay for his studies.

Kemal learned about his HIV status in 2014, when he updated his medical book and passed an HIV test. “I didn’t immediately understand what it was: they didn’t give me a medical book, well, okay. 2,000 rubles in cash, “says Kemal.

The man got worse every month. He dropped out of school but continued to work. At some point, it became very bad, and he went to the hospital. “As I later found out, HIV had already spilled over into AIDS and I had Kaposi’s sarcoma,” says Kemal. Thanks to the work of the foundation’s staff, he was able to recover and start taking antiretroviral drugs.

“Now I work in those jobs where a medical book and a contract are not needed. Every day I take therapy. It costs 10 thousand rubles a month – a significant amount for an illegal migrant. But I have HIV, with which I can live in Moscow, but in Turkmenistan is not, because they deny the presence of HIV-infected, “- explains the man.

The abolition of the deportation rule is beneficial even economically, says Daniil Kashnitsky: it will enable migrants to take therapy on time, and HIV will not turn into AIDS, which develops serious and costly diseases.

“When life is threatened, a person is subject to emergency treatment, which is provided to everyone in Russia free of charge. According to our data, inpatient treatment of a person with HIV-associated diseases will cost Russia three times more than if he buys the therapy himself or receives it for AIDS. -the center of his state, – explains the expert. – The principle itself is important here: a person takes therapy – and in three months his viral load drops to zero. He will not transmit HIV through unprotected sex, he can give birth to healthy children, work and pay taxes. not being treated, he develops one of the concomitant diseases – and the cost of treatment, already from the Russian budget, will be at least three times more expensive than a year’s course of therapy. ”

Kirill Barskiy, the coordinator of the Steps Foundation, emphasises that the authorities’ attempt to control does not work with any disease: “People will still hide. Do not forget that HIV infection has a window period of six months when the virus is not detected. that the authorities have to wait six months for a second test, at the same time prohibiting the migrant from any contacts. But this is impossible. Therefore, mechanisms are needed to control the process of treatment of foreigners. In fact, no one knows the real statistics of HIV-positive migrants in Russia. Accordingly, we do not know how many are taking treatment and controlling the disease, and how many are not. If a person is not expelled, he will not hide, and this will make it possible to build a system for monitoring his disease and preventing its spread. ”

Deportation of relatives with HIV: banned since 2015, but ongoing

NGOs and the community have long been fighting for the complete abolition of the deportation rule, says Daniil Kashnitsky. The first letter with such an initiative was sent to the government in May 2018, then they turned to relevant government agencies.

“We have received replies to all our letters, but these are polite enumerations of the norms of Russian legislation concerning foreigners with HIV. The letters invariably mention the norm that foreigners with HIV, whose relatives are Russian citizens, may remain in Russia. In practice, only a few have managed to achieve this. , therefore, the norm must be abolished entirely, because it is bad for migrants, for Russia and its budget. There is not a single plus in maintaining this norm, “Kashnitsky is sure.

The ruling of the Constitutional Court that if an HIV-positive foreigner has a spouse, children or parents who are Russian citizens, then he cannot be expelled from the country, was adopted in 2015. However, in reality, lawyers have been fighting for years for the rights of HIV-infected foreigners to live with their families in Russia.

Alisher, originally from Andijan, came to Russia in 2013 after his parents. His father already has Russian citizenship. At first, the man lived with his parents in one of the regions, and then moved to Moscow, where he met a Russian woman.

In 2015, they had a daughter with Alisher, and in 2016, a son. The marriage was not registered, but Alisher is listed as a father in the birth certificates of the children. In 2017, the man decided to apply for a temporary residence permit in Russia (RVP) for marriage. To do this, it was required to pass an HIV test, which turned out to be positive.

The man did not know that the entrance to the country was closed for HIV-positive migrants, and after another flight to his homeland, he was not allowed to enter Russia. It was in the spring of 2018. The wife appealed against the decision of Rospotrebnadzor in the district court of Khabarovsk, at the place of permanent registration of Alisher. But in December 2019, the judge left the decision of the migration authorities unchanged.

“I have been in charge of this case for several years,” says Olga Belousova, a lawyer who assists migrants in similar situations. “Now his wife has hired a lawyer who represents Alisher’s interests in Russian courts. …

Such cases last at least a year, notes Olga Belousova. And there are times when the deportation rule leads to sad consequences. The lawyer tells how she handled the case of an HIV-infected girl from Ukraine, who in Russia received a residence permit on her father’s side. At the stage of taking the tests, the girl was diagnosed with HIV, issued a document obliging her to leave Russia, and put a lifelong entry ban. In 2019 she returned to Ukraine.

“The girl had the right to be in Russia. She contacted us, we completed all the documents on time, but at the trial we were told that we were late and did not cancel the decision of Rospotrebnadzor. Against the background of this news, her father had a heart attack, and in August He died in 2019. My applicant was unable to bury him or visit her relatives, “Olga Belousova said.

But there are stories with happy endings. Now a lawyer is working on the case of a woman from Kazakhstan who, together with her husband and two children, applied for citizenship under the resettlement program.

“They were refused because the woman was diagnosed with HIV. She decided to divorce in order to give her husband and children an opportunity to obtain citizenship. She lived in Kazakhstan for a year and did not see her children, did not take part in their upbringing. After the husband and children received citizenship, the family decided to recover. We submitted a request to Rospotrebnadzor to find out about the woman’s position, and we received an answer that she was not on the lists of those who were denied entry to Russia, since during the pandemic the adoption of such decisions was suspended. She has Russian relatives, and the family will finally be reunited. ”

Why the deportation norm is not only outdated, but also economically unprofitable for Russia

The coordinator of the Regional Expert Group on the Health of Migrants Daniil Kashnitsky emphasises that the law on HIV adopted in 1995 was long out of date: “Then the deportation rule was prescribed, because there was no effective treatment for either foreigners or Russians, and people with HIV were quickly dying. Thanks to modern drugs, which, moreover, become cheaper every year, treating people is much more profitable than driving them out of the country. ”

Kirill Barsky from the Steps Foundation says that during negotiations with the community, the authorities operate with the fact that “foreigners are spreading the infection”, although no one can verify and prove this.

“However, the main counterargument comes not from the deputies, but from the economic departments, which believe that they will have to pay for the treatment of foreigners from the state budget,” says Barsky. for a start, it was possible to carry out surveillance of a real disease. And for this it is necessary to remove protective measures so that people are not afraid to go to hospitals. ”

“It is impossible to talk about building a system of assistance to HIV-positive foreigners at the expense of the countries of origin of migrants or the Global Fund, as long as there is a rule on deportation,” continues Kirill Barsky. “People are afraid to seek help. In principle, they do not want to talk to doctors, fearing, that at any moment they will be put in the CVDIG and sent home.Migrants are in a situation where they understand that they need help, and often they can pay for therapy themselves, but cannot tell about it, because they understand what the consequences could be. Often, even the citizens of the EAEU countries, who do not need to take an HIV test to obtain a patent, live well here and receive therapy from their homeland, but they are still afraid to get to the clinic, because they are at risk of being deported. ”

Daniil Kashnitsky, who works with representatives of AIDS centers in the countries of origin of migrants, notes that Russia should not be afraid that if the deportation rule is canceled, the costs of treating foreigners will fall on its budget: “Employees of AIDS centers in Central Asian countries are not only ready to share therapy, they They are already doing this. They send therapy to their migrants, regardless of their status of residence in Russia. For example, during the closed borders, Kyrgyzstan gave therapy to his hands for up to a year. so he knows what’s going on with his patient. ”

Kirill Barskiy confirms that the countries of origin (NGOs contacted the Ministry of Health of Uzbekistan, Kyrgyzstan, Moldova and other states) answered that they were ready to treat their citizens. Kyrgyzstan gave a detailed answer that it is ready to discuss these initiatives between the countries and, if necessary, to adopt appropriate changes to the legislation.

“In order for Russian officials to change their minds about HIV among foreigners, our experts are preparing an economic argument that the benefits of removing barriers are much higher than their existence. All civilised countries have removed barriers, and the countries of North America and Europe are even treating at their own expense foreigners, because they understand how it is economically beneficial for them. We are not opposing the state, but we are promoting a scientific justification for the need to revise the deportation rule, “Kirill Barsky concludes.

Екатерина Иващенко

“Видит своих детей только по видеосвязи”. Как закон о депортации мигрантов с ВИЧ превращает иностранцев в нелегалов и разрушает семьи

Россия – одна из 19 стран в мире, где ВИЧ – основание для депортации. На практике мигранты, узнавая о своем положительном статусе, не уезжают, а превращаются в нелегалов и боятся обращаться за лечением. Те, кто сообщает о себе, могут быть высланы, даже если в России у них есть семья, – хотя с 2015 года это запрещено.

Рассказываем, почему закон о депортации вредит не только самим мигрантам, но и экономике России, а также здоровью всех ее жителей, независимо от гражданства.

Сардору 24 года. Он приехал на заработки в Россию из Кыргызстана девять лет назад, 15-летним. Первой в Россию уехала его мать – после того как ее и троих детей бросил супруг. Сардор не ужился с отцом и мачехой, поэтому после восьмого класса приехал к матери. Подростка отправили автобусом через Казахстан, оставив водителю доверенность.

“Я мечтал получить хорошее образование, стать врачом, а в итоге, когда приехал в Россию, ни слова не говорил по-русски”, – говорит Сардор. До 16 лет он работал на кирпичном заводе в деревне под Новосибирском, потом вернулся на родину, получил паспорт и снова приехал в Россию.

Три года назад Сардор перебрался в Москву, где работал в самых разных сферах, начиная от дворника и заканчивая поваром. Про свой ВИЧ-статус он узнал в прошлом году, когда серьезно заболел зимой и сдавал анализы. Получать антиретровирусную терапию ему помогает профильная НПО (неправительственная организация). Возвращаться на родину молодой человек не хочет: говорит, что там по отношению к ВИЧ-инфицированным существует дискриминация. Родственникам о своем статусе он тоже не говорит.

Как закон о депортации превращает мигрантов в нелегалов

Профильные НПО и правозащитники годами бьются за право таких, как Сардор, жить в России без угрозы депортации. Но Россия остается одной из 19 стран мира, откуда выдворяют ВИЧ-положительных иностранцев. Эти ограничения прописаны в принятом еще в 1995 году законе “О предупреждении распространения в Российской Федерации заболевания, вызываемого вирусом иммунодефицита человека”.

Если человек сдает тест на ВИЧ официально: например, для получения патента или оформления документов на гражданство, – его данные попадают в Роспотребнадзор, который выносит решение о нежелательности пребывания иностранца на территории России и отправляет документ в МВД. Так как в таких случаях люди должны самостоятельно покинуть страну, они чаще всего остаются в России нелегально. Те, кто знает об этой норме заранее, сдают тест анонимно. В случае положительного результата они могут пересекать границу, чтобы получать лечение на родине, но не оформляют документы.

Координатор по академическим связям Региональной экспертной группы по здоровью мигрантов Даниил Кашницкий объясняет, что на практике норма о депортации ВИЧ-инфицированных иностранцев не работает, потому что сама депортация дорога даже для России – самого богатого государства в регионе: “После того как Роспотребнадзор принимает решение о выдворении человека, оно отправляется на выполнение в МВД. Но человека невозможно найти, потому что он чаще всего проживает не по месту регистрации, плюс сама депортация стоит денег, к которой добавляется стоимость содержания людей в ЦВСИГах. То есть из России их насильно не выдворяют. А люди с ВИЧ-положительным статусом, понимая, что им, например, не получить патент для работы и лучше не покидать страну, потому что они никогда не смогут вернуться, уходят в нелегальность”.

Скрытая эпидемия ВИЧ: статистика и причины

В 2021 году Научно-исследовательский финансовый институт Минфина России обнародовал социально-экономическое исследование государственной политики борьбы с ВИЧ, в котором в том числе упоминаются мигранты.

В документе сказано, что “одной из составляющих проблемы высоких уровней заболеваемости населения России ВИЧ-инфекцией могут являться растущие масштабы скрытой эпидемии, формируемой по большей части мигрантами из Молдовы, Таджикистана, Узбекистана, Украины. В условиях действующего законодательства представители подобной группы населения вынуждены скрывать свой статус”.

“По данным на 2018 год, на долю иностранных граждан приходилось только 2,1% новых случаев выявления ВИЧ-инфекции, но данные МВД по количеству нелегальных мигрантов не позволяют говорить о том, что официальная статистика отражает истинную картину заболеваемости и распространенности ВИЧ-инфекции среди иностранных граждан”, – говорится в исследовании.

Авторы документа прямо говорят, что в основе скрытой эпидемии лежит текущее правовое положение ВИЧ-инфицированных мигрантов: “В условиях российского законодательства, предполагающего ограничение на въезд и пребывание на территории страны для инфицированных ВИЧ, иностранные граждане вынуждены скрывать свой статус, что представляет собой существенную угрозу для развития скрытой эпидемии”.

“Я читал этот доклад, и меня смутила эта цитата”, – говорит Даниил Кашницкий, объясняя, что имеет в виду утверждение авторов доклада о том, что “одной из составляющих проблемы высоких уровней заболеваемости населения России ВИЧ-инфекцией могут являться растущие масштабы скрытой эпидемии, формируемой по большей части мигрантами из Молдовы, Таджикистана, Узбекистана, Украины”.

“Говорить, что мигранты вносят вклад в эпидемию, неправильно. Если миграция хорошо организована, то это со всех сторон исключительно положительный процесс. Не миграция фактор риска, а те обстоятельства, в которые попадают мигранты, и те законы, которые действуют в стране приема, в нашем случае в России”, – подчеркивает Кашницкий.

Имеющиеся цифры по мигрантам действительно невысокие, особенно в сравнении с общими данными по России, 1,2% взрослого населения которой инфицировано ВИЧ. По информации Роспотребнадзора, в 2017 году в России на ВИЧ было протестировано 2,5 миллиона иностранцев. Среди граждан стран ближнего зарубежья выявлено 32 885 случаев ВИЧ, 70% выявленных инфицированных – из Украины, Узбекистана и Таджикистана. “В 2014-2015 годы выявлялось по 4000-4500 новых случае ВИЧ-инфекции среди иностранных граждан, преимущественно Украины, которые массово ехали в Россию. Сейчас выявляется порядка 3500 случаев в год. Но мигрантов с ВИЧ больше, потому что часть из них сдает анализы анонимно, а часть избегает тестирования, зная, что они инфицированы”, – говорил тогда представитель Роспотребнадзора.

Интересна ситуация с Туркменистаном, который официально докладывал о двух случаях ВИЧ-инфекции на территории страны. При этом на территории России в 2017 году Роспотребнадзор зафиксировал 136 случаев ВИЧ-инфекции среди граждан этой страны, хотя поток мигрантов оттуда небольшой.

Отдельное положение у граждан Кыргызстана. Дело в том, что страна входит в ЕАЭС, поэтому, в отличие от узбекистанцев и таджикистанцев, ее граждане не получают патент, для которого нужно сдавать тест на ВИЧ.

Помогать людям с ВИЧ дешевле, чем лечить от СПИДа. Кто это делает

О том, что иностранцы с ВИЧ остаются в России, свидетельствуют, например, данные движения “Пациентский контроль”: “В 2020 году благодаря предоставленным пожертвованиям и объединенному усилию ВИЧ-активистов помощь на территории России с АРВ-препаратами получили 449 человек из 19 стран, из них: Таджикистана – 88, Кыргызстана – 67, Узбекистана – 33, Казахстана – 20 и Туркменистана – 2”.

Кирилл Барский, координатор программ фонда “Шаги” – одной из немногих российских неправительственных организаций, которые помогают ВИЧ-положительным мигрантам, – рассказывает, что иностранцы обращаются к ним за помощью с момента основания фонда в 2004 году. Только в 2020 году – более 2000 человек. Обратившиеся в фонд люди хотели анонимно сдать тест на ВИЧ, гепатит и даже коронавирус, получить консультацию на тему своего здоровья, а также искали помощи в поиске терапии.

36-летний Кемаль – один из тех, кому “Шаги” буквально помогли встать на ноги. Кемаль оказался в России 10 лет назад. Приехал из Туркменистана на заработки под предлогом учебы – по-другому сюда было не попасть из-за визового режима между странами. Молодой человек действительно учился в вузе, а по ночам работал грузчиком, поваром, официантом, чтобы оплачивать обучение.

Про свой ВИЧ-статус Кемаль узнал в 2014 году, когда обновлял медкнижку и сдал тест на ВИЧ. “Я не сразу понял, что это такое: не дали медкнижку, ну и ладно. Но без нее с работы уволили, еще и последнюю зарплату не выплатили. Я устроился работать уборщиком в ночной клуб. Работал без договора, зато каждый день получал 1500-2000 рублей наличными”, – рассказывает Кемаль.

С каждым месяцем мужчине становилось хуже. Он бросил учебу, но продолжал работать. В какой-то момент стало совсем плохо, и он обратился в больницу. “Как я потом узнал, ВИЧ уже перетекал в СПИД и у меня началась саркома Капоши”, – говорит Кемаль. Благодаря работе сотрудников фонда ему удалось вылечиться и начать принимать антиретровирусные препараты.

“Сейчас я работаю на тех работах, где не нужна медкнижка и договор. Каждый день принимаю терапию. На нее уходит 10 тысяч рублей в месяц – существенная сумма для нелегального мигранта. Но у меня ВИЧ, с которым в Москве я могу жить, а в Туркменистане нет, потому что там отрицают наличие ВИЧ-инфицированных”, – объясняет мужчина.

Отмена нормы о депортации выгодна даже экономически, считает Даниил Кашницкий: она даст возможность мигрантам вовремя принимать терапию, и ВИЧ не перейдет в СПИД, при котором развиваются тяжелые и дорогостоящие заболевания.

“При угрозе жизни человек подпадает под лечение по экстренной помощи, которая в России оказывается всем бесплатно. Согласно нашим данным, России обойдется в три раза дороже стационарное лечение человека с ВИЧ-ассоциированными заболеваниями, чем если он будет сам покупать терапию или получать ее от СПИД-центра своего государства, – объясняет эксперт. – Тут важен сам принцип: человек принимает терапию – и за три месяца его вирусная нагрузка снижается до нуля. Он не передаст ВИЧ при незащищенном сексе, может рожать здоровых детей, работать и платить налоги. Либо человек не лечится, у него развивается одно из сопутствующих заболеваний – и расходы на лечение, уже из российского бюджета, будут как минимум в три раза дороже годового курса терапии”.

Координатор фонда “Шаги” Кирилл Барский подчеркивает, что попытка контроля со стороны властей не работает ни с каким заболеванием: “Люди все равно будут прятаться. Не стоит забывать, что у ВИЧ-инфекции есть период окна в полгода, когда вирус не выявляется. Получается, что власти должны ждать полгода повторного теста, параллельно запрещая мигранту любые контакты. Но это невозможно. Поэтому нужны механизмы, которые будут контролировать процесс лечения иностранцев. На самом деле никто не знает реальную статистику ВИЧ-позитивных мигрантов в России. Соответственно, мы не знаем, сколько принимает лечение и контролирует заболевание, а сколько – нет. Если человека не будут выдворять, то он не будет прятаться, и это даст возможность выстроить систему наблюдения за его заболеванием и предотвращением ее распространения”.

Депортация родственников с ВИЧ: запрещена с 2015-го, но продолжается

НПО и сообщество давно борются за полную отмену нормы о депортации, рассказывает Даниил Кашницкий. Первое письмо с такой инициативой отправили в правительство в мае 2018 года, затем обратились и в профильные госорганы.

“На все свои письма мы получили ответы, но это вежливые перечисления норм российского законодательства, касающиеся иностранцев с ВИЧ. Неизменно в письмах упоминают норму, что в России могут остаться иностранцы с ВИЧ, родственники которых – граждане России. На практике лишь единицам удалось этого добиться, поэтому норму надо отменять целиком, потому что это плохо для мигрантов, для России и ее бюджета. В сохранении этой нормы нет ни одного плюса”, – уверен Кашницкий.

Постановление Конституционного суда о том, что если у ВИЧ-положительного иностранца есть супруг, дети или родители – граждане России, то его нельзя выдворять из страны, принято в 2015 году. Однако в реальности юристы годами борются за права ВИЧ-инфицированных иностранцев жить со своей семьей в России.

Алишер родом из Андижана, в Россию приехал в 2013 году вслед за своими родителями. У его отца уже есть гражданство России. Первое время мужчина жил с родителями в одном из регионов, а потом переехал в Москву, где познакомился с россиянкой.

В 2015 году у них с Алишером родилась дочь, а в 2016-м – сын. Брак не был зарегистрирован, но в свидетельствах о рождении детей Алишер указан как отец. В 2017 году мужчина решил подать документы на получение разрешения на временное проживание в России (РВП) по браку. Для этого требовалось сдать анализ на ВИЧ, который оказался положительным.

Мужчина не знал, что для ВИЧ-положительных мигрантов закрывают въезд в страну, и после очередного полета на родину в Россию его не впустили. Это было весной 2018 года. Супруга обжаловала решение Роспотребнадзора в районном суде Хабаровска, по месту постоянной регистрации Алишера. Но в декабре 2019 года судья оставила решение миграционных властей без изменений.

“Я курирую это дело уже несколько лет, – говорит юрист Ольга Белоусова, которая оказывает помощь мигрантам, попавшим в подобные ситуации. – Сейчас его жена наняла адвоката, который представляет интересы Алишера в российских судах. А пока он видит своих детей только по видеосвязи”.

Такие дела длятся минимум год, отмечает Ольга Белоусова. И бывают случаи, когда норма о депортации приводит к печальным последствиям. Юрист рассказывает, как вела дело ВИЧ-инфицированной девушки из Украины, которая в России получала вид на жительство по отцу. На этапе сдачи анализов у девушки обнаружили ВИЧ, выдали документ, обязывающий покинуть Россию, и поставили пожизненный запрет на въезд. В 2019 году она вернулась в Украину.

“Девушка имела право находиться в России. Она связалась с нами, все документы мы оформили в срок, но на суде нам сказали, что мы опоздали, и не отменили решение Роспотребнадзора. На фоне этих новостей у ее отца случился сердечный приступ, и в августе 2019 года он скончался. Моя заявительница не смогла ни похоронить его, ни приехать к родственникам”, – рассказала Ольга Белоусова.

Но есть истории и со счастливым концом. Сейчас юрист ведет дело женщины из Казахстана, которая вместе с мужем и двумя детьми подавала на гражданство по программе переселения.

“Им отказали, так как у женщины обнаружили ВИЧ. Она решила развестись, чтобы дать возможность мужу и детям получить гражданство. Год жила в Казахстане и не видела своих детей, не принимала участие в их воспитании. После получения гражданства мужем и детьми семья решила восстановиться. Мы подали запрос в Роспотребнадзор, чтобы узнать о положении женщины, и нам пришел ответ, что ее нет в списках тех, кому закрыт въезд в Россию, так как на время пандемии принятие таких решений было приостановлено. Теперь мы срочно готовим документы, что у нее есть родственники-россияне, и семья наконец-то воссоединится”.

Почему норма депортации не только устарела, но и экономически невыгодна России

Координатор Региональной экспертной группы по здоровью мигрантов Даниил Кашницкий подчеркивает, что принятый в 1995 году закон о ВИЧ давно устарел: “Тогда норма о депортации была прописана, потому что не было эффективного лечения ни для иностранцев, ни для россиян и люди с ВИЧ быстро умирали. Благодаря современным препаратам, которые к тому же с каждым годом становятся дешевле, лечить людей намного выгоднее, чем выгонять из страны”.

Кирилл Барский из фонда “Шаги” рассказывает, что во время переговоров с сообществом власти оперируют тем, что “иностранцы распространяют инфекцию”, хотя никто не может это проверить и доказать.

“Однако основная контраргументация идет со стороны не депутатов, а экономических ведомств, которые считают, что платить за лечение иностранцев придется из средств госбюджета, – говорит Барский. – Никто из этих ведомств не рассматривает возможность дать этим людям обнаружиться и быть в законном поле, чтобы для начала можно было осуществить надзор за реальным заболеванием. А для этого надо снять заградительные меры, чтобы люди не боялись обращаться в больницы”.

“Невозможно говорить о выстраивании оказания системы помощи ВИЧ-положительным иностранцам за счет стран исхода мигрантов или Глобального фонда, пока существует норма о депортации, – продолжает Кирилл Барский. – Люди боятся обращаться за помощью. Они в принципе не хотят разговаривать с врачами, боясь, что в любую секунду их посадят в ЦВСИГ и отправят на родину. Мигранты находятся в такой ситуации, когда понимают, что им нужна помощь, и зачастую сами могут оплачивать терапию, но не могут про это рассказать, потому что понимают, какие могут быть последствия. Нередко даже граждане стран ЕАЭС, которым не надо сдавать тест на ВИЧ для получения патента, прекрасно здесь живут и получают терапию с родины, но все равно боятся попасть в поликлинику, потому что подвержены риску быть депортированными”.

Сотрудничающий с представителями СПИД-центров стран исхода мигрантов Даниил Кашницкий отмечает, что Россия не должна бояться, что в случае отмены нормы о депортации расходы на лечение иностранцев лягут на ее бюджет: “Сотрудники СПИД-центров стран Центральной Азии не только готовы делиться терапией, они уже это делают. Они своим мигрантам, независимо от их статуса проживания в России, отправляют терапию через родственников. Например, во время закрытых границ Кыргызстан выдавал терапию на руки до года. Единственно, раз полгода человек должен отправлять лечащему врачу результаты своих тестов на ВИЧ, чтобы он знал, что происходит с его пациентом”.

Кирилл Барский подтверждает, что страны исхода (НКО обращались в Минздрав Узбекистана, Кыргызстана, Молдовы и других государств) ответили, что готовы лечить своих граждан. Кыргызстан дал развернутый ответ, что готов обсуждать эти инициативы между странами и, если потребуется, принять соответствующие изменения в законодательство.

“Чтобы российские чиновники могли изменить мнение о ВИЧ среди иностранцев, наши эксперты готовят экономическую аргументацию того, что выгода от снятия заградительных мер гораздо выше, чем их существование. Все цивилизованные страны сняли заградительные меры, а страны Северной Америки и Европы даже за свой счет лечат иностранцев, потому что понимают, как это экономически выгодно им. Мы не противостоим государству, а продвигаем научное обоснование необходимости пересмотра нормы о депортации”, – заключает Кирилл Барский.

Nepal: How critical HIV medicine reached a traveler stranded in Nepal during the pandemic

Stranded in Nepal without HIV medicine

Wang Tang (not his real name) had never been to Nepal before, but at the end of March 2020 it was one of the few countries that had not closed its borders with China. Since he was desperate to get away from Beijing after having had to stay at home for months after the coronavirus outbreak spread throughout China, he bought a ticket.

But days after he arrived, while he was staying in Pokhara, the fourth stop on his trip, the local government announced that the city would be shut down. He heard that the lockdown would not last longer than a month.

As someone who is living with HIV, he had brought along enough HIV treatment to last for a month. However, he soon learned that the re-opening of the city was to be postponed, which meant that he was at risk of running out of the medicine he needed to take regularly in order to suppress his HIV viral load and stay healthy.

Mr Wang swallowed hard while counting the remaining tablets. He had no idea how to get more.

As the lockdown dragged on, it seemed that no end was in sight. Mr Wang started to take his medicine every other day so that his supply would last a little bit longer.

He contacted his friends back at home, hoping that they could send medicine to Nepal, but they couldn’t. The country was under lockdown—nothing could be imported.

Then, Mr Wang contacted his friend Mu-Mu, the head of Beijing Red Pomegranate, a nongovernmental organization providing volunteer services for people living with HIV. It was with Mu-Mu’s help that Mr Wang learned how to obtain HIV treatment after he was diagnosed as living with HIV. Having known each other for many years, Mu-Mu had the trust of his friend. Mu-Mu contacted the UNAIDS Country Office for China to see if it was possible to deliver medicines to Mr Wang. A UNAIDS staff member quickly got in touch with the UNAIDS Country Office for Nepal.

Everything happened so quickly that Mr Wang was shocked when he received a message from Priti Acharya, who works for AHF Nepal and had been contacted by the UNAIDS Nepal office, saying that she would bring the medicine to him.

The next day, Ms Acharya rode her motorbike for 15 km on a dusty road before reaching the place where she would meet Mr Wang. When he came down from the mountains to meet her, Ms Acharya, drenched in sweat, was waiting under the midday sun.

“I was so happy and thankful for her hard work. She gave me a sunny Nepalese smile in return, as well as detailed instructions on the medicine’s dosage,” said Mr Wang.

They took a photograph together, then Mr Wang watched Ms Acharya as she left on her motorbike. Her image, disappearing in the distance, is carved into his memory. To attend the five-minute meeting, Ms Acharya had to ride a round trip of more than 30 km.

“For half a month or so, I had been suffering from pain and anxiety almost every day due to the lack of medication and the loneliness of being in a foreign country on my own. I could not believe that I got the HIV medicine in such a short time,” said Mr Wang. After the trip, he wrote to thank Ms Acharya, explaining how important the medicine he now had in his hand was: “it’s life-saving.”

At the end of his stay in Nepal, Mr Wang wanted to do something for UNAIDS. As he is an experienced photographer, he volunteered to carry out a photo shoot for UNAIDS’ Nepal office.

The subject he chose was former soccer player Gopal Shrestha, the face of an HIV charity in Nepal and the first person living with HIV to reach the summit of Mount Everest. After his HIV diagnosis in 1994, Mr Shrestha launched the Step-Up Campaign and spent many years climbing mountains worldwide, hoping to give strength and hope to people living with HIV.

In 2019, Mr Shrestha reached the peak of the world’s highest mountain, Mount Everest, recording a historic breakthrough for people living with HIV. “If 28 000 people have already climbed Mount Everest, why can’t I?” he said. “By climbing the highest mountain in the world, I want to prove that we are no different from anyone else and that we can all make a difference.”

“The moment I saw him, I could tell he was a sophisticated man,” said Mr Wang. Without instructions, Mr Shrestha posed naturally in front of the camera. He displayed confidence and charm. His eyes, content and clear, reflected nature’s beauty. “The eyes surely are the window to the soul,” Mr Wang said.

Mr Wang is looking forward to his next trip to Nepal. After the pandemic, Pokhara’s lakeside will be flooded with tourists, and he looks forward to seeing the mountain town bustling with people like it used to.

Jordan: Health professionals mandated to report individual’s HIV status to the government

Foreigners Living with HIV in Jordan Face an Impossible Choice

Government Mandates Reporting HIV Status, Deports People Living with HIV

In Jordan, medical professionals and health facilities are mandated to report an individual’s HIV status to the government. Foreign nationals found to be HIV-positive are summarily deported regardless of the consequences to their health and safety and banned for life from returning.

Earlier this year, an Iraqi gay man living with HIV fled to Jordan to escape persecution he faced at home for being gay, yet he could not access HIV treatment without being immediately deported. When his health rapidly deteriorated, he could not seek medical attention for fear of being deported. Whatever decision he made would threaten his life.

Jordan also obliges nationals to undergo HIV testing when seeking employment in the public sector and for non-nationals obtaining work permits, and denies them jobs if they are HIV-positive. It also requires testing for non-nationals renewing residency permits. For LGBT people living with HIV, the stigma and discrimination by medical professionals and employers often bars them from accessing basic rights, without any legal recourse.

Abdallah Hanatleh, executive director of “Sawaed,” an Amman-based organization that facilitates access to HIV treatment, told Human Rights Watch that his organization documents dozens of deportations based on HIV status annually.

Jordan is not alone in this abusive practice. Gulf states including Saudi Arabia and the United Arab Emirates also deport people found to be HIV-positive without any provision for continuity of care. Worse yet, in Jordan, as in Saudi Arabia and the UAE, HIV-positive foreign nationals in the criminal justice system are denied adequate access to treatment in prison. “They are placed in solitary confinement, further isolating and stigmatizing them,” Hanatleh said.

International law prohibits deportations based solely on HIV status. Jordan should explicitly ban discrimination based on HIV status and stop deporting HIV-positive individuals under the principle of non-refoulement. This principle applies to asylum seekers and refugees, and for people with HIV, it means that governments are prohibited from returning them — depending on how advanced the disease — to places where they do not have adequate access to medical care and social support, or where they risk being subjected to persecution or degrading treatment on account of their HIV status.

Jordan should not mandate reporting of HIV status and employers should not be requiring HIV testing in the first place. People living with HIV should never be forced to forego lifesaving treatment in order to avoid deportation to danger.

Jordan: Jordan’s HIV deportation policy threatens lives

Foreigners Living with HIV in Jordan Face an Impossible Choice

Government Mandates Reporting HIV Status, Deports People Living with HIV.

Northern Cyprus: Challenging discriminatory immigration laws against HIV-Positive foreign national

Immigration Law Permits Deportation Of Foreign Nationals In Northern Cyprus On The Basis Of HIV Status

The CAP 105 Aliens and Immigration Law prohibits HIV positive foreign nationals from staying in Northern Cyprus. Human rights organisations in the country have called for the policy to be set aside, arguing that it is discriminatory and that it undermines human rights. It also appears that the provisions of the Aliens and Immigration Law are not in line with the country’s own constitution, which provides for equality before the law and prohibits the enactment of any policy or legislation which is discriminatory.

PROTECTING PUBLIC HEALTH VS. UNDERMINING RIGHTS

Article 6(1)(c) of the Aliens Law and Immigration Law states that any foreign national suffering from a contagious or infectious disease that is a danger to public health (including HIV, Hepatitis B and C, and tuberculosis) may be deported. The supposed rationale behind this article is that allowing foreign nationals who are infected with a contagious disease to enter or stay in the country will pose a risk to public health, which the current health system may not be able to contain. However, this is not the case with HIV, as evidenced by a report on the analysis of the HIV epidemic in Cyprus which was presented by researchers from Near East University Experimental Health Sciences Research Centre to the Minister of Tourism and Environment, Fikri Ataoğlu, in 2018. The report stated that there was no likelihood of an HIV epidemic in Cyprus for the next 50 years.

A report by the Joint United Nations Programme on HIV/AIDS (UNAIDS) on HIV-related travel restrictions clearly shows that restrictions on entry, stay, and residence in a country based on HIV status are discriminatory and cannot be justified on public health grounds. It also indicates that such restrictions do not protect public health, but in fact impede efforts to protect public health by creating barriers to access services for people living with HIV and people at higher risk of HIV.

Voices of International Students, a local NGO in Northern Cyprus that advocates for the rights of international students, released a report titled “If laws kill!” in which they stated that by criminalising foreign nationals living with HIV, the Northern Cyprus government is, in fact, creating an environment for the transmission of the disease and other STDs. This is because if people fear being deported on the basis of a positive test, they will tend to not go for tests.

TREATMENT OF SIMILAR POLICIES UNDER INTERNATIONAL LAW

Although Northern Cyprus is a de facto state, the European Court of Human Rights (ECHR) stated in Loizidou v. Turkey that the European Convention on Human Rights (Convention) applies to Northern Cyprus by virtue of Turkey’s control over that part of the island. Therefore, residents of Northern Cyprus can seek recourse from the ECHR after exhausting local remedies.

In Kiyutin v. Russia, the ECHR held that member states could not refuse foreign nationals residence permits on the basis of HIV status, as this was a violation of article 14 of the Convention which prohibited discrimination. Similarly, in the case of D v. the United Kingdom the court held that the removal of a patient dying of AIDS to his country of origin, where he had no access to adequate medical treatment, accommodation, family, financial, or moral support, constituted a violation of article 3 on the prohibition of torture or inhuman or degrading treatment. The Convention explicitly affirms that foreign nationals should enjoy the same rights as citizens, particularly the right of due process, political freedoms, and equal legal protection.

Under international law, it is acknowledged that states may impose immigration and visa restrictions as a valid exercise of their national sovereignty. However, they are also bound to uphold the human rights of non-discrimination and equality before the law. If states limit these rights, they must show that this is necessary to achieve a legitimate goal, and that the means used actually achieve the goal in the least restrictive manner possible. The Northern Cyprus government has not shown that they are limiting the rights of foreign nationals to achieve a legitimate goal. As stated above, such restrictions do not protect public health, but in fact impede efforts to protect public health by creating barriers to access services for people living with HIV and people at higher risk of HIV. In addition, the blanket exclusion of all people living with HIV is arguably not the most rational or least restrictive means possible of achieving the goal of protecting public health.

In 2008, the Seoul High Court in the Heo case prevented the deportation of a Chinese citizen of Korean descent from South Korea on the basis of his HIV status, stating that the protection of public health should be balanced against the right to medical treatment and the right to privacy. In 2010, the United States government removed HIV from the definition of “communicable disease of public health significance,” and from the scope of assessment for aliens entering the country. This act ensured that HIV status alone cannot be a reason for excluding, removing, or deporting a person from the United States. In March 2015, the Constitutional Court of Russia held that HIV status was not a ground for deportation. According to the ruling, being HIV-positive did not represent an unconditional basis for deportation from the country for foreign nationals who had families in Russia.

Sadly, the Alien and Immigration Law appears to be out of step with international law and norms. The trauma experienced by foreign nationals in this regard resonate in the words of a female Nigerian student who was deported from Northern Cyprus on the basis of her HIV status:

Recounting what happened from the day I was called to the police station, to having to sleep there for a night and then sent off to the airport with my luggage, being told to drag my luggage with handcuffs on my hands, wasn’t such a good image for people looking and I actually did not feel good about myself, I thought I was such a bad person but apparently that’s the law and I hope doing this, things will actually change for the better.

Challenging the constitutionality of the Aliens and Immigration Law in the local courts could prove difficult, unless an applicant with legal standing – such as a foreign national who is on the verge of deportation and who has the capacity to litigate – raises such challenges.

Egypt: UNAIDS helps non-nationals in Egypt to get supplies of antiretroviral therapy

UNAIDS supporting people stranded in Egypt to access HIV treatment

Hundreds of thousands of people around the world have been stranded abroad due to the bans on flights and border closures imposed to stop COVID-19. As elsewhere, thousands of non-nationals have been stranded in Egypt indefinitely.

Travel restrictions have had many repercussions on the daily lives of non-nationals, putting significant economic pressure on them and potentially putting their well-being at risk.

The UNAIDS Country Office for Egypt has been working on COVID-19 from the start of the pandemic in the country, establishing a direct line of communication with the National AIDS Program and working with it to ensure the continuation of HIV treatment by everyone on it and to help non-nationals in Egypt to get supplies of antiretroviral therapy.

Sophia Bianchi (not her real name) is an Italian tourist stranded in Sharm El Sheikh. “I ordered my antiretroviral treatment in late April from Italy via a courier service. Unfortunately, the shipment was stuck at the airport customs in Cairo for weeks. I contacted UNAIDS and they have been very helpful, following up daily with the Egyptian Ministry of Health and Population to get approval for releasing the shipment and checking on me and my health. They kept pushing through the Eid holidays and it all got resolved in two weeks. It was a stressful time but now I am relieved,” she said.

Antiretroviral therapy is available in Egypt free of charge to all nationals and registered refugees. However, as there is no community-based dispensing, nor private market purchase of antiretroviral medicines, gaps remain in ensuring that non-nationals can access treatment. For this reason, UNAIDS’ work during the COVID-19 pandemic has been essential in bridging the gaps.

There are strict rules on the dispensing of antiretroviral therapy in Egypt—only close family members are able to collect it from the dispensing centre. For Fatima Ahmed (not her real name), a refugee from Yemen who because of chronic illnesses that put her at higher risk from COVID-19 cannot leave her house, this was a significant barrier to accessing her HIV treatment. UNAIDS got in contact with the Egyptian Ministry of Health and Population to get an exceptional approval to dispense her medicine through a nongovernmental organization.

“I have not left the house for more than three months. My family has not been able to support me financially, so I was left without revenue. Thanks to the support of the National AIDS Program and MENA Rosa, a nongovernmental organization, peer supporters have delivered three months of antiretroviral treatment to my doorstep,” said Ms Ahmed.

However, much still remains to be done in reaching out to the most in need in Egypt. UNAIDS in Egypt has been advocating for the right to health and universal health coverage for everyone and is working in partnership with the Egyptian Ministry of Health and Population to ensure treatment for all nationals and non-nationals in the country.

“We believe in the absolute right of everyone to have access to their basic right to health. Ensuring access to antiretroviral therapy during these exceptional times is therefore our upmost priority. We are working relentlessly with our governmental and nongovernmental partners to build long-term policies to ensure treatment and care services for people living with HIV during times of emergency,” said Walid Kamal, the UNAIDS Country Director for Egypt.

Russia: New bill proposed on the deportation of migrants with “dangerous” diseases, including HIV

The State Duma may pass a law on the expulsion of migrants with dangerous diseases

The Ministry of Internal Affairs has prepared a bill on the expulsion of migrants with dangerous diseases. Including with coronavirus. The decision on deportation will also be made by the Ministry of Health, the FSB and the bodies of sanitary and epidemiological surveillance. They must coordinate their actions with the Ministry of Justice. At the same time, it is necessary to provide sick people with treatment, accompaniment and transportation.
In addition to coronavirus, the list also includes plague, cholera, tuberculosis, HIV and anthrax. The document, according to the channel “Russia 24”, will be presented to the Cabinet in March, the State Duma will consider it in May.

Госдума может принять закон о выдворении мигрантов с опасными болезнями

МВД подготовило законопроект о порядке выдворения мигрантов с опасными заболеваниями. В том числе, с коронавирусом. Решение о депортации будут также принимать Минздрав, ФСБ и органы санитарно-эпидемиологического надзора. Свои действия они должны согласовывать с Минюстом. Заболевшим, при этом, необходимо предоставить лечение, сопровождение и перевозку.

Кроме коронавируса, в списке также чума, холера, туберкулез, ВИЧ и сибирская язва. Документ, по данным телеканала “Россия 24”, представят кабмину в марте, Госдума рассмотрит его в мае.

South Africa: African migrants face dual challenge of navigating HIV care and social stigma

The social management of HIV: African migrants in South Africa

HIV is the most common chronic illness in South Africa. One in every five is infected and one in every 13 takes antiretroviral drugs daily. Managing HIV medically has become more of a part of normal life.

Amid this public health emergency, some 2.5 million foreign-born African immigrants live in South Africa. They largely come from countries with the highest HIV prevalence rates in the world, such as Lesotho. Yet their access to health care and services is limited, because they are vulnerable in various ways. Though entitled to inclusion and care in South Africa, they may face deportation, xenophobia, exploitation, language barriers, cultural estrangement and social isolation.

In spite of these challenges, migrants do manage HIV medically. But we do not really know how they manage socially in communities where the stigma of the disease affects all dimensions of life. HIV is often referred to today as a “manageable” chronic illness, but it is not just a medical condition. It is also very much a social condition as living with HIV comprises both clinical features of care and experiences of stigma and social angst.

Understanding how migrants manage this social dimension of their condition matters because it shapes the landscapes and outcomes of their care. It directly influences when and where people seek treatment, and how well they adhere to it if they do. This in turn affects critical issues such as drug resistance and prevention of transmission.

In a recent journal article, I unravel complexities of stigma and perceptions of HIV in Mozambican migrant communities. My research exposes layers and shades of stigma across different social networks and locations, which influence how HIV is managed socially. It shows how an individual’s HIV status determines how other community members are regarded and interacted with in daily life.

Perceptual contrasts

Nowhere in South Africa is the migrant population as dense as in inner-city Johannesburg. In their urban enclaves, community members inevitably lead lives entwined with those of people receiving care for HIV, whether aware of their infection or not.

HIV is spoken of here in ways that acknowledge, perpetuate and replicate stigma. For instance, Mozambicans may allude to HIV as “stepping on the mine”, as “being poisoned” or as “getting stung”. Open conversation about HIV is avoided, which in turn creates an anxiety that motivates secrecy. This is so because disclosure of HIV serostatus may put social life at risk.

I explore perceptions of HIV among two groups of Mozambican migrants in Johannesburg: one consisting of patients receiving care for HIV in a hospital; and the other of community members unaware of their own serostatus.

The contrast between how these two groups perceive of each other is staggering. The patients apprehensively conceal their status for fear of what others might think of them. But these others express mostly empathy and understanding for their condition.

I identify two reasons for such stark perceptual contrasts. The first lies in a transformation of identity, which results in a division between an “us” and a “them”, between the HIV-positive and the HIV-negative.

This process creates a schism between “patienthood” and “personhood”. When a person tests positive for HIV, fears of physical death in the future transform into fears of social disruption in the present. Loneliness and isolation then result from the person keeping her HIV status secret.

As the identity of a community member shifts from personhood to patienthood, as she receives counselling and care, she comes to associate disclosure with her own (and others’) social death. Her serostatus then becomes a secret in her life, while her notion of others’ perceptions of HIV becomes confined to the realm of the suspected and nervously anticipated. Expecting social misfortunes should others learn of her status, she opts for concealment as a strategy of survival in the community.

Secondly, I find that stigma is tied to location, because of the ways in which location is tied to social networks. In different social networks such as family at home, friends, work colleagues, acquaintances in the community or the nightlife, the stakes of disclosure vary considerably.

For instance, one focal point of stigma is the local HIV clinic. It is supposed to care for its patients, but at the same time it also estranges them, because others might recognise them there and so become antagonists rather than fellow patients.

In fact, Mozambicans largely prefer to avoid clinics in South Africa and go home to Mozambique for treatment. The stakes of disclosure, involving livelihoods, partners and identities, are far too high to risk being seen receiving care in South Africa. Disclosure may be less hurtful in certain locations where social networks are more sympathetic.

This may further complicate the therapeutic journey of migrants in terms of costs, retention in treatment or simply having to explain away the true purpose of one’s absence.

Medicalised, not socialised

HIV may have become easier to manage medically, but stigma continues to cause distress and remains severely challenging to manage. This is also a challenge for health care provision, as it sways choices of when and where to seek care: a South African clinic, for example, or a distant, socially safer treatment option.

HIV may have been medicalised, yes, but not socialised.

UNAIDS and UNDP urge countries to lift all forms of HIV-related travel restrictions

UNAIDS and UNDP call on 48* countries and territories to remove all HIV-related travel restrictions

New data show that in 2019 around 48* countries and territories still have restrictions that include mandatory HIV testing and disclosure as part of requirements for entry, residence, work and/or study permits

GENEVA, 27 June 2019—UNAIDS and the United Nations Development Programme (UNDP) are urging countries to keep the promises made in the 2016 United Nations Political Declaration on Ending AIDS to remove all forms of HIV-related travel restrictions. Travel restrictions based on real or perceived HIV status are discriminatory, prevent people from accessing HIV services and propagate stigma and discrimination. Since 2015, four countries have taken steps to lift their HIV-related travel restrictions—Belarus, Lithuania, the Republic of Korea and Uzbekistan.

“Travel restrictions on the basis of HIV status violate human rights and are not effective in achieving the public health goal of preventing HIV transmission,” said Gunilla Carlsson, UNAIDS Executive Director, a.i. “UNAIDS calls on all countries that still have HIV-related travel restrictions to remove them.”

“HIV-related travel restrictions fuel exclusion and intolerance by fostering the dangerous and false idea that people on the move spread disease,” said Mandeep Dhaliwal, Director of UNDP’s HIV, Health and Development Group. “The 2018 Supplement of the Global Commission on HIV and the Law was unequivocal in its findings that these policies are counterproductive to effective AIDS responses.”

Out of the 48 countries and territories that maintain restrictions, at least 30 still impose bans on entry or stay and residence based on HIV status and 19 deport non-nationals on the grounds of their HIV status. Other countries and territories may require an HIV test or diagnosis as a requirement for a study, work or entry visa. The majority of countries that retain travel restrictions are in the Middle East and North Africa, but many countries in Asia and the Pacific and eastern Europe and central Asia also impose restrictions.

“HIV-related travel restrictions violate human rights and stimulate stigma and discrimination. They do not decrease the transmission of HIV and are based on moralistic notions of people living with HIV and key populations. It is truly incomprehensible that HIV-related entry and residency restrictions still exist,” said Rico Gustav, Executive Director of the Global Network of People Living with HIV.

The Human Rights Council, meeting in Geneva, Switzerland, this week for its 41st session, has consistently drawn the attention of the international community to, and raised awareness on, the importance of promoting human rights in the response to HIV, most recently in its 5 July 2018 resolution on human rights in the context of HIV.

“Policies requiring compulsory tests for HIV to impose travel restrictions are not based on scientific evidence, are harmful to the enjoyment of human rights and perpetuate discrimination and stigma,” said Dainius Pūras, Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of health. “They are a direct barrier to accessing health care and therefore ineffective in terms of public health. I call on states to abolish discriminatory policies that require mandatory testing and impose travel restrictions based on HIV status.”

The new data compiled by UNAIDS include for the first time an analysis of the kinds of travel restrictions imposed by countries and territories and include cases in which people are forced to take a test to renew a residency permit. The data were validated with Member States through their permanent missions to the United Nations.

UNAIDS and UNDP, as the convenor of the Joint Programme’s work on human rights, stigma and discrimination, are continuing to work with partners, governments and civil society organizations to change all laws that restrict travel based on HIV status as part of the Global Partnership for Action to Eliminate all Forms of HIV-Related Stigma and Discrimination. This is a partnership of United Nations Member States, United Nations entities, civil society and the private and academic sectors for catalysing efforts in countries to implement and scale up programmes and improve shared responsibility and accountability for ending HIV-related stigma and discrimination.

*The 48 countries and territories that still have some form of HIV related travel restriction are: Angola, Aruba, Australia, Azerbaijan, Bahrain, Belize, Bosnia and Herzegovina, Brunei Darussalam, Cayman Islands, Cook Islands, Cuba, Dominican Republic, Egypt, Indonesia, Iraq, Israel, Jordan, Kazakhstan, Kuwait, Kyrgyzstan, Lebanon, Malaysia, Maldives, Marshall Islands, Mauritius, New Zealand, Oman, Palau, Papua New Guinea, Paraguay, Qatar, Russian Federation, Saint Kitts and Nevis, Samoa, Saudi Arabia, Saint Vincent and the Grenadines, Singapore, Solomon Islands, Sudan, Syrian Arab Republic, Tonga, Tunisia, Turkmenistan, Turks and Caicos, Tuvalu, Ukraine, United Arab Emirates and Yemen.

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

Travel and long-stay restrictions for foreign nationals with HIV have no logical basis and have been deemed a human rights violation by the United Nations

Published in South China Morning Post on February 5, 2019

Visa restrictions for HIV-positive immigrants still in place in dozens of countries

Recent leak in Singapore of data of HIV-positive people renewed attention on its curbs on long-term stays by those who have the virus
Countries with restrictions include Russia and the United Arab Emirates; there’s no logical basis for them any more, UNAids says

A data leak of Singaporean medical records exposing the HIV-positive status of 14,200 people last month triggered concerns about a backlash for those whose health status was made public in a country that continues to stigmatise the disease.

But the case, involving the records of 8,800 foreign nationals who tested positive for HIV in Singapore, also shines a spotlight on the city state’s restrictive policies towards foreigners with HIV, who face barriers to staying in the country for more than 90 days unless married to a Singaporean national.

The records were leaked by a foreigner in just such a situation, American Mikhy Farrera Brochez, who was deported after serving jail time for drug-related crimes and fraud, including hiding his HIV status. He was able to access the records with help from his boyfriend, a Singaporean doctor.

Singapore is one of only a handful of developed nations that still have laws restricting the long-term stay of foreign nationals with HIV – laws that have been deemed a human rights violation by the United Nations.

“When this [1998] law was brought in there was a lot more fear of unknown issues around disease … but [today] the logic is just not borne out by any scientific or medical basis,” says Eamonn Murphy, UNAids regional director for Asia and the Pacific.

Instead, countries that still have such restrictions in place often do so because of “historical convention, ideology, or even passivity”, Murphy says. He notes that UNAids is renewing its focus on the issue this year, compiling a new report on national restrictions.

UNAids most recent comprehensive report on HIV-related travel and immigration laws in 2015 listed 35 countries with such restrictions.

However, incomplete data published in 2018 by UNAids named at least 18 countries that have policies restricting entry, stay or residence for people living with HIV. Information from many countries were left off the list, and will be updated this year to reflect the true extent. The same report found that 60 countries require testing for residence or other permits, including marriage, not limited to foreigners.

The exact numbers, however, are difficult to pin down, experts say. An independently researched global database counts 49 countries with HIV-related restrictions on long-term stay in 2018, based on information sourced from local embassies and reports from travellers and immigrants. Countries with restrictions include Russia, Singapore, and the United Arab Emirates.

“The data the countries present about themselves in diplomatic settings can be different from the policies that are actually executed,” says American epidemiologist Jessica Keralis, who has researched the public health impacts of such HIV-related restrictions.

For example, countries may not have regulations “on the books”, but employers can revoke visas for HIV-positive employees, or state insurance policy can make it difficult for immigrants to afford treatment, she says.

In other cases, official policy may not be known by regional or local officials and institutions.

These distinctions matter for HIV-positive immigrants, whether white-collar workers, migrant labourers or students, according to David Haerry, who publishes the Global Database on HIV-Specific Travel and Residence Restrictions, which names the 49 countries.

“Oftentimes people [sent abroad for work] don’t know and they fall in the trap: if you don’t know and you have to be tested on the ground, and then you are sent back on health grounds, your company knows,” he says. “It’s a big issue.”

Haerry receives daily emails through the database from people around the world wondering how to travel or relocate safely while living with HIV. In recent years, he’s seen restrictive policies become more of an issue for students looking to study abroad, but who fear the consequences of mandatory HIV testing even in countries where there is no explicit restriction on those who are HIV-positive.

For such situations, “we have no solution”, Haerry says.

Many national restrictions are holdovers from the 1980s, before the disease’s transmission was understood and the antiretroviral therapies and daily medications that can prevent its spread became widely available, according to UNAids’ Murphy. But he has seen progress globally.

A number of countries changed their policies after UNAids launched a 2008 campaign against the 59 governments that had bans at that time. The United States, South Korea and China were among the nations to remove restrictions in 2010, although South Korea retained some related to immigration, while China reportedly has mandatory HIV testing for some visas.

Singapore revised its own regulations in 2015 to allow people living with HIV to enter the country for short-term stays of less than three months, while South Korea in 2017 removed its final restriction, which mandated the testing of foreign teachers.

But conservative cultures, social stigma and inertia have kept some restrictions in play in other nations, experts say. The majority of such restrictions are found in conservative countries; more countries in the Middle East than anywhere else have them.

“The basis of discrimination is misconception and fear, and with HIV these boil down to drug use, men who have sex with men, and all these realities that countries don’t want to face,” says Peter Wiessner, who co-authors the global database. “There’s also xenophobia mixed in.”

That element can have a negative public health impact, according to Keralis.

“It communicates that HIV is a foreign contagion and a foreigners’ problem, and if [citizens] don’t mix with foreigners then they are not at risk,” she says. She notes that, paired with a lack of proper sex education, this can create a dangerous situation.

“There’s no incentive for people to seek more information or modify their behaviours,” she says.