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.

Lesotho: The power of community leaders in HIV awareness and support

Improving HIV testing, disclosure and treatment for migrant communities

In the busy town of Maputsoe, in Lesotho on the border with South Africa, a hairdresser recounts how her engagement with an IOM change agent led to important shifts in her knowledge about family planning, provided pivotal counselling, and helped facilitate HIV testing and treatment for herself and her new boyfriend.

Now pregnant, Palesa, is aware of and accessing a prevention-of-mother-to-child-transmission (PMTCT) service and shares sexual and reproductive health and rights (SRHR) and HIV information and commodities with her own clientele.

She first learned about the SRHR-HIV Knows No Borders Project two years ago, through a door-to-door visit from one of the change agents, Thuso, a well-known counsellor, pastor and traditional healer. Thuso came to her small hair salon on multiple occasions, to provide her with information on SRHR, HIV and family planning. Palesa, 30, had a four-year-old daughter when she began a new relationship with Refiloe, a man she met in Maputsoe.

She had no plans to have more children but was unaware of locally available family planning options, and how to access services.
Palesa was reluctant to tell her boyfriend about her HIV positive status for fear he would no longer want to be with her. Thuso encouraged her to open up to him and offered to speak with the couple about the issue and provide any information they needed.

With Thuso’s support, they went for HIV testing, where Refiloe, to his surprise, also tested positive. The couple is still together and receiving treatment and support. Armed with her knowledge about SRHR-HIV issues Palesa began to reach out and share what she had learned with her friends and family.

She keeps a steady supply of condoms at her hairdressing salon to distribute to clients, with whom she also shares her experience. She acknowledges that many migrants passing through Maputsoe may not feel comfortable accessing formal health services for basic information about SRHR. Her salon, along with many others identified by the project in major border towns, have become hubs for delivering information, initiating referrals and distribution of condoms.

Engaging known leaders within the community helped build the rapport necessary when engaging with the multiple sensitive health and relationship issues that Palesa’s circumstances raised. The knowledge and support she received from the programme are now having ripple effects, as she continues to share what she learned.

IN A BOX

The SRHR-HIV Knows No Borders Project was launched in early 2017, as a collaborative effort between the International Organization of Migration (IOM), Save The Children (SC) Netherlands, and Witwatersrand School of Public Health (WSPH).

This consortium aims to implement a holistic, regional approach to improve sexual and reproductive health and HIV (SRH-HIV) related outcomes amongst migrants (including migrant adolescents, young people and sex workers) as well as non-migrant adolescents, young people and sex workers and others living in migration-affected communities in six countries in the Southern African Development Community (SADC) region, namely Eswatini, Lesotho, Malawi, Mozambique, South Africa and Zambia.

The project relies on community-based change agents who have been identified in collaboration with community leaders to promote sexual and reproductive health and HIV and assist individuals and communities to realise their rights and access basic services. By engaging known leaders within the community as change agents, the project has been able to build trust with individuals within the communities it aims to reach. This trust is particularly important when addressing sensitive issues such as SRHR and HIV.
*(all names have been changed in this story)

This story was written by Abibo Ngandu, IOM Southern Africa’s Public Information Officer.

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.