HIV positive people: travel restrictions

US should ease its travel restrictions on HIV positive people, think tank says

Bob Roehr
Washington, DC

An independent US think tank has called for a change in the law that prohibits HIV positive visitors and immigrants coming to the United States, allowing only occasional waivers on a case by case basis.
The Center for Strategic and International Studies made its recommendations in a report that was discussed at a forum in Washington, DC, last week.
The "travel ban" was passed by Congress in 1993 when hysteria over HIV was at its peak, before the introduction of effective treatments. In protest, the International AIDS Society has refused to hold its huge biennial conference in the US until the law is changed, and the World Health Organization has called the policy a violation of human rights.
A coauthor of the report, Phillip Nieburg, said that our HIV knowledge base had grown since 1993 and that it was now clear that HIV is not an easily spread contagious disease. There was no justification for the law in terms of public health, he said.
Nor was it consistent with the international leadership role on HIV that the US has shown with its president's emergency plan for AIDS relief (PEPFAR). "It is just one more thing where we are out of line and inconsistent with what we are trying to do," said Helene Gayle, another coauthor of the report and president of the large international charity CARE.
The easiest part of the law to change may be visas for short term visitors. Individuals may be granted a waiver through a special application. But the applicant runs the risk of disclosure and discrimination, and the fee can be prohibitive for people on low incomes. Blanket waivers have been granted for people planning to attend large events, such as the Gay Games in Chicago last July.
The Bush administration is moving to address these issues, albeit slowly. On World AIDS Day (1 December) last year the president announced that he would issue an executive order addressing the visa concerns.
Speaking from the forum's audience, Tom Walsh, of the US Department of State's Office of the US Global AIDS Coordinator, said, "The process is under way, it is complex, and I wish there was more that I could say." Others have said that the delay results from trying to work within the confines of the law to protect the confidentiality of applicants.
Supporters of the current law fear that allowing HIV positive people into the US will increase the burden on the country's public health system. They gained ammunition after the international AIDS conference in Toronto last summer when more than 150 HIV positive people attending the conference chose to remain in Canada and seek asylum, claiming that they feared discrimination or worse in their own countries. The cost of drugs alone for those people would cost about $1m (£0.5m; 0.7m) a year in the US.
Dr Nieburg called that argument inherently discriminatory, given that other costly chronic health problems are not singled out for a blanket ban but are handled on a case by case basis.
Louis Sullivan, who was secretary of health and human services when the law was enacted, against his advice, said that the emotions and stigma surrounding AIDS had declined notably since then. The introduction of effective treatments and the greater availability of treatment in developing countries make this "truly a propitious time to try and end these [legal] restrictions," he said.

Moving Beyond the US Government Policy of Inadmissibility of HIV-Infected Noncitizens is at www.csis.org/media/csis/pubs/movingbeyondinadmissibility.pdf.

BMJ 2007;334:820-821 (21 April)
http://www.bmj.com