by Bob Roehr
WASHINGTON, D.C. – The U.S. "travel ban" on HIV-positive foreign visitors and immigrants is a vestige of the darkest days of the epidemic. It may be drastically modified or even eliminated completely if the organizers of an April 12 forum in Washington, D.C. have their way.
U.S. authorities always have had the power to bar foreigners who pose a public health threat from entering the country. That was interpreted to exclude an HIV-positive Dutch visitor traveling to speak in the U.S. in 1989. It sparked a protest at the International AIDS Conference in San Francisco in 1990 and the conference vowed not to return until U.S policy changes. The World Health Organization (WHO) has called the policy a violation of human rights.
But Congress codified the policy into law in 1993, despite objections from then Secretary of Health and Human Services Louis Sullivan. It specifically prohibited foreigners from becoming immigrants or even obtaining a visa to visit the U.S. if they are HIV-positive. However, the provision may be waived on an individual basis if it is deemed to be in the best interest of the U.S. to do so. Blanket waivers have been issued for specific events such as the Gay Games in Chicago.
Attending the International AIDS Conference in Toronto last summer "brought home in a very powerful and real way that it is forbidden to have such a thing on U.S. soil," said J. Stephen Morrison, executive director of the Center for Strategic and International Studies. He said the U.S. policy "is misaligned with current realities and evolving U.S. interests," and it is time to consider a change.
Phillip Nieburg, coauthor of a report that lays out the history of the policy and how it might be changed, said our knowledge base has grown since 1993 and it is clear that HIV is not an easily spread contagious disease. There is no public health justification for the law.
Helene Gayle has been a leading expert on HIV prevention at the Centers for Disease Control and Prevention (CDC) and the Gates Foundation, and is now president of CARE, a large international charity working in the developing world.
She said the law is not consistent with the international leadership role on HIV that the U.S. has demonstrated with PEPFAR, the President's Emergency Plan for AIDS Relief. "It is just one more thing where we are out of line and inconsistent with what we are trying to do."
Critics of the waiver process for short-term visitors say that many persons do not know that they are HIV-positive when they apply for a visa. For those who do know, disclosing that to a State Department official runs the risk that the official or local support staff might disclose that medically confidential information. In many countries, that can lead to stigma and discrimination within the society. Furthermore, the application fee for the waiver can be prohibitive for persons with low incomes.
The Bush administration acknowledges the privacy concerns and on World AIDS Day, Dec. 1, the President surprised AIDS advocates by quietly announcing that he would issue an executive order addressing those concerns.
Rising from the audience, Tom Walsh, with the Office of the U.S. Global AIDS Coordinator at the Department of State, told the forum "The process is underway, it is complex, and I wish there was more that I could say." Others have said that delay is due to trying to work within the confines of the law so as not to require new legislation.
Supporters of the current law fear that allowing people who are HIV-positive to enter the country either as immigrants or on short-term visas, with the fear that they will stay, will only add to the burden of already stressed AIDS services.
They can point to what happened after the International AIDS Conference in Toronto last summer. More than 150 HIV-positive attendees chose to remain in Canada and seek asylum. The claimants said they feared discrimination or worse in their own countries. The cost of drugs alone for those people would run about $1 million a year in the U.S.
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.
Former Secretary Sullivan believes that both the stigma surrounding AIDS and emotions that ran high in 1993 when the policy was enacted, have declined notably since then. The introduction of effective therapy and the increased availability of that therapy in the developing countries make this "truly a propitious time to try and end these [legal] restrictions."
Todd Pilcher was less optimistic. The attorney with the Whitman-Walker Clinic in Washington, D.C. said, "I think we are going to get a lot of debate on it being a burden to our system" of care for Americans living with HIV.
More online:
Moving Beyond the US Government Policy of Inadmissibility of NIH-Infected Noncitizens is available at http://www.csis.org/media/csis/pubs/movingbeyondinadmissibility.pdf
