Countries and HIV-related travel restrictions: An overview considering future studies
This article provides a brief overview of HIV-related travel restrictions, the reasons offered for their existence and their impact on people living with HIV/AIDS. Areas that require further research are also highlighted.
One of the main reasons why people living with HIV/AIDS (PLWHA) do not get tested for the human immunodeficiency virus (HIV) or seek treatment is the stigma and discrimination associated with the disease. In some instances treatment was only sought once the HIV-infected individual developed the acquired immunodeficiency syndrome (AIDS) (Erasmus, 2013; Maughan-Brown & Nyblade, 2013). This article explores one of the main contributing factors to the stigma and discrimination PLWHA face on a daily basis.
A brief history
In the 1980s, when the virus first became known, some governments passed laws that would restrict the entry, stay and residence of PLWHA in their countries to protect their citizens from the HIV epidemic and moderate the financial burden of caring for HIV-positive travellers that would be placed on the health system (Chang et al., 2013). The World Health Organization (WHO) tried to allay the fears of these governments when they issued a statement that preventing PLWHA from entering a country would not stop the spread of the virus and that taking such a step would only give rise to stigma (Lazarus et al., 2010; Wiessner & Lemmen, 2013). But many of the governments ignored the statement including major role players such as the United States of America, China, South Korea, and Saudi Arabia (Wiessner & Lemmen, 2013; Rushton, 2012).
Among literature sources, a discrepancy exists regarding the number of countries with HIV-related travel restrictions (CHTRs) ranging from 37 to 66 (Wiessner & Lemmen, 2013; Chang et al., 2013; Ford, 2013; UNAIDS, 2013; Rushton, 2012; Amon & Todrys, 2008).
Implications of HIV-related travel restrictions
HIV-related travel restrictions usually take the form of laws or administrative policies (Chang et al., 2013). Countries with HIV-related travel restrictions may require people to declare their HIV status when applying for a visa in their country of origin, upon arrival at entering points of the destination or after a set period of time in the destination country. The PLWHA might be refused entry, have their status displayed in their passport or another immigration document, be detained before deportation, or deported. The laws and policies of CHTRs warrant any or all of these declarations and consequences as per their discretion (Chang et al., 2012).
The reasons given for these restrictions are that PLWHA pose a threat to those countries’ public health and are a burden to their health systems (Amon & Todrys, 2008; Rushton, 2012). In their paper Amon & Todrys (2008) addressed these reasons by showing their implications. By advancing these reasons and restrictions, CHTRs promote the idea that HIV is a foreign problem, and that the only way to keep the citizens HIV-free is to keep PLWHA out. Furthermore, PLWHA can make no worthwhile contribution to the economy, and should have no human rights (Amon & Todrys, 2008; Wiessner & Lemmen, 2013). Thus, citizens and governments ignore the fact that PLWHA who travel or immigrate to these countries can actually make a useful contribution to a country’s economy; pay taxes if they are eligible, and could take care of their own health if given the freedom to do so. The human rights of PLWHA to freedom of movement are also impeded.
Consequently, HIV-prevention and treatment campaigns are not very effective in CHTRs, since citizens living with HIV/AIDS fear stigmatisation and discrimination (Amon & Todrys, 2008). Citizens are also misinformed about the disease. A lack of confidentiality prevails as migrant workers and other groups of PLWHA are not informed about their sero-positivity, while their employers and immigration officials are (Amon & Todrys, 2008; UNAIDS, 2009; Wiessner & Lemmen, 2013).
International HIV/AIDS organisations, e.g. the International AIDS Society and the Joint United Nations Programme on HIV/AIDS (UNAIDS), have been negotiating with the governments of the 66 CHTRs to observe the human rights of PLWHA (Rushton, 2012; Wiessner & Lemmen, 2013) with moderate success. In the years since 2010, eight countries (including the United States of America, China, South Korea) have repealed their laws on HIV-related travel restrictions (Wiessner & Lemmen, 2013).
The motivating factors behind these decisions have been the subject of much study (Chang et al., 2012; Rushton, 2012; Taylor, 2012). Chang et al. (2012) reported that the USA repealed its HIV-travel restriction laws because of its leadership in the world and because of “intense domestic advocacy”. They also found that countries with travel restrictions often have a high percentage of international migrant workers and a lack of association between the gross national income of CHTRs and the restrictions the governments placed.
Further study warranted
At the 7th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention, Peter Wiessner from Wiessner and Lemmen (2013) participated in a satellite broadcast on How Can Science Help End HIV-related Travel Restrictions? (Ford, 2013). He put forward a list of areas where objective research is needed (see Box 1.)
|Box 1: Future Research
Research areas highlighted by Peter Wiessner at the 7th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention (Ford, 2012).*
- Comparable studies on the success or failure of control mechanisms targeting sexual behaviour.
- Studies of the impact of inclusion or exclusion of PLWHA into public health and prevention activities
- What is the impact of punitive laws?
- What is the impact of the realisation of GIPA (greater involvement of PLWHA) principles?
- Assessment of the contributions of migrant work force into the economic growth of host countries
- Data on the myth of medical tourism
- Costs of testing principals at borders compared to the costs of the inclusion of migrant workers into antiretroviral delivery programmes
- Data on the effectiveness or dangers of HIV specific entry regulations as a method of prevention
- Research on the impact of stigma and discrimination related to restrictions in entry and residence
- Data on the experiences of countries that revised their restrictions.
*The points above were taken from his PowerPoint slides.
Clearly HIV-related travel restrictions violate human rights; yet, governments cannot be faulted in the bid to protect their public health. Therefore, objective research is needed to give a clear picture of the problem in quantified terms.
- Amon, J. J. and Todrys, K. W. (2008) ‘Fear of foreigners: HIV-related restrictions on entry, stay, and residence’ Journal of the International AIDS Society 11, 8.
- Chang, F., Prytherch, H., Nesbitt, R. C. and Wilder-Smith, A. (2013) ‘HIV-related travel restrictions: trends and country characteristics’ Global Health Action 6, 20472.
- Erasmus, J. (2013) ‘Recent study on managing HIV stigma and discrimination’, AfroAIDSinfo. Issue 13 no. 6, Public (Open access).
- Ford, O. (2013) ‘How Can Science Help End HIV-Related Travel Restrictions? (Video)’ [Online] Accessed on 14 February 2014.
- Joint United Nations Programme on HIV/AIDS (2009) The Impact of HIV-related restrictions on entry, stay, and residence: Personal narratives. [Online] Retrieved on 14 February 2014.
- Joint United Nations Programme on HIV/AIDS (2013), Global report: UNAIDS report on the global AIDS epidemic 2013.
- Lazarus, J. V., Curth, N., Weait, M. and Matic, S. (2010) ‘HIV-related restrictions on entry, residence and stay in the WHO European Region: A survey’ Journal of the International AIDS Society 13:2.
- Mahto, M., Ponnusamy, K., Schuhwerk, M., Richens, J., Lambert, N., Wilkins, E., Churchill, D. R., Miller, R. F. and Behrens, R. H. (2006) ‘Knowledge, attitudes and health outcomes in HIV-infected travellers to the USA’ HIV Medicine 7, 201-204.
- Maughan-Brown, B. and Nyblade, L. (2013), ‘Different dimensions of HIV-related stigma may have opposite effects on HIV testing: Evidence among young men and women in South Africa’, AIDS and Behavior [Online] Accessed on 9 October 2013.
- Rushton, S. (2012) ‘The global debate over HIV-related travel restrictions: Framing and policy change’ Global Public Health 7(Supplement 2), S159-S175.
- Taylor, R. C. R. (2012) ‘The politics of securing obrders and the identitites of disease’ Sociology of Health & Illness 35, 241-254.
- Wiessner, P. and Lemmen, K. (2012) Quick reference guide: Entry and residence regulations for people living with HIV 2012/2013, 10th edition, Berlin: Deutsche AIDS-Hilfe e. V.
Author: Waldo Adams (BSc Hons Biochemistry)
Reviewed by: Hendra van Zyl (MPH), Jean Fourie (MPhil) and Michelle Moorhouse (MBBCh, DA)
Date: March 2014
Adams, W. (2014) Countries and HIV-related travel restrictions: An overview considering future studies, AfroAIDSinfo. Issue 14 no. 3, Science (Open access).
4 March, 2014