Discrimination within Public Health

I have recently moved abroad — not exactly an unusual process for me, but there was one thing that surprised me. When I was applying for my visa, the embassy requested to have an extensive medical examination, designed mainly to confirm that I do not suffer from what one might call the trifecta of the world’s current most frightening infectious diseases: HIV, syphilis, and tuberculosis.

Upon first finding out about such visa requirement, which I have not encountered before, having previously moved abroad on two separate occasions, I did not particularly protest. ‘Endangerment of public health’ seemed like a reasonable concern. It wasn’t until I was walking back from my examination that I started to realize that this meant: “Wait, why can’t I have AIDS and study abroad too?” 

A quick internet search informed me that many countries around the world have restrictions against entry by individuals with the three aforementioned diseases, HIV-positive individuals in particular. The majority of these restrictions apply to long-term stays or immigration, however, some are valid for short-term trips as well. The Global Database on HIV-specific Travel & Residence Restrictions advises HIV-infected individuals to check a country’s policy on the matter before planning a trip and outlines the specificities of restrictions in each state.

Certain countries that previously partook in HIV travel restrictions have since realized the error of their judgment. The US, for instance, famously faced controversy over their HIV travel regulations; the backlash against their HIV entry ban and the efforts of many advocates helped lift the ban in 2010, after 22 years in action. Several countries followed the US’s example; others, however, adopted an even more discriminatory approach and changed their regulations to prohibit HIV-positive citizens of specific countries from crossing their borders.

I can understand the grounds for tuberculosis travel restrictions as TB is passed on through the air and individuals have about a 9.5% chance of developing active TB within 6 months of exposure to the bacteria. However, the invention of antibiotics in the 1940s and triple therapy in the ‘50s made TB curable. The tuberculosis vaccination, introduced two decades earlier, is currently the most widely implemented vaccination in the world, with over 90% of children being vaccinated. These discoveries, along with the increase in general hygiene and several new methods of TB testing, continue steadily decreasing TB mortality rates. Tuberculosis is currently considered to be “the disease of poverty”, with most TB deaths concentrated in South-East Asia and Africa. Even in well-developed countries, the infection rates are generally higher among non-whites. Leading causes of TB deaths are the absence of medication and sanitation — both not only solvable but already solved for the people of the right social standing, living in the right part of the world.

The necessary connection between HIV and Tuberculosis is, of course, to be mentioned: HIV-infected individuals are much more likely to develop TB. In fact, most HIV-related deaths occur due to tuberculosis (approximately 400 000 in 2016). This, however, does not justify travel restrictions for HIV-positive, TB-free individuals. There are, after all, two important differences between AIDS and TB: one is a deadly result of an STD; another is airborne and has been curable for nearly 80 years. 

Almost 38 million people worldwide are currently infected with HIV. Contrary to popular belief, 52% of them (as of 2018) are females and only 79% are aware of their HIV-positive status. Gay men, transgender individuals, drug-users, and sex workers are referred to as ‘key HIV populations’ and are considered to be at the highest risk, although they accounted for just 54% of HIV infections in the world in 2018. Unprotected sex remains the leading cause of HIV transmission, while drug use is a close second. Blood transfusions, handling of infected medical equipment, and transmission through childbirth or breastfeeding are less common, however can also cause HIV infections. 

HIV deaths are commonly associated with underdeveloped countries; however, there are people living with HIV all over the globe. 1.1 million people are living with HIV in the US alone, over 18,000 of whom have already developed AIDS. Medical research on the subject of AIDS continues progressing, giving hope to HIV infected individuals. In 2011, their life expectancy, with treatment, was 70 years old. Nonetheless, UNAIDS, a global anti-AIDS organization, reports that “A total of 48 countries and territories still maintain travel restrictions on people living with HIV” (as of July 2019). 

These millions of people who, despite their diagnosis, have a real chance to lead long and fruitful lives, will not be able to live, work, study, or even travel to 48 territories around the world due to their HIV-positive status.

Made even more grim by the fact that 1.7 million of them are children under 15, this statistic doesn’t paint a very tolerant picture and can, in fact, be considered a violation of Article 13 of the Universal Declaration of Human Rights (1948), which states “everyone has the right to freedom of movement[…]to leave any country, including his own, and to return to his country.” 

I suppose this “better safe than sorry” approach may appear reasonable to a law-maker. However, sheltering their citizens from this reality, where HIV, along with TB and syphilis, are real threats, cannot be the best solution our governments are able to come up with. AIDS is a worldwide issue, and we should be encouraged to steer clear of unprotected sex and used needles regardless of where in the world we are. Instead, decision-makers continuously chose to encourage our irresponsibility and undermine the personal choice to be safe rather than sorry. What does it say about us and our national representatives, if we’d rather discriminate than take charge for our own health, sexual and otherwise? 

Cover image by Unsplash