Irene Fernandez 1946-2014

1. OverviewHIV-related entry and residence restrictionsPeter WiessnerEATG Policy Co-Chairpeter-wiessner@t-online.deJuly 20, 2014, international AIDS Conference, Melbourne, Australia

2. Irene Fernandez 1946-2014

3. Personal testimony “Hi Peter, Sorry for bothering you. I am 25-year-old, male and HIV+. Holder of both PR China and Hong Kong Passport. I now have a job offer in Australia, which will not only enhance my personal and career development, but also fulfil a long-held dream. But as Australian Government requires a medical examination I am afraid of being denied a working visa. However, I believe that Australia is a democracy, such thing should not happen....Another concern: will the Australian government disclose my HIV conditions to my Would-be employer? Still I believe as a democracy, its national and state government will keep such sensitive information confidential, right? Feeling so sad as I am 25 only and should be deprived of some right due to the virus when a good opportunity knocks at my door and I really want it.I myself strongly believe I can contribute a lot to my would-be employer. Thanks for you time and if u cannot answer, at least point out the right directions. Towhomshould I turn tohelp?“

4. Letters like this arrive us frequently... Relevant for long term stays at a foreign country (students, interns, migrant workers Applies as well to people from rich countries) Where would you search for accurate information? • Is it advisable to contact the authorities directly ? • Would you discuss your situation with your future employer? • Would you lie? And if your lie gets discovered: would you know what the consequencesare? Is there the danger to get deported? • If you are open about your situation and the visa gets denied: would you ever get a second chance? • Who can give advise on how to circumvent the restrictions?

5. Positive developments in recent years: USA, China, Armenia, Namibia, India, South Korea, Bulgaria, Ukraine, Moldova, Mongolia, Andorra, Bahamas, Slovakia, Tajikistan, Uzbekistan, Australia (?) … State sponsored discrimination: Map reflects the situation in 1999

6. Historical background: laws that restrict entry and residence for PLHIV as a relict from a time passed… 30 years ago Paranoia and fears around the new disease Lack of knowledge (transmission, life expectancy, prevention, costs) “Old” public health measurements: focus on screening and control, directive, exclusionary … Border controls, mandatory HIV-testing and deportation perceived as an adequate prevention strategy

7. Wrong and discriminatory perceptions … • PLHIV behave irresponsibly, are highly infectious, spread the disease and need to get controlled • PLHIV have a short life expectancy and can’t contribute to the growth of society • PLHIV are a burden to the health care budged • PLHIV cross borders to exploit our health care systems • PLHIV are part of the problem and not part of the solution • HIV is a foreign problem that can be kept outside by border controls Remaining restrictions are discriminatory, based on fears and not on evidence

8. Australia New regulations regarding the countries health assessment process for long-term visa applicants (> 90 days) PLHIV treated similarly to other people with chronic health conditions and disabilities (no “automatic” exclusion) HIV-tests in Australia still mandatory! People applying have to satisfy the Australian authorities that they will notprejudice the access of Australian citizens to healthcare facilities be a risk to public health or safety constitute an undue cost to the Australian community.

9. Melbourne Declaration: “nobody left behind” “§1 Governments must repeal repressive laws and end policies that reinforce discriminatory and stigmatizing practices that increase the vulnerability to HIV, while also passing laws that actively promote equality.” I would have loved to see Australia to keep up with its on declaration (no mandatory HIV testing at borders!)

10. Our own expertise… Community driven research since 1999 2 surveys 1999 & 2008 (Deutsche AIDS Hilfe) • Embassies around the world (200 countries) • Data on specific regulations regarding entry/residence for PLHIV • User feedback from our website www.hivrestrictions.org Questionnaire • HIV-specific regulations short/longer term stays? • Medical examination at borders? HIV-tests? • Rules on controlling / deporting people with HIV? • Import of HIV medication for private use possible?

11. Limitations/challenges Quality of feedback received highly diverse Suspiciousness and unwillingness to provide information: “who are you and who gives you the authority…” Frequent changes in laws, regulations and application Lack of awareness by governments Incoherence/chaos between legislation and law enforcement in embassies (application forms etc. India) Contradictory information by different sources Not only Governments establish restrictions: Universities, employers, recruitment agencies etc. (user feedback: Pakistan, Thailand, Vietnam)

12. Results 200 countries included 1999: more than 100 countries with restrictions 2014: 54 countries with restrictions for long term stays (> 90 days) Only 4 countries with no information: • Bermuda, Kiribati, Sao Tome, Tuvalu

13. 17 countries deny visas for short term stays (< 90 days)

14. 13 countries categorically refuse entry for PLHIV

15. 25 countries have laws to deport PLHIV

16. Practices to exclude …. Health related questions included in visa application forms Health certificate required for work and study permits (HIV-tests mandatory) (Medical) examination by immigration officers at borders or by physicians under contract Mandatory HIV-tests at borders, before or shortly after entry Regular HIV-tests for foreigners already staying in the country (migrant workers, students) Recruitment agencies require HIV-tests ………… HIV-testing used to exclude people from ARV-treatment Testing standards violated (VCT)

17. Positive developments! 134 countries without any restrictions Growing awareness (UNAIDS task teams recommendations) Adoption of the goal to end restrictions by the UN General Assembly in 2011 Internal policies (UNAIDS/IAS): not to hold conferences at places that restrict entry for PLHIV as a powerful trigger for changes in immigration law To revise restrictions gives countries the chance to lift up their image: USA, Moldova, Namibia, Australia (?)

18. Our own advocacy Webpage: Global Database on HIV-specific travel and residence restrictions: www.hivrestrictions.org Co-author: David Haerry • Print materials: Quick Reference • guide book (DAH) • 10 editions since 1999 • 9 languages (co-author: Karl Lemmen)

19. Global Database on HIV specific travel and residence restrictions: www.hivrestrictions.org • Co-hosted by DAH, EATG, IAS, GNP+ • Detailed information on entry, residence (date and source mentioned) • Additional information on treatment options/NGOs relevant for PLHIV • User feedback included • information on criminalization of HIV transmission/exposure included

20. Future (research needs) • Comparative Studies of the impact of inclusion/exclusion of PLHIV into Public Health and prevention activities • Assessment of the contributions of migrant work force into economy growth in host countries • Cost analyses: expenditure of screening policesin relation to expected costs for treatment and care • Data on the myth around “health” tourism • Data on experiences by countries that revised restrictions • Data from industries regarding impact and damage caused

21. Further advocacy needs • Translate recommendations into action (UNAIDS Task Team, Melbourne declaration) • Shame and blame: xenophobia and discrimination as policy instrument by certain politicians • Built up coalitions: Civil society, UNAIDS, UNDP, IOM, ILO, industry (?) • Use sport events for advocacy purposes to highlight human rights violation • 2022: World Cup/Qatar (highlight HIV related deportation, exploitation and and human right violations of migrant workers • The role of recruitment agencies!

22. The perfect place for HIV related entry and residence regulations.. Acknowedgement: Karl Lemmen and David Haerry Thanks to users for providing feedback! Email: peter-wiessner@t-online.de Thank you!