Travel restrictions

The government of Mauritius commits to removing the current stay and residence restrictions for people living with HIV. During a meeting with UNAIDS Executive Director Michel Sidibé in Port Louis on 18 April, Prime Minister of Mauritius Navin Ramgoolam pledged to setting up a special committee to review and make recommendations towards lifting the remaining travel restrictions in the country.

Mauritius is one of the 44 countries in the world that enforce HIV-related restrictions to entry, stay and residence for people living with HIV. Welcoming the government’s decision, Mr Sidibé stressed on the need to making sure that people have equal access to freedom of movement – regardless of their HIV status. He added HIV treatment has revolutionized the life of people living with HIV and allowed them to be productive, equal and global citizens.

Earlier in the day, Mr Sidibé met with President of Mauritius Kailash Purryag at State House in Le Réduit to discuss progress and challenges in the national AIDS response. President Purryag outlined his vision to eliminating extreme poverty which is critical to overcoming the AIDS epidemic.

In the last few years, Mauritius has made good progress in its AIDS response. In 2012, only 2 babies were born with HIV in the country and more than 95% of pregnant women living with HIV were accessing treatment. An estimated 11 000 people were living with HIV in Mauritius in 2012 – an increase from 7 300 in 2001. The HIV epidemic in Mauritius is concentrated among people who inject drugs. In 2011, it was estimated that 10 000 people were injecting drugs in Mauritius – 51.6% of people who inject drugs were living with HIV in 2012.

Mr Sidibé commended the government of Mauritius for its leadership and efforts in making an AIDS-free generation a reality. Mr Sidibé also applauded Mauritius for successfully implementing harm reduction programmes in prison settings for people who inject drugs.

According to government figures, HIV infection among people who inject drugs has started to decline from 73% in 2010 to 68% in 2011 due to innovative programmes which provide free syringes and needles as well as opioid substitution therapy.

During his visit, Mr Sidibé also met with the Minister of Foreign Affairs, the Minister of Health, and representatives from the Indian Ocean Commission and civil society to take stock of the AIDS response in Mauritius. The discussions focused particularly on provision of HIV prevention and treatment services to key population at risk of HIV, stigma reduction and equity in the AIDS response, as well as applying regional approach to the AIDS response in the Indian Ocean islands.

GENEVA, 28 March 2014—UNAIDS welcomes the recent lifting of all restrictions on entry, stay and residence for people living with HIV in Tajikistan. The amendments to the Law on HIV/AIDS were signed by the President of Tajikistan Emomalii Rahmon, on 14 March 2014.

Restrictions that limit an individual’s movement based solely on HIV-positive status are discriminatory and violate human rights. There is no evidence that such restrictions protect public health or prevent HIV transmission. Furthermore, HIV-related travel restrictions have no economic justification, as people living with HIV can lead long and productive working lives.

Tajikistan’s updated law removes mandatory HIV testing for all foreigners, including the personnel of foreign missions, refugees and stateless people. With these changes, all HIV-related restrictions on entry, stay and residence are eliminated in Tajikistan. UNAIDS will continue to work with Tajikistan to support a comprehensive and human rights-based response to the HIV epidemic.

With the removal of Tajikistan’s restrictions, UNAIDS counts 40 countries, territories, and areas that impose some form of restriction on the entry, stay and residence based on HIV status. 

No travel restrictions in Andorra and Slovakia confirmed.

GENEVA, 21 October 2013—The Joint United Nations Programme on HIV/AIDS (UNAIDS) welcomes the recent lifting of all restrictions on entry, stay and residence for people living with HIV in Uzbekistan. The reforms were passed by Parliament in August of 2013 and signed by the President of Uzbekistan, Islam Karimov, on 23 September 2013.

“I welcome this important milestone in Uzbekistan and I hope this will encourage other countries to take similar action towards a world with zero HIV-related stigma and discrimination,” said the Executive Director of UNAIDS, Michel Sidibé.

UNAIDS advocates for the right to equal freedom of movement—regardless of HIV status. There is no evidence that restrictions on the entry, stay or residence of people living with HIV protect the public’s health.

As part of its on-going dialogue with countries on this issue, in July 2013, UNAIDS sent official communications to all countries, territories and areas that appeared to have HIV-related entry, stay and residence restrictions. Through this exercise, new information was received from Andorra and the Slovak Republic, indicating that there are no HIV-related restrictions in these countries. 

With the removal of Uzbekistan’s restrictions, and confirmation that there are no restrictions in Andorra and Slovakia—UNAIDS counts 41 countries, territories, and areas that impose some form of restriction on the entry, stay and residence based on HIV status. These include: Aruba, Australia, Bahrain, Belarus, Belize, Brunei Darussalam, Comoros, Cuba, Cyprus, Democratic People’s Republic of Korea, Dominican Republic, Egypt, Iraq, Israel, Jordan, Kuwait, Lebanon, Lithuania, Malaysia, Marshall Islands, Mauritius, New Zealand, Nicaragua, Oman, Papua New Guinea, Paraguay, Qatar, Russian Federation, Samoa, Saudi Arabia, Singapore, Solomon Islands, Sudan, Syrian Arab Republic, Chinese Taipei, Tajikistan, Tonga, Turkmenistan, Turks and Caicos Islands, United Arab Emirates and Yemen. 

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners to maximize results for the AIDS response. Learn more at unaids.org and connect with us on Facebook and Twitter.

Global leaders oppose policies as discriminatory and bad for business

GENEVA/NEW YORK, 28 November 2012—This World AIDS Day, Chief Executives (CEO’s) from some of the world’s largest companies are calling for an end to travel restrictions for people living with HIV. More than 40 CEOs have signed an unprecedented pledge urging the repeal of laws and policies in 45 countries that still deport, detain or deny entry to people solely because they are living with HIV.

The CEOs represent nearly 2 million employees in industries from banking to mining, travel to technology. They include companies like Johnson & Johnson, The Coca-Cola Company, Pfizer, Heineken, Merck, the National Basketball Association, Kenya Airways and Thomson Reuters.

“HIV travel restrictions are discriminatory and bad for business,” said Chip Bergh, President & CEO of Levi Strauss & Co. “Global business leaders are coming together to make sure we end these unreasonable restrictions.”

The CEO pledge is an initiative of the Joint United Nations Programme on HIV/AIDS (UNAIDS), Levi Strauss & Co. and GBCHealth, a coalition of companies that address global health challenges.

“Restrictions on entry, stay and residence for people living with HIV are discriminatory and a violation of human rights,” said Michel Sidibé, Executive Director of UNAIDS. “Every individual should have equal access to freedom of movement. I urge all countries to remove all such restrictions based on HIV status.”

CEOs oppose HIV travel restrictions because they are discriminatory and because to succeed in today’s globalized economy, companies must be able to send their employees and best talent overseas, regardless of their HIV status.

“It’s time to send HIV travel restrictions packing,” said Kenneth Cole, CEO of Kenneth Cole Productions. “Using our collective might, I believe we can use our influence to eliminate these discriminatory practices."

The United States of America lifted its 22-year HIV travel ban in 2010. Other countries, including Armenia, China, Fiji, Moldova, Namibia and Ukraine, have also recently removed such restrictions. However, 45 countries still deny entry, stay, residence or work visas for people living with HIV. These countries include major hubs for international business.

“Travel restrictions on individuals with HIV are unnecessary and hinder the ability for individuals and companies to operate in a truly global workforce,” said Mark Bertolini, Chairman, CEO & President of Aetna.

Most HIV-travel restrictions were imposed by governments in the 1980s when less was known about the transmission of HIV, and treatment didn’t exist. Since then, we’ve learned how to effectively prevent, manage and treat HIV.

Travel restrictions vary in different countries and can include preventing people living with HIV from entering altogether or deporting foreigners once their HIV status is discovered. Restrictions also include denying work visas, prohibiting short-terms stays for business trips or conferences and blocking longer-term stays or residence for work relocations and study abroad programs.

The CEO call to end HIV-related travel restrictions, first launched at the 2012 International AIDS Conference in Washington, D.C., comes on the eve of Secretary of State Hillary Rodham Clinton’s release of a blueprint that outlines the goals and objectives for the next phase of the United States’ effort to achieve an AIDS-Free Generation.    

“Eliminating HIV travel restrictions is a win-win,” said GBCHealth Managing Director and Co-President Michael Schreiber.  “It’s the right thing to do from a humanitarian perspective and the right thing to do from a business perspective.”

Participating CEOs:

Aigboje Aig-Imoukhuede, Group Managing Director/CEO, Access Bank Plc;  Mark Bertolini, Chairman, CEO and President, Aetna; Cynthia Carroll, Chief Executive, Anglo American plc; Vincent A. Forlenza,  Chairman of the Board, CEO and President, BD; Debra Lee, Chairman & CEO, BET Networks;  Andy Burness, President, Burness Communications; Lamberto Andreotti, CEO, Bristol-Myers Squibb Company; Muhtar Kent, Chairman of the Board and CEO, The Coca-Cola Company;  Richard Edelman, President & CEO, Edelman;  Mark R. Kramer, Founder and Managing Director,  FSG;  Glenn K. Murphy, Chairman and CEO, Gap Inc.; Jonathan D. Klein, CEO and Co-Founder, Getty Images;  John C. Martin, PhD, Chairman and CEO, Gilead Sciences, Inc.;  Karl-Johan Persson, CEO, H&M Hennes & Mauritz AB;  Dr. Chris Kirubi, Chairman, Haco Tiger Brands;  Jean-Francois van Boxmeer, Chairman of the Executive Board/CEO, HEINEKEN NV;  Victor Y. Yuan, Chairman, Horizon Research and Consultancy Group;  Bong Yong Dam, CEO, Hub One International Company Ltd;  Jena Gardner, President & CEO, JG Black Book of Travel;  Alex Gorsky, Chief Executive Officer, Johnson & Johnson;  Kenneth Cole, CEO, Kenneth Cole Productions; Dr .Titus Naikuni, MD and CEO, Kenya Airways Ltd;  Chip Bergh, President & CEO, Levi Strauss & Co.;  Kaushik Shah, CEO/Director, Mabati Rolling Mills Ltd;  Kenneth C. Frazier, Chairman and CEO, Merck;  Heather Bresch, CEO, Mylan; David J. Stern, Commissioner, National Basketball Association (NBA); Blake Nordstrom, President, Nordstrom, Inc.;  Ji Yong, General Manager, Northeast Pharmaceutical Group Co., Ltd; Douglas A. Michels, President & CEO, OraSure Technologies, Inc.; Ian C. Read, Chairman and CEO, Pfizer Inc.; Tzameret Fuerst, CEO, Prepex;  Bob Collymore, CEO, Safaricom; Hiromasa Yonekura, Chairman, Sumitomo Chemical;  Liam E. McGee, Chairman, President and CEO, The Hartford;  James C. Smith, CEO, Thomson Reuters; Mikkel Vestergaard Frandsen, CEO, Vestergaard Frandsen;  Philippe Dauman, President & CEO, Viacom; Richard Branson, Founder, Virgin Unite;  Melissa Waggener Zorkin, CEO, President & Founder, Waggener Edstrom Worldwide;  Andy Payne, CEO, Wilderness Holdings Ltd;  David Sable, CEO, Y&R;  William H. Roedy, AIDS Activist and former Chairman, MTVN International

The Haitian civil society organization SEROvie was one of the 10 community-based organizations who won a Red Ribbon Award this week for its work in the prevention of sexual HIV transmission.

During its 14 year existence the group has repeatedly switched strategy. First they cast themselves as HIV educators, raising awareness everywhere from schools to church groups. Gradually they began talking gender, explaining to Haitians how prejudice and power-dynamics upped some people’s HIV risk. This ground-work was necessary to venture where they really wished to work—with the neglected gay, bisexual, sex worker and transgender communities.

“There was nothing for them then,” reflects executive director Steeve Laguerre. “Before we started, the men who have sex with men (MSM) didn’t know where to go to get HIV services. When they went to the usual sites they were not welcome at all so they were afraid to go. They were dying at home, alone.”

SEROvie conducts HIV prevention, health referrals, and psychological and social support, as well as home-based care visits, vocational training and a micro-credit programme. Today, 10% of the organization’s 4 000 beneficiaries are living with HIV and are accessing antiretroviral treatment and connecting with others through support group systems. Over the years SEROvie has fostered relationships with a range of community-friendly services. These are places where MSM and transgender people can get non-judgmental care along with information that is relevant to their lives. For Laguerre the key to serving this hard-to-reach community is, above all else, listening.

“We had to learn not to impose activities, interventions and services that we thought were a good idea. You need to listen to the community. Your programme interventions need to come from them and then you will be successful. What we did at first was think to ourselves ‘Let’s have such and such training. I am sure they need it’. Then you are asking yourself why they are not showing up,” Laguerre reasons.

It’s through this approach that the organization came up with its most recent incarnation. Today SEROvie supports the development of a lesbian gay, bisexual and transgender (LGBT) network throughout Haiti while providing MSM with education opportunities and job training. One man might want help to pursue a degree. Another may wish to set up a hairdressing service in his village. Some would like to fix computers, cook or drive cars. More than 500 persons have been trained in this way. But what do hairdressing and driving have to do with HIV?

“We were providing sensitization regarding HIV and sexually transmitted infections (STIs) and then we asked ‘What’s next?’ We asked the men and they said ‘We are not working. We would like to work’,” Laguerre recounts. By empowering the community economically, the men are more empowered about their sexual decision-making as the vulnerabilities MSM face everywhere are intensified by poverty.

Asked what advice he would offer other Caribbean non-governmental organisations (NGOs) on pressing the political class for action on behalf of marginalized and vulnerable groups, Laguerre stresses the importance of obstinate persistence.

“It takes constant work to build a relationship. You need to invite them within the institution so they can see what exactly you are doing. You need to send reports to them. You have to force communication with them,” he says.

That strategy is paying off. Recently Haiti’s Ministry of Health approved funding and asked SEROvie to help them implement activities for the LGBT community and sex workers in ten districts throughout the country.

“That,” Laguerre says with a satisfied smile, “is a first.”

Ten community-based organizations, which have shown exceptional and inspiring action on AIDS were honoured with the 2012 Red Ribbon Award in a special session of the XIX International AIDS Conference (AIDS 2012) on Wednesday. The Red Ribbon Award is the world's leading award for innovative and outstanding community work in the response to the AIDS epidemic.

L to R: Co-moderators of the satellite session on HIV travel restrictions Dr Paul De Lay, UNAIDS Deputy Executive Director, Programmes and Professor Myongsei Sohn, Dean of the School of Public Health at Yonsei University.

As he opened the satellite session on HIV Travel Restrictions: Latest Developments, UNAIDS Deputy Executive Director, Programmes and co-moderator of the panel, Dr Paul De Lay said “It is fitting that one of the first satellites at AIDS2012 is one on travel restrictions.   We would not be here today if the US government had not lifted its HIV-related restrictions on entry, stay and residence in January 2010.”

Co-hosted by UNAIDS and the Korean Center for Disease Control and Prevention, the satellite aimed to hear new developments in Korea about their own restrictions as well as to take stock of where the global situation of travel restrictions stands some 30 years into the epidemic.

“It is very meaningful and significant that there are still many innocent people who have been denied their basic human rights just because they live with HIV,” said Kim Bong-hyun, Deputy Minister for Multilateral and Global Affairs, Ministry of Foreign Affairs and Trade of the Republic of Korea in his keynote speech. “I am pleased to state, on behalf of my government, that the Republic of Korea has no HIV-specific travel restrictions under the Immigration Control Act and its implementing regulations. Lifting travel restrictions is a small step on our long journey to realize a society where there is no discrimination against people with HIV,” he added.

With the announcement of the Republic of Korea , there are 8 countries that have lifted their restrictions since 2010. However, some 45 countries, territories and areas still continue to employ some form of restriction on the entry, stay and residence of people living with HIV (“HIV-related travel restrictions”).

The momentum to remove remaining restrictions is growing.  Helga Ying, Senior Director of Worldwide Government Affairs and Public Policy at Levi Strauss & Co., described an initiative by UNAIDS, in partnership with the Global Business Coalition on Health, in which some 24 CEOs have signed a pledge against HIV-related restrictions on entry, stay and residence.  “Globalized travel and relocation have become routine; companies need to move their best talent where they need them. These restrictions hurt not only individuals but also businesses,” said Ms Ying. The goal of the initiative is to get 100 CEOs to sign the pledge by World AIDS Day 2012.  “Everyone can make a difference and businesses can too,” added Ms Ying.

Participants at the satellite also heard the experience of Ukraine in removing its restrictions.  Dr Marina Zelenska, Head of HIV/AIDS Department, State Service for Social Diseases of Ukraine described how, in 2010, the country decided to change the law to ensure that it provided legal and social protection of people living with HIV and prevented discrimination.  Part of that law reform was to remove the provision banning HIV positive people from entry.

George Bartolome of United Western Visayas, a support group of people living with HIV from Central Philippines, presented a powerful personal story of how travel restrictions had been applied against him as a migrant worker in Saudi Arabia. When he was told he was HIV-positive, he was so shocked that when he stepped out into the street, he was hit by a car.  Later he was taken to a hospital and locked in a room for 10 days before he was deported.  “It was a horrible experience; I would not wish it to happen to anyone else.  It was traumatic.”   He recommended that all governments remove such restrictions. “HIV is not a reason for deportation.”

Another key issue discussed at the session was the large numbers of migrant workers who are either subjected to pre-departure and post-arrival mandatory HIV testing or summarily deported when found infected in the country of destination—without informed consent, counselling or confidentiality. Malu Marin of Action for Health Initiatives (ACHIEVE), Inc./CARAM Asia highlighted that such restrictions make even less sense with the significant advancements in HIV treatment which renders people living with HIV long-lived and productive citizens as well as non-infectious.

At this historic moment of the return to of the International AIDS Conference to the United States, the satellite helped to galvanise further action on and attention to the issue of HIV travel restrictions, with the acknowledgement that there are 45 countries to go.  UNAIDS committed to support these governments to remove such restrictions and ensure that all countries have effective and rights-based approaches to HIV.

UNAIDS Executive Director Michel Sidibé and President Ratu Epeli Nailitikau engage in discussion during ICAAP 10.
Credit: UNAIDS/Kim

In a meeting with the President of Fiji on 27 August, UNAIDS Executive Director Michel Sidibé commended the Fijian leader and his Government for recent amendments to the country’s 2011 HIV/AIDS Decree. Officially endorsed on 25 August, the amendments remove HIV-related travel restrictions and ensure greater protection for the rights of people living with HIV.

“Mr President, the United Nations salutes the bold and clear decision of your Government earlier this week to lift all travel restrictions for people living with HIV,” said Mr Sidibé. “People around the world need a voice like yours. I want to sincerely thank and recognize your efforts in the global response to AIDS.”

Calling AIDS “a great humanitarian challenge,” President Ratu Epeli Nailitikau said he was committed to not only preventing new HIV infections but also to working with people living with HIV and their families.

“I don’t see any nobler cause than AIDS,” said President Nailitikau. “In the history of Fiji, we lost a third of our population due to measles; whole generations of the community perished. The flu had the same devastating effect. With a population of just 800 000, we cannot afford to lose any more of our population. That, for me, is the driving force of my engagement.”

The UNAIDS office in the Pacific is currently working with the Government of Fiji to translate the recommendations from the June 2011 UN General Assembly High Level Meeting on AIDS into action. Key areas of focus include eliminating new HIV infections among children, ensuring HIV services for key affected populations are available, and implementing the newly-amended Fijian HIV/AIDS Decree.

According to government figures, coverage of services to prevent new HIV infections in children in Fiji is low. Though there has been progress in expanding HIV services for populations at higher risk of HIV infection, stigma and discrimination remain major barriers to access.

While at ICAAP 10, the President of Fiji chaired a session focused on the AIDS response in the Pacific region. Participants addressed the role of faith-based organizations and young people in the HIV response, as well as the importance of providing an enabling legal environment to protect the rights of people living with and affected by HIV.

Migrant worker Sarath shares his experiences with the panel.
Credit: UNAIDS/Kim

There are still about 50 countries, territories and areas around the world that impose some form of restriction on the entry, stay and residence of people living with HIV. Such restrictions remain a key form of discrimination, affecting the rights and freedom of movement of many migrants living with HIV and would-be migrants.

A symposium held at the 10^th International Congress on AIDS in Asia and the Pacific on 27 August brought together expert panellists from various countries with and without HIV-related travel restrictions to discuss the experiences faced by migrant workers and by public health systems. Their aim was to put forward recommendations and concrete policy actions needed to eliminate travel restrictions for migrants living with HIV.

Organized by the Joint United Nations Initiative on Mobility and HIV/AIDS in South East Asia (JUNIMA) and sponsored by UNAIDS, UNDP and ILO, the panel was chaired by Clifton Cortez, the UNDP Practice Team Leader on HIV, Health and Development for Asia and the Pacific.

“HIV is not a condition that should determine whether you are allowed to work or not; however, some 15 countries in Asia and the Pacific impose some form of restriction on the entry, stay and residence of people living with HIV. We surely can be better than that,” said Mr Cortez.

Mr Cortez was joined by Dr Chanvit Tharathep, Thailand’s Ministry of Public Health, Ms Maria Lourdes Marin, Executive Director, Action for Health Initiatives (ACHIEVE), Inc. Philippines, and Dr Lee Hang-Sun from the Ministry of Public Health in South Korea.

Sarath, as a migrant worker, shared experience of the limitations imposed by travel restrictions with the panel: “Testing for HIV and deportation of people who test positive makes no sense neither from a public health perspective nor from a financial point of view. We generate a lot of economic benefits to both sending and host countries and usually fall between the cracks in accessing social services, especially when we are abroad.”

Reintegration of migrants

Ms Marin talked about the reintegration process when migrants deported for their HIV status return home. This is a real issue for the Philippines which sends large numbers of migrants overseas.  

“The reintegration process must be needs-based and responsive to specific contexts of migrants. It needs to be holistic, and address all the dimensions of HIV such as economic, political and psychosocial,” said Ms Marin. “To do that you need to have discussions taking into account all phases of the migration cycle, including pre-departure and post-arrival.”

Some countries hold that HIV-related travel restrictions are imposed to protect their nationals from ‘foreign’ diseases and to avoid increased healthcare costs.  This rationale was refuted by Dr Chanvit from Thailand, a country which does not impose HIV-related travel restrictions:

“By providing universal access to health care for all, including migrants, we have not experienced an overflow of the health care system by migrants. What we have seen however is that we are better able to control infectious diseases and give treatment and care to those that need it.”

Dr Lee shared the South Korea experience: “Some people in South Korea still believe that HIV is a virus that comes from abroad. I hope ICAAP will give us the opportunity to join hands with civil society and work together on addressing the misconceptions regarding HIV.”

The way forward

The panel explored a series of recommendations to eliminate HIV-related travel restrictions and to promote universal access for migrant workers living with HIV. These included:

• Harmonize national policies on HIV and migration, promote collaboration between relevant ministries and civil society groups and support sustained bilateral and multi-country dialogues between sending and receiving countries;
• Establish minimum labour standards and health rights for migrant workers, and ensure that there are protection and support systems for migrants in destination countries;
• Build the capacity of Asian source countries to effectively reintegrate returning migrant workers living with HIV.

JUNIMA brings together governments (including ASEAN Secretariat), leading NGO networks, and the United Nations family, to promote universal access to HIV prevention, treatment, care and support for migrant workers in South East Asia and southern China.

(Left to Right): Paul De Lay, UNAIDS Deputy Executive Director; Ms. Rosilyne Borland, HIV and Health Promotion Coordinator, IOM; Ambassador William Lacy Swing, Deputy General, IOM; Mr. Udo Janz, Director of UNHCR New York; Dr. Sophia Kisting, Director, ILO/AIDS; at Migration and HIV event, held at UN Headquarters, NYC, on June 10, 2011.
Credit: UNAIDS/B. Hamilton

For the world’s 214 million international migrants and 740 million internal migrants the sometimes challenging conditions of the migration process can leave them vulnerable to HIV infection. Yet, even with the increasing interest in the health and human rights of this key group, the links between migration, population mobility and HIV are still not widely understood.

During the General Assembly High Level Meeting on AIDS in New York governments, civil society partners and intergovernmental agencies came together to explore the relationship between migration and the AIDS epidemic and to examine ways of increasing access to HIV services for people on the move.

The side-event, on 10 June, was sponsored by the International Organization for Migration (IOM), the International Labour Organization (ILO), the UN High Commissioner for Refugees (UNHCR) and UNAIDS.

Ambassador William Lacy Swing, IOM’s Director General and Dr Paul De Lay, UNAIDS Deputy Executive Director, Programme, co-hosted the event. This follows the signing of a revised cooperation of agreement between the two organizations in January this year. The agreement addresses the potential vulnerability of migrants to HIV and strengthens efforts to integrate migrants and mobile populations into AIDS policies and programmes at national, regional and international levels.

“We must harness the benefits of migration for migrants and states, by ensuring migrants can access HIV prevention, care, treatment and support services,” said Ambassador Swing.

Dr De Lay raised an issue which many ‘people on the move’ face on a daily basis: discrimination. He spoke of the need to vigorously challenge discrimination directed at migrants, and would-be migrants, which prevents freedom of movement. These include the HIV-related entry, stay and residency restrictions in some countries. “Every individual should have equal access to freedom of movement regardless of HIV status. UNAIDS opposes restrictions that single out HIV for special treatment and that restrict movement based on HIV status only. Such restrictions are discriminatory,” he said.

Best practices

The side-event emphasized the importance of sharing best practices and lessons learned by governments and civil society on managing migration and HIV and ensuring the rights of migrants to access health and social services.

It was acknowledged that while mobility in and of itself does not necessarily result in increased health risks, the sometimes challenging conditions of the migration process—before migration, during movement, in destination communities and upon return—may impact the health of migrants and make them more vulnerable to the virus.

International commitments

The meeting explored progress on a number of international commitments and policy frameworks such as sections of the 2001 UNGASS Declaration of Commitment on AIDS which facilitate access to HIV programmes for migrants and mobile workers.  

Migration-related aspects of the ILO Recommendation on HIV and AIDS and the World of Work, 2010 (No 200) were also discussed. Dr Sophia Kisting, Director of ILO/AIDS, stressed that stigma and discrimination, difficult working conditions and long separation from their families and cultures increase migrant workers’ vulnerability to HIV. “For these reasons, the Recommendation makes special mention of migrant workers.  It calls on countries of origin, transit and destination to take measures to ensure access to HIV prevention, treatment, care and support services for such workers,” she said.

In its Technical cooperation projects, the ILO has promoted an integrated approach involving a variety of actors, such as government, recruitment agencies and trades unions. Programmes in Indonesia, Nepal and Sri Lanka have shown the usefulness of this approach and succeeded in including HIV in pre-departure training for labour migrants and initiating policy dialogue between sending and receiving countries.

Addressing such issues is of key importance given that, for example, according to Sri Lanka’s national AIDS committee, some 30-40% of women in Sri Lanka who test positive for HIV have returned home after living in the Middle East.

Udo Janz, Director of UNHCR New York Office, welcomed the chance afforded by the side-meeting to consolidate gains made and chart future action in ensuring migrants and mobile populations, including those forcibly displaced, are provided with HIV services.    

UN General Assembly High Level Meeting on AIDS

Thirty years into the AIDS epidemic, and 10 years since the landmark UN General Assembly Special Session on HIV/AIDS, the world has come together to review progress and chart the future course of the global AIDS response at the 2011 UN General Assembly High Level Meeting on AIDS from 8–10 June 2011 in New York. Member States are expected to adopt a new Declaration that will reaffirm current commitments and commit to actions to guide and sustain the global AIDS response.

A version of this story first appeared in 2010 UNAIDS OUTLOOK report

For many of the millions of people living with HIV around the world, travel restrictions are a daily reminder that they do not have the freedom to move internationally—or, even worse, that they may have to leave the place they call home.

Some 49 countries, territories and areas currently impose some form of travel restriction on the entry, stay and residence of people based on their HIV status.

When Mark Taylor,* a Canadian citizen working for a company in New York’s financial sector, fell in love with his life in the Big Apple, he never gave it a second thought to apply for permanent residency in the United States of America. It was 1995 and he was thriving both professionally and personally.

“My new employer said it would sponsor my permanent residency, and we began the process of obtaining all of the required approvals,” Mr Taylor said.

In early 2002, with his residency paperwork completed, Mr Taylor was advised to have a medical exam in Canada to speed up the process.

“When I went to pick up the results, I was told that the HIV test had come back positive. As you might expect, I was devastated. I had been HIV negative the last time I took the test in Canada. Not only did I have to worry about my health and well-being, but I was sure that I would be forced to leave New York, my job and all the friends I had there. I immediately sank into a deep depression, feeling hopeless and helpless.”

For the 22 years the USA had a travel ban on people living with HIV. Life stories like Mr Taylor’s were not uncommon. It started in 1987, when the USA added HIV infection to a list of conditions making a person ‘medically inadmissible’, effectively banning people living with HIV from the country. It was a hardship imposed on many people.

“A huge range of frustrations and ridiculous restrictions weighed on people’s abilities to visit the United States, to do business in the United States, to see family, to see friends and to go to weddings or funerals,” said the Executive Director of Immigration Equality, Ms Rachel Tiven.

Over the years her not-for-profit organization received an average of 1500 phone calls each year on its hotline, a quarter with questions about HIV travel restrictions.

“People called us to say,” she said “I am at JFK Airport and they found my meds when I went through customs and they are telling me I have to get back on the plane—is that true?”

Too often it was true. People would have to get back on the airplane. For the United Nations General Assembly High-level Meeting on AIDS held in 2006 in New York a special waiver had to be sought for delegates living with HIV to visit the country to participate. It’s one of the reasons that the Executive Director of UNAIDS, Michel Sidibé, made lifting travel restrictions a priority.

“To not be able to participate in the very discussions about your future is not acceptable,” he said. “Everyone should have equal freedom of global movement,” he added.

Ms Tiven added, “It’s simply not an effective way to limit the spread of the virus. We know that it is not just rhetoric. It is good public health practice for people to know their status and to seek treatment, to be clear about their status with the people they are intimate with, and  to not make travel restrictions the reason people don’t test to find out their status or not disclose their HIV status.”

It’s this very situation that Mr Taylor found himself in—he didn’t take routine HIV tests in the USA and in the end feels fortunate to have taken the test in Canada, where under the law his results could not be released to anyone without his consent. Mr Taylor put on hold his hope for permanent residency, but learned he could remain in the USA on his existing visa for an extended period of time. It was good news, but with a caveat.

“I could only remain in the USA if I was employed by my sponsoring company. During the turbulent times in the financial industry in the past eight years, I always feared that I was one round of layoff s away from having to leave the country,” he said.

While Mr Taylor sought medical care and counselling, he believes his career suffered significantly. He tried to live as normal a life as possible, but always felt he was one misfortune away from having to leave the life he had established.

“I was reluctant to disagree or challenge colleagues on business matters. I always had the underlying fear that I could not do anything that might jeopardize my job,” he added. “During this time I also became involved in a serious relationship, and the thought of being torn away from my partner was a source of even more anxiety.”

Some 49 countries, territories and areas currently impose some form of travel restriction on the entry, stay or residence of people based on their HIV status. The International Guidelines on HIV/AIDS and Human Rights state that any restriction on liberty of movement or choice of residence based on suspected or real HIV status alone, including HIV screening of international travellers, is discriminatory.

International commitment to the issue is growing. In October 2009, the United Nations Human Rights Council adopted a resolution calling for the elimination of restrictions. The Inter-Parliamentary Union at its 186th session in April 2010 adopted a statement to encourage “parliamentarians in countries with restrictions to play a leading role in their elimination, by reforming laws and by monitoring the regulations, policies and practices of relevant authorities in their countries. It urges parliamentarians to advocate for the right of their citizens living with HIV to have equal freedom of movement and to press senior officials in their governments to take up the issue with countries that have such restrictions.”

China lifted its travel ban on people living with HIV just days before the opening of the Expo 2010 Shanghai. Justice Edwin Cameron of the South African Constitutional Court, who is living with HIV, had travelled to China twice in the previous 18 months to and met with government officials to discuss the travel ban.

“I am particularly delighted to hear of this decision, as the visa restrictions were illogical. They nearly led to the cancellation of my last trip to China because of a misunderstanding between government departments. I am relieved this will never happen again to anyone living with HIV,” he said.

In early 2009, with signs of movement towards regulatory changes in the USA, Mr Taylor decided to reactivate his application for permanent residency. It was a risky roll of the dice, as he was betting that new regulations would be in place by the time his application made it through the system.

“Throughout the year, I followed the regulatory process closely. I would check the government web sites obsessively throughout the day for any new news,” he said.

The news came in late 2009—the USA lift ed its entry, stay and residence ban, with President Barack Obama saying at the press conference, “If we want to be a global leader in combating HIV/AIDS, we need to act like it.”

It’s an announcement Mr Taylor remembers well, “I breathed a sigh of relief that had been pent up for over six years. A few weeks later, I received notification that my application had been approved, and a week later my permanent resident card appeared in the mail.”

And for organizations like Immigration Equality it means a shift towards outreach and to educating the public about the repeal. The organization will also monitor its implementation in the USA to ensure that all people living with HIV can enjoy the positive impact of the lifting of the ban.

And for Mr Taylor the announcement came just as he accepted a buy-out severance package from his company. He now has the freedom to think about what to do next in New York.

Mr Taylor added, “I finally feel like everyone else.”

* Some names have been changed.