Privilege: Are you restricted from Certain Countries?

A huge portion of public health is advocacy. Until HIV /AIDS concerns became my full time job, I did not think about HIV/AIDS in a life span context. Once you have HIV/AIDS, there is no medical cure and you live with this diagnosis for the rest of your life. With advancements in treatment and access to healthcare, people are able to live for the most part fulfilling lives. Unfortunately, there is an aspect to life with HIV that hinders the living process: stigma and its cousin discrimination. Stigma means that HIV negative people automatically gain this concept of privilege. Since you do not face the daily hurdles HIV positive people face, your life is easier in one respect (other forms of discrimination and  apply here as well but that would add at least 5 more pages in Word to venture into those complexities, for the sake of brevity I am just covering HIV tonight).

For an example, you have the freedom to travel. Travel is not something one would think as a privilege but there are countries who deport visitors with an HIV positive diagnosis. Entry into countries depends on a clean personal record and following the labyrinth of visa laws verbatim, but usually health history is completely irrelevant to a customs check.
However this is not the case for HIV,

According to UNAIDS, over 30 countries still have restrictions on entry. Progress has been made, and the USA’s abolition of restrictions is fairly recent.

20150918_evol_travel_900

Credit to UNAIDS 2015

While these efforts are great, there are miles to go before we sleep. Here is another map explaining the categories of restrictions.

20150918_welcomenot_900

Credit to UNAIDS, 2015

As a public health student, I see why governments would want to restrict entry to PLWHIV. The threat of an infectious disease that is known to be fatal and expensive, would motivate people to prevent that concern from entering the country. I agree that quarantine should be implemented in highly infectious conditions like ebola and tuberculosis that are transmitted by air or casual contact.

With that said, baring restrictions actually creates more problems (or stigma). Besides how attempting to track detailed medical histories with blood test in a customs takes resources (and customs are bureaucratic enough), HIV is not infectious through casual contact. HIV is transmitted through contact with blood, breast milk, semen, and vaginal secretions. HIV is not an immediate threat to unaffected citizens, unless sexual intercourse or copious bleeding occurs in the customs line (and there are bigger issues beyond HIV if that is the case). Also if you dig into the rationale behind the countries that have the highest restrictions, public health has less weight than cultural perspectives of the LGBTQ+ community and racism (the countries with highest HIV prevalence rates are all in Sub Saharan Africa. Regardless of the reasons, it does not change the fact that this is health discrimination which fuels stigma.

In case anyone is doubtful this is discrimination or why is this still a problem when most of the world is against restrictions, substitute HIV for the other health experience mentioned frequently on Eish: autism. If heaven forbid mental health restrictions start to form entry requirements, I would really have to reevaluate this global health career path since in international fields, employers need you have flexible mobility (you do not get to pick where the next outbreak takes place). Also if you think about all the reasons why people go abroad beyond work (tourism, love, school, and oh yeah volunteering), living becomes a restricting process.

People with HIV did not ask to live with a life threatening condition but from what I have seen many are thriving. We need more HIV positive individuals to work in global health. They would do a better job in my role as they actually understand what HIV is like and can connect with communities. It is hard enough to live with HIV but people with HIV should have the right to benefit from cultural exchange just like everyone else. Let’s continue to work towards an accepting world with no restrictions.

Finally to end this on a pleasant note, here is an awesome project showing how dogs are supporting HIV positive people and their efforts to live.

When Dogs Heal

References:

http://www.hivtravel.org/Default.aspx?pageId=152
http://www.bodypositive.org.nz/Pages/Travel_and_Immigration/

All the best,
Katey-Red

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