AIDS paranoia

In 1987, at the height of AIDS hysteria, the World Health Organization issued a statement denouncing the mandatory HIV testing of travellers as “ineffective, impracticable, and wasteful.”

In Canada, mandatory testing for HIV has repeatedly been rejected by community activists and public health bodies. Yet Immigration Minister Elinor Caplan announced on Sep 21 her plans for mandatory HIV screening for travellers to Canada, “to protect the health of Canadians.”

The minister’s announcement is misleading because it creates the impression that Canada does not currently screen newcomers for HIV; we do.

An immigrant or long-term visitor is required to complete forms which ask whether he or she has a serious illness. Lying about one’s health results in refused entry and potential prosecution. As well, there is a broad discretion given to immigration officers and doctors to test anyone for a variety of diseases including cancer, diabetes and HIV.

Under our current system, people with HIV are detected, and rejected as an “excessive burden” on Canada’s health resources.

The new policy doesn’t make sense, considering the current system has been in place for more than 20 years, and there is no evidence of soaring rates of HIV infection. Even if such evidence existed, it would be speculative to associate these rates with immigrants.

Historically there have been two arguments advanced for HIV testing of newcomers: first, testing newcomers will prevent or slow the spread of HIV in Canada; second, allowing HIV-positive newcomers will tax Canada’s health systems.

Halting the spread of HIV is a legitimate concern. However, the push for mandatory testing of immigrants misunderstands the means by which HIV is transmitted – which is surprising, given that the recommendation originated from Health Canada. Unlike other diseases, HIV is not easily transmitted; you can’t be infected through casual contact. HIV is spread through unprotected penetrative sex, transfusion of blood or blood products, or transmission from mother to child before or during childbirth. HIV is not cholera or yellow fever. Given these isolated and specific means of transmission, there is little risk of an outbreak of HIV in Canada due to the admission of people with HIV.

The costs of the test, as well as the personnel and resources needed to administer it, would be considerable. The World Health Organization has estimated such costs to be between US$10 and US$20 for each person tested. Given the high volume of traffic through Canada’s borders, an enormous amount of testing would have to take place, at an enormous cost.

There are many reasons why the effectiveness of testing to prevent the spread of HIV would be minimal. First of all, there is the accuracy of the HIV test itself. There is a margin of error for false positives and false negatives which would be increased in this situation, given the quality control issues inherent to a large bureaucracy such as Canada Immigration.

Compounding this reduced effectiveness is the fact that there is a window of time, approximately three months after infection, during which HIV tests will not identify a newly infected person. Immigration tests will miss people who are within this period.

Both of these factors guarantee that, testing or not, newcomers with HIV will be admitted to Canada.

Why pick on newcomers? Surely, Canadian travellers who are infected abroad and return to Canada are equally at risk of transmitting the disease to other Canadians. Any policy of mandatory testing for newcomers designed to prevent the spread of HIV must include Canadian travellers returning from abroad in order to be effective. Similarly, newborn babies are potential carriers of HIV, but we do not impose mandatory testing on newborns. We should not have a different policy for immigrants when the same risks are posed by Canadian residents. It would be difficult to shield such a policy from accusations of discrimination.

The concern that people with HIV would pose a burden on Canada’s health services is exaggerated and outdated. Today people with HIV are living longer, healthier lives with years of productivity. If people qualify for immigration to Canada based on their contribution to our economy or their significant family ties, it makes no sense to exclude them based on what is increasingly becoming a chronic but manageable disease.

The HIV prevention strategies we use for Canadian residents should be the same for newcomers: clear and culturally acceptable education about the nature of HIV, the means of transmission, and how a person can take measures to safeguard their health and the health of others.

Mandatory testing simply diverts resources from these proven techniques, while giving us a false sense of security about the risk of transmission. Ultimately, the risk of HIV transmission will depend on the behaviour, rather than the HIV status, of both Canadians and newcomers.