Global Overview of HIV-related Restrictions on Entry, Stay and Residence Steven J Kraus Director, UNAIDS Regional Support Team for Asia and the Pacific 7 th IAS Conference on HIV Pathogenesis, Treatment and Prevention 2 July 2013

What are HIV-related restrictions on entry, stay or residence (“travel restrictions”)? Restrict entry, stay, work and/or residence based on HIV status only Single out HIV for negative consequences (making them discriminatory) Apply a blanket restriction against all people living with HIV (making them unreasonable) Can be a law, regulation, policy or practice

What are HIV-related travel restrictions? (continued) Not a new issue – most put in place in the 1980s, a time of fear, ignorance and prejudice about HIV Governments cite two reasons:  To protect public health (“keep HIV out”)  To avoid costs associated with care, support and treatment for people living with HIV

Examples of restrictions Mandatory HIV testing and requirement to show HIV-negative status in order to get visa to enter or stay Requirement to disclose HIV status on visa application forms and/or apply for special “waivers” due to HIV status Sometimes applied to certain categories of people: e.g. Africans, students, entertainers Detention or deportation of HIV-positive non- nationals on basis of HIV status

Examples of impact Company cannot post employee in certain countries Person subject to testing in home country or destination country without counselling, informed consent, confidentiality Economic loss, job loss, study loss Loss of dignity, emotional distress Detention, sometimes without treatment Summary deportation without due process or economic fairness Denial of asylum, family unification

131 countries, areas have no HIV-specific restrictions 44 countries, areas have some form of restriction (see below); Current state of restrictions 1. Andorra17. Kuwait33. Slovakia 2. Aruba18. Lebanon34. Solomon Islands 3. Australia19. Lithuania35. Sudan 4. Bahrain20. Malaysia36. Syrian Arab Republic 5. Belarus21. Marshall Islands37. Chinese Taipei 6. Belize22. Mauritius38. Tajikistan 7. Brunei Darussalam23. New Zealand39. Tonga 8. Comoros24. Nicaragua40. Turkmenistan 9. Cuba25. Oman41. Turks and Caicos Islands 10. Cyprus26. Papua New Guinea42. United Arab Emirates 11. Democratic People’s Republic of Korea 27. Paraguay43. Uzbekistan 12. Dominican Republic28. Qatar44. Yemen 13. Egypt29. Russian Federation 14. Iraq30. Samoa 15. Israel31. Saudi Arabia 16. Jordan32. Singapore

131 countries, areas have no HIV-specific restrictions 44 countries, areas have some form of restriction (see below); Current state of restrictions 1. Andorra17. Kuwait33. Slovakia 2. Aruba18. Lebanon34. Solomon Islands 3. Australia19. Lithuania35. Sudan 4. Bahrain20. Malaysia36. Syrian Arab Republic 5. Belarus21. Marshall Islands37. Chinese Taipei 6. Belize22. Mauritius38. Tajikistan 7. Brunei Darussalam23. New Zealand39. Tonga 8. Comoros24. Nicaragua40. Turkmenistan 9. Cuba25. Oman41. Turks and Caicos Islands 10. Cyprus26. Papua New Guinea42. United Arab Emirates 11. Democratic People’s Republic of Korea 27. Paraguay43. Uzbekistan 12. Dominican Republic28. Qatar44. Yemen 13. Egypt29. Russian Federation 14. Iraq30. Samoa 15. Israel31. Saudi Arabia 16. Jordan32. Singapore

Map of HIV-related restrictions on entry, stay and residence as of January 2013

Travel Restrictions are irrational Do not protect public health (can harm it by creating false perception that government policy keeps HIV outside therefore no need to take precautions); do not “keep HIV out” HIV is not contagious and people can protect themselves The world is “smaller” and movement more important HIV treatment = long, productive lives HIV treatment = being non-infectious

Policy and human rights considerations Countries can exclude entry based on proof of becoming undue economic burden However, every individual should have equal access to freedom of movement within countries, and the right to non-discrimination on grounds of health status is increasingly being considered relevant to countries’ requirements for entry, stay and residence. Humanitarian concerns should always supersede economic considerations.

Towards “Zero Discrimination”: momentum to eliminate HIV-related travel restrictions WHO, UNAIDS, IOM and the Global Fund have called for removal In 2011 Resolution, Human Rights Council At AIDS2012, global business leaders issued a call for the elimination of restrictions (over 50 of world’s largest companies have signed on) Since 2010, 9 countries have lifted travel restrictions: Armenia, China, Fiji, Namibia, Republic of Moldova, Mongolia, Republic of Korea, Ukraine, and the United States of America

In the 2011 Political Declaration on HIV, governments of 192 Member States committed to: “identifying and reviewing any remaining HIV-related restrictions on entry, stay and residence so as to eliminate them.” Commitments to remove restrictions by 2015

UNAIDS Advocacy and Action Toolkits Two toolkits to support multi-sectoral coalitions to engage in advocacy and action to eliminate HIV-related restrictions on entry, stay and residence: In your own country In migrant receiving countries

Global Commission on HIV and the Law Recommendations included: In matters relating to HIV and the law, countries should offer the same standard of protection to migrants, visitors and residents who are not citizens as they do to their own citizens. Countries must repeal travel and other restrictions that prohibit people living with HIV from entering a country and/or regulations that mandate HIV tests for foreigners within a country. Countries must implement regulatory reform to allow for legal registration of migrants with health services and to ensure that migrants can access the same quality of HIV prevention, treatment and care services and commodities that are available to citizens. All HIV testing and STI screening for migrants must be informed and voluntary, and all treatment and prophylaxis for migrants must be ethical and medically indicated. 14 eminent world leaders. 18 months of evidence-gathering and analysis.

Role of scientists and the medical and public health community Actively support advocacy for removal of travel restrictions as a public health measure Advocate for evidence informed HIV laws and policies