Washington D.C., USA, 22-27 July 2012 Global Overview of HIV-related Restrictions on Entry, Stay and Residence Susan Timberlake Chief,

Washington D.C., USA, 22-27 July 2012www.aids2012.org

Global Overview of HIV-related Restrictions on Entry, Stay and Residence

Susan Timberlake

Chief, Human Rights and Law Division

UNAIDS

22 July 2012


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 restrictions46 countries, areas have some form of restriction (see below);

Current state of restrictions

1. Andorra 17. Kuwait 33. Saudi Arabia2. Aruba 18. Lebanon 34. Singapore3. Australia 19. Lithuania 35. Slovakia4. Bahrain 20. Malaysia 36. Solomon Islands5. Belarus 21. Marshall Islands 37. Sudan6. Belize 22. Mauritius 38. Syrian Arab Republic7. Brunei Darussalam 23. Mongolia 39. Chinese Taipei8. Comoros 24. New Zealand 40. Tajikistan9. Cuba 25. Nicaragua 41. Tonga10. Cyprus 26. Oman 42. Turkmenistan

11. Democratic People’s Republic of Korea

27. Papua New Guinea 43. Turks and Caicos Islands

12. Dominican Republic 28. Paraguay 44. United Arab Emirates13. Egypt 29. Qatar 45. Uzbekistan14. Iraq 30. Republic of Korea 46. Yemen15. Israel 31. Russian Federation 16. Jordan 32. Samoa


Travel Restrictions are irrational• Do not protect public health (can harm it); 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• Countries can exclude based on proof of becoming undue

economic burden• Every individual should have equal access to freedom of

movement• Rational Alternative: prevention/treatment info/services

to those entering/leaving (citizens and noncitizens)


• Global: top priority of UNAIDS (International Task Team) and global networks of people living with HIV (monitoring, advocacy); private sector (CEO sign-on initiative); aspect of migrants’ rights

• Regional: Asia, Gulf, Russia and Central Asia• National: bilateral action, civil society action

packs, national level coalitions, including people living with HIV

Action to remove them


Towards “Zero Discrimination”: momentum to eliminate them

• WHO, UNAIDS and IOM have called for removal• World Health Assembly, UNAIDS and GF boards have

called for removal• In 2011 Resolution, Human Rights Councils • In 2011 Political Declaration on HIV, governments

committed to removing restrictions on entry, stay and residence

• At AIDS2012, global business leaders have issued a call for the elimination of restrictions

• Since 2010, 7 countries have lifted travel restrictions: Armenia, China, Fiji, Namibia, Republic of Moldova, Ukraine, and the United States of America


THANK YOU!


Impact of HIV travel restrictions on migrant workers in

Asia and the Gulf States

Malu Marin ACHIEVE, Inc. /CARAM Asia

19th IAC, Washington D.C.

CARAM Asia


Impact of HIV travel restrictions on migrant workers in

Asia and the Gulf States



CARAM Asia

RESPONSE TO HIV/AIDS IN KOREA

international context

XIX IAC, July 2012 Lee Dukhyoung, Korea CDC

14

CONTENTS

Timeline Challenges Opportunities

Timeline

Timeline 1

17

1981~1985 Fear and stigma imported before real in-

fection; during the incubation period, fear and

stigma grown by reluctant medical society and fear mongering media.

“You never have second chance to change

first impression”

Timeline 2

20

1985. First HIV infection of a foreign res-ident reported in Korea

1987 Nov. AIDS Prevention Act (AIDS law) 1988 Jun. Seafarers subject to HIV testing

by Enforcement Decree of the law

Timeline 3

1988 Dec. Testing for specific group of for-eigner newly stipulated (the law amended)

1989 Dec. HIV testing requirement for long-term stay(>90 days) foreigner at en-tertainment, sports by amended Enforce-ment Decree

1993 Jul. Mandatory testing for seafarers abolished by amended Enforcement De-cree

21

Timeline 4

2010 Jan. Removed restrictions of reentry/stay because of HIV-positive status by amending the Directive of the Entry of HIV Infected Foreigners (internal guideline of the Ministry of Justice)

2010 Aug. HIV testing requirement of in-coming and before placement health exam on foreign worker removed in the labor-re-lated Regulation

2010 Nov. HIV-related restrictions abol-ished in the Immigration Control Act

Timeline 5

2012 Jul.

24

Challenges

25

“We against they” proposition

Blood HIV screening tool directly applied to person as “risk population group”

26

Over-reliance on HIV testing

1986. 3 persons with HIV confirmed out of sex workers (in US military base ar-eas)

> from 1987, all of them to be tested once a year

1987. HIV testing partly applied on sea-farers

> early 1989, seafarers included in mandatory testing target

1988-89. HIV testing requirement on for-eigner of specific group

27

Biased by numerator analysis

Proportion of sex worker (in US military base areas) to total cumulative number of persons with HIV by year

Year 1987 1988.6 1996 2010

Sex worker(A

)

8 11 15 ?

Total(B) 14 26 570 7,656

A/B(%) (57) (43) (3) ( <1) ?

1988 Seoul Olympic Games

29

Opportunities

30

Change of the disease paradigm

1996-97

31

Civil Societies Global opportunities International NGOs, esp. International AIDS Soci-

ety

32

UN Advocacy

WHO UNAIDS since 1994 Global Fund for AIDS 2011 UN High-level Meeting on HIV/AIDS

KCDC at Osong( 五松 , 5 pine trees)

KOREA CENTERS FOR DISEASE CONTROL& PREVENTION

33

KCDC at Osong( 五松 , 5 pine trees)

Impact of HIV travel restrictions

on migrant workers in Asia and the Gulf States



CARAM Asia

Some migration figures

Temporary labor migration towards the Middle East and, in particular, the Arab States, represents the dominant flow.

The stock of migrants in the Middle East in 2011 stands at an estimated 28.5 million migrants.

There are 13.2 million migrants in South East Asia and East Asia.

1.2 million are working in Malaysia alone.

The Philippines has an estimated 3.8 million contract workers abroad and majority of these work in Asia and the Gulf States.

In the Philippines, domestic workers and household workers make up the single largest group of female newly-hired overseas contract workers at any given year.

Almost 80 percent of all Indonesian migrant workers are women and 88 percent work in the informal sector.

In Sri Lanka 42% of all overseas workers in 2010 were female domestic workers, deployed mostly in Middle East countries.

CARAM Asia

Health Testing

Mandatory requirement for work permit

Pre-departure, post-arrival and upon renewal of work contract

Migrant workers are being screened for up to 22 diseases and conditions including pregnancy and HIV.

Administered without regard for universal standards (counseling, consent and confidentiality)

HIV+ diagnosis Quarantine (in the Gulf States)

Immediate deportation (Asia)

Inhumane treatment

No access to treatment or referrals abroad

Fall out of the health system when they get home

Absence of counseling results to psychological trauma, stress and internalized stigma

Immediate loss of income

Categorized as “permanently unfit ” and blocked from ever legally entering a GCC country to work again

Migrants’ results are fed into a database that is shared with all other Gulf Cooperation Council Approved Medical Centres Association (GAMCA) centres.

Migrants end up stigmatized and discriminated, e.g. blamed as vectors of diseases in both origin and destination countries.

Impact

Policy Implications

Health of migrant workers must go beyond work examinations for Fit/Unfit status

Compulsory health testing of migrant workers has become a money making tool for recruitment agents and testing facilities

Mandatory Testing is discriminatory and contradicts national laws on HIV testing

Not a public health approach- no prevention, treatment/ referral service

Mandatory testing skews HIV data in both countries of origin and destination, especially if the bulk of cases are coming from migrant workers.

Challenges

Migration and HIV and AIDS, separately and jointly, are politically- contentious subjects

Negotiations, whether bilateral or multi-lateral, tread on issues of migrants’ rights, citizenship, public health and national sovereignty.

Efforts High Level Multi-Stakeholder

Dialogue on HIV Prevention, Treatment, Care and Support in the ASEAN Region, February 2009. Convened by JUNIMA*, ASEAN Secretariat and CARAM Asia.

Regional Dialogue on the Health Challenges for Asian Labour Migrants, July 2010. Convened by JUNIMA and IOM, with ASEAN, SAARC, GCC.

*Joint United Nations Initiative on Mobility and HIV/AIDS in SEA

Efforts Migration Roundtable between

Malaysia and Indonesia: Improving migrant workers’ access to HIV-related prevention and healthcare services, March 2011. Convened by UNDP.

High Level Multi-stakeholder Dialogue on Migrant Workers’ Health and Access to HIV services in the ASEAN Region, November 2011. Convened by JUNIMA, ASEAN and UNDP.

Removing HIV Travel Restrictions in Ukraine

Latest Developments

Marina Zelenska, Ministry of Health of Ukraine

XIX INTERNATIONAL AIDS CONFERENCE

46

Ukraine and HIV

Ukraine is the second largest country in Europe, after the Russian Federation, with an area of 603,700 sq km. The territory from North to South is 893 km, from West to East is 1316 km. The population of Ukraine is 46.6 ml people.

•The HIV epidemic was first recognized in Ukraine in 1987. Since then, Ukraine has maintained and developed a standardized system for passive surveillance based on confidential name-based reporting of HIV cases.

47

HIV/AIDS legislation – one of the state priorities

Ukraine was the first post-Soviet state to adopt the AIDS Law (1991).

August 24, 1991 is the birthday of independent Ukraine (creation of an independent state)

December 12, 1991 – adoption of the Law “On AIDS prevention and social protection of the population”. One of the first regulatory documents passed by the Parliament of independent Ukraine.

48

Adaptation of Ukrainian legislation to international law

12.12.1991 – adoption of the Law “On AIDS prevention and social protection of the population”.

12.23.2010 – new version of the law. New version title: “On stemming the spread of diseases caused by HIV as well as legal and social protection of people living with HIV” Priority in the new version of the Law – respect for human rights and freedoms in accordance with best international practices.

03.03.1998 – new version of the Law in accordance to ratification of the Convention for the Protection of Human Rights (1950) of 07.17..97 (cancellation of HIV mandatory testing for prisoners, PLHIV rights codified)11.15.2001, 04.14.2009 – amendment to the Law.

49

Amendments to the Law are based on:

International law acts relating to HIV/AIDS

Methodological materials of international organizations working in the area of HIV/AIDS prevention

Results of a detailed expert review of the provisions contained in the 1st version of the law, conducted by a UNAIDS panel of experts (Geneva), and their recommendations

50

Key international instruments used to develop amendments

Political Declaration on HIV/AIDS, 2006 Taking Action against HIV – Handbook for Parliamentarians

UNAIDS/Inter-Parliamentary Union/UNDP), 2007 International Guidelines on HIV/AIDS and Human Right,

UNAIDS/ Office of the United Nations High Commissioner for Human Rights (consolidated version 2006)

UNAIDS recommendations on terminology, 2007 UNAIDS/WHO Policy Statement on HIV Testing, June 2004 • Criminal Law, Public Health and HIV Transmission: A Policy

Options Paper. – UNAIDS/02.15R, Geneva, Switzerland, 2002, 52.

“Criminalization of HIV Transmission. Policy Brief, UNAIDS), August 2008.

51

Principles and innovations of the Law

Legal protection of people living with HIV and their families

Preventing discrimination against PLHIV and most at-risk populations

Ensuring the right to access HIV prevention, treatment, care and support:

• Expanding access to free HIV testing• Introducing a harm reduction strategy to prevent the spread of HIV• Ensuring free access to post-exposure prevention services• Ensuing participation of organizations of different types of ownership in

the provision of charity, health and social services to PLHIV• Doctor’s right to take additional measures to prevent HIV transmission;• Procedure for notifying HIV status

Cance

led

HIV Travel Restrictions

Previous version of the Law (1991):

Article 11. Diplomatic missions and consulates of Ukraine shall issue entry visas to foreigners and persons without citizenship, who stay in Ukraine for more than three months, provided that they have produced a document confirming their HIV-negative status, unless otherwise is stipulated in international treaties Ukraine is a party to.

Ukraine is quickly adapting to best international standards that ensure PLHIV’s human rights and freedoms.

At present, Ukraine has a favorable regulatory environment in place to ensure that PLHIV can exercise their rights.

New challenge facing Ukraine is to create a system to ensure that all entities (government bodies, NGOs, public officials and citizens) strictly comply with the Law.

UKRAINE: further steps

54

Thank you for attention!

Documents

Washington D.C., USA, 22-27 July 2012 Global Overview of HIV-related Restrictions on Entry, Stay and Residence Susan Timberlake Chief,