Global Overview of
HIV-related Restrictions on
Entry, Stay and Residence
Susan Timberlake
Chief, Human Rights and Law Division
UNAIDS
22 July 2012
www.aids2012.org
Washington D.C., USA, 22-27 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
www.aids2012.org
Washington D.C., USA, 22-27 July 2012
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
www.aids2012.org
Washington D.C., USA, 22-27 July 2012
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
www.aids2012.org
Washington D.C., USA, 22-27 July 2012
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
www.aids2012.org
Washington D.C., USA, 22-27 July 2012
Current state of restrictions
131 countries, areas have no HIV-specific restrictions
46 countries, areas have some form of restriction (see below);
1. Andorra
2. Aruba
3. Australia
4. Bahrain
5. Belarus
6. Belize
7. Brunei Darussalam
8. Comoros
9. Cuba
10. Cyprus
11. Democratic People’s
Republic of Korea
12. Dominican Republic
13. Egypt
14. Iraq
15. Israel
16. Jordan
17. Kuwait
18. Lebanon
19. Lithuania
20. Malaysia
21. Marshall Islands
22. Mauritius
23. Mongolia
24. New Zealand
25. Nicaragua
26. Oman
27. Papua New Guinea
33. Saudi Arabia
34. Singapore
35. Slovakia
36. Solomon Islands
37. Sudan
38. Syrian Arab Republic
39. Chinese Taipei
40. Tajikistan
41. Tonga
42. Turkmenistan
43. Turks and Caicos Islands
28. Paraguay
29. Qatar
30. Republic of Korea
31. Russian Federation
32. Samoa
44. United Arab Emirates
45. Uzbekistan
46. Yemen
www.aids2012.org
Washington D.C., USA, 22-27 July 2012
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)
www.aids2012.org
Washington D.C., USA, 22-27 July 2012
Action to remove them
• 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
www.aids2012.org
Washington D.C., USA, 22-27 July 2012
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
www.aids2012.org
Washington D.C., USA, 22-27 July 2012
THANK YOU!
www.aids2012.org
Washington D.C., USA, 22-27 July 2012
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
www.aids2012.org
Washington D.C., USA, 22-27 July 2012
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
www.aids2012.org
Washington D.C., USA, 22-27 July 2012
RESPONSE TO HIV/AIDS
IN KOREA
international context
XIX IAC, July 2012
Lee Dukhyoung, Korea CDC
14
CONTENTS



Timeline
Challenges
Opportunities
Timeline
Timeline 1

1981~1985
Fear and stigma imported before real infection;
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”
17
Timeline 2



1985.
First HIV infection of a foreign resident
reported in Korea
1987 Nov. AIDS Prevention Act (AIDS law)
1988 Jun. Seafarers subject to HIV testing by
Enforcement Decree of the law
20
Timeline 3



1988 Dec. Testing for specific group of foreigner
newly stipulated (the law amended)
1989 Dec. HIV testing requirement for long-term
stay(>90 days) foreigner at entertainment,
sports by amended Enforcement Decree
1993 Jul. Mandatory testing for seafarers
abolished by amended Enforcement Decree
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 incoming
and before placement health exam on foreign
worker removed in the labor-related Regulation
2010 Nov. HIV-related restrictions abolished in
the Immigration Control Act
Timeline 5

2012 Jul.
Challenges
24
“We against they” proposition

Blood HIV screening tool directly applied to
person as “risk population group”
25
Over-reliance on HIV testing

1986. 3 persons with HIV confirmed out of sex
workers (in US military base areas)
> from 1987, all of them to be tested once a year

1987. HIV testing partly applied on seafarers
> early 1989, seafarers included in mandatory testing
target

1988-89. HIV testing requirement on foreigner
of specific group
26
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) ?
27
1988 Seoul Olympic Games
Opportunities
29
Change of the disease paradigm

1996-97
30
Civil Societies


Global opportunities
International NGOs, esp. International AIDS Society
31
UN Advocacy




WHO
UNAIDS since 1994
Global Fund for AIDS
2011 UN High-level Meeting on HIV/AIDS
32
KCDC
at Osong(五松, 5 pine trees)
KOREA CENTERS FOR DISEASE CONTROL& PREVENTION
KCDC
at Osong(五松, 5 pine trees)
33
Impact of HIV travel
restrictions
on migrant workers in
Asia and the Gulf States
CARAM Asia
Malu Marin
ACHIEVE, Inc. /CARAM Asia
19th IAC, Washington D.C.
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.
CARAM Asia
 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.
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
Impact
 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.
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 politicallycontentious 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.
XIX INTERNATIONAL AIDS
CONFERENCE
Removing HIV Travel
Restrictions in Ukraine
Latest Developments
Marina Zelenska,
Ministry of Health of Ukraine
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.
46
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.
47
Adaptation of Ukrainian legislation
to international law
12.12.1991 – adoption of the Law “On AIDS prevention and
social protection of the population”.
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.
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.
48
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
49
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.
50
Principles and innovations of the Law
Legal protection of people living with HIV and their
families
Preventing discrimination against PLHIV and most atrisk 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
51
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 HIVnegative status, unless otherwise is stipulated in international
treaties Ukraine is a party to.
UKRAINE: further steps
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.
Thank you for attention!
54