Borders, Bullies and Global Health

Posted on Apr 20, 2007

By Scott Tucker

“HIV migrants pour into the state.”  So read a headline in Melbourne’s Herald Sun on April 13. On the same day, Australian Prime Minister John Howard was interviewed on Southern Cross radio in Melbourne.  He was asked to give his own views regarding HIV-positive immigrants.  He answered that a ban on such immigrants would be a good general rule, though there might be humanitarian exceptions. His remarks have caused a storm of protest among healthcare professionals, scientists and community groups in Australia.

If we wonder why Howard has weighed in on the issues of public health and immigration at just this time, there are at least two persuasive reasons.  A new medical study from the state of Victoria claims that the number of people with HIV who have moved to Australia since 2004 has nearly tripled.  Those numbers are disputed in the Australian medical community. Howard knows little about global epidemics and still less about epidemiology, but he is a calculating politician.  Australian reporters asked him direct questions about this study.  That is the first reason.

The second reason is plainly the partisan politics of Australia, and more particularly the nearing elections. Epidemiology in any nation is never quite an exact science, but national narratives about purity and pollution belong more properly in the realm of mythology.  The boundary between that mythic realm and partisan politics is not always fixed or clear.  Howard either cannot or will not make the necessary distinctions between a disease such as AIDS and a disease such as tuberculosis.  This may be simple ignorance.  But it is also politically convenient in the current contest for state power.

John Howard and his deeply divided Liberal Party have been getting low scores in polls of the Australian public.  His main political rival is Kevin Rudd, a dynamic leader of the Labor Party, who has a chance to become prime minister after the next big elections.  Australia has a parliamentary system and no fixed election dates, so elections could occur fairly soon but could come as late as December.

Howard, who received a visit from U.S. Vice President Dick Cheney in February, is staking out political ground not only as a defender of Australian culture and borders but as one of the leaders of the free world. So, while we can feel confident that Cheney thanked the prime minister for his continuing membership in the dwindling “coalition of the willing,” it’s unlikely that Howard’s American visitor would have attempted to dissuade him from raising the issue of HIV and immigration.

“The United States has had these sorts of strict entry restrictions on HIV for many, many years,” said Yusef Azard of the National AIDS Trust.  “It’s got the highest rate of HIV in the developed world. So it doesn’t actually do any good. People go underground. Stigma and discrimination increases in the country and makes the response to HIV all the more difficult.”  In 1987 HIV was included in a U.S. immigration law among other diseases judged to be a “communicable disease of public health significance.”  The U.S. Department of Health and Human Services attempted to remove HIV and certain other conditions from the immigration exclusion list on the grounds that these illnesses are not spread by casual contact and are not transmitted through common vectors such as food and water.  In May 1993, Congress approved a law codifying the exclusion of HIV-positive immigrants.  Despite campaign promises to the contrary, President Bill Clinton signed this bill into law.  In this way the United States set an early bad example.

Howard gives the wrong diagnosis

A recent study from the health department of the state of Victoria showed, according to the Australian news announcer Mark Colvin, “an alarming increase in the number of HIV-positive people who’ve moved there from interstate and overseas.”  When Howard was asked to respond to this report on the radio, he was also asked bluntly whether HIV-positive people should be allowed to immigrate.

“Well, I would like to get a bit more counsel and advice on that,” Howard answered. “My initial reaction is no.  There may be some humanitarian considerations that could temper that in certain cases, but prima facie, no. But it would require a change in the law, yes.”

Simeon Beckett, president of Australian Lawyers for Human Rights, has suggested that such counsel has already been freely and fully given.  Beckett reminded the prime minister and the minister for immigration that “certain protections for people who are suffering from a disability such as HIV or AIDS” do exist under Australia’s Disability Discrimination Act.

Howard added, “I think we should have the most stringent possible conditions in relation to that nationwide, and I know the health minister is concerned about that and is examining ways of tightening things up.”

“It’s very tight already,” responded Don Baxter of the nongovernment group the Australian Federation of AIDS Organisations.  He said HIV tests were already among the health checks given to prospective immigrants.  Most HIV-positive applicants have been rejected, and the reason given is that they would place an unfair financial burden on the public health system.

Chris Lemoh, an infectious disease specialist who studies HIV and AIDS among African immigrants in Victoria, condemned Howard’s comments.

“It’s a hysterical overreaction,” Lemoh said, “it mixes racism with phobia about infectious disease.  To not allow people to come on the basis of any health condition is immoral, it’s unethical and it’s impractical to enforce.”

Howard has some trouble distinguishing between an infectious disease such as HIV and AIDS, which is spread primarily through intimate sexual contact and through injection drug use, and a genuinely contagious disease such as tuberculosis, which can be spread through sneezing and coughing. Howard has said Australia places immigration restrictions upon people with tuberculosis and thus he supports strong restrictions against people who test positive for HIV.

Public health campaigners in Australia have argued that Howard is wrong on both medical and legal grounds.  An HIV/AIDS legal center stated that “the vast majority” of HIV-positive immigrants were already screened out and already blocked from entry.  Even so, a minority of HIV-positive immigrants have been granted citizenship on humanitarian grounds, especially when they have been family members, spouses or life partners of Australian citizens.

The website of the Australian Immigration Department differs from the prime minister’s account of the existing rules and laws:

“A positive HIV or other test will not necessarily lead to a visa being denied. The main factor to be taken into account is the cost of the condition to Australia’s health care and community services.”

The Immigration Department’s website also states that not all immigrants with tuberculosis are automatically barred from entering or living in Australia.  If a medical treatment has been successful or if tests indicate a particular TB case is “non-active,” this is taken into account.  This is the guidance given on the website:

“TB is mentioned in legislation as precluding the issue of a visa, but opportunity is given to enable an applicant to undergo treatment in most cases. ...”  As long as medical care and monitoring are ongoing, the website states clearly, “Your visa is not at risk, once in Australia, no matter what status of tuberculosis is diagnosed.”

Drug-resistant strains of gonorrhea and of tuberculosis, among other diseases, are being monitored by doctors, scientists and epidemiologists around the world.  Medical testing, reporting and treatment are not equally distributed, of course, across all borders.  All of these factors are worth consideration in public health programs, in human rights campaigns and in immigration policy.  But because common sense and humanity are shown to immigrants suffering from a disease such as tuberculosis, if we trust the account given by Australia’s Immigration Department, then the same decency is deserved by immigrants suffering from a disease such as HIV and AIDS.

Comments

Are you a Truthdig member yet? Login now, or register with Truthdig.