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Canada: no entry for immigrants with HIV

21 September 2000 (Toronto Star)

OTTAWA, 21 September 2000 (Toronto Star)

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Refugees and those with close family in Canada are excepted

By Allan Thompson
Toronto Star Ottawa Bureau

Immigrants with HIV will be banned from entering Canada, Citizenship and Immigration Minister Elinor Caplan said yesterday.

The only exceptions will be for refugees who come to Canada because they fear persecution in their homelands, or immigrants who already have close family members in Canada, such as spouses, partners and dependent children.

Caplan told reporters yesterday she would act on a recommendation from Health Canada that all would-be immigrants face routine testing for HIV before they are allowed into the country.

"That would make you medically inadmissible," Caplan said.

Critics called the testing unnecessary.

Ralf Jurgens of the Canadian AIDS-HIV Legal Network said there are no public health grounds for HIV testing of immigrants. That is the position of the United Nations, he said.

"We don’t test all Canadians for HIV. The simple reason for that is that HIV is not easily transmissible. It is only transmitted through sexual contact or the sharing of (drug) injection equipment."

Worldwide, 34.3 million people are infected with the human immuno-deficiency virus (HIV), which causes AIDS, according to data from the 13th International AIDS Conference in South Africa this spring.

Caplan said people with HIV would be barred both because they could put a strain on Canada’s health care system and because they could endanger other residents of Canada.

"The health of Canadians will be the number one priority," Caplan said.

She noted there already is mandatory testing for syphilis and tuberculosis.

Those who test positive for syphilis or TB may be admitted but are subject to follow-up tracking.

An internal Health Canada memorandum, obtained under the Access to Information Act, describes the existing policy (of no HIV screening) as "the highest health risk option, since persons who do not know their HIV status are currently admitted and thus present an increased risk of spreading HIV to others."

"What the scientists concluded is that from the point of view of the health of Canadians, we have to take into account the possibility of others being infected with HIV," Health Minister Allan Rock told reporters.

Health Canada calculated that on average, a migrant with an infectious disease like HIV transmits the condition to at least one Canadian resident.

It is not known how many HIV-infected immigrants enter Canada but the estimate is one in 1,000, said Ron St. John of the federal Laboratory Centre for Disease Control.

It is estimated that HIV-infected immigrants generate 37 HIV infections in Canada each year, he said.

The lifetime medical cost of caring for an HIV-infected patient is in the range of $150,000 to $260,000, he said.

While Health Canada recommended mandatory HIV tests for all visitors, refugees and immigrants, Caplan said it is not feasible to impose the HIV test on the millions of visitors or returning travellers who enter Canada every year.

"We know that it is impossible to shrink wrap our borders," she said.

Instead, the measure will be applied only to applicants for landed immigrant status.

The issue has come up before. In 1995, then immigration minister Sergio Marchi considered mandatory testing for HIV but never imposed the measure.

In a 1995 report, a group of doctors, economists and medical ethics experts concluded that immigrants with heart disease pose more of a potential health burden to Canada than those with HIV.

Several states restrict the entry of people with HIV. Singapore, for example, requires anyone who wants to live and work there for more than six months to undergo a test for the virus. Those found infected are expelled.

Australia screens newcomers but allows those with HIV to stay, provided they meet certain criteria, such as having a spouse who is a citizen.

The United States tests new immigrants for the virus and also bars people known to be infected from entering even for short visits.

Dr. Philip Berger, an AIDS expert at St. Michael’s Hospital, said there’s no need to screen newcomers for HIV since this virus isn’t casually transmitted.

"People can protect themselves," he said, adding targeting immigrants smacks of racism.

"Since HIV prevalence is higher in African countries, this would be a good way of keeping out immigrants from those areas," Berger said. "This policy will discriminate against people in the poorest countries in the world - mostly non-white countries."

With files from Leslie Papp and Canadian Press