The start of the New Year brought the news that the United States and South Korea had ended their travel bans against visitors living with HIV/AIDS. UNAIDS Executive Director Michel Sidibe said the repeals were "a victory for human rights on two sides of the globe." President Obama declared that the U.S. policy was based on fear, not science, and United Nations Secretary-General Ban Ki-moon has urged all countries with restrictions -- more than 50 around the globe -- to follow the lead of the US and South Korea and remove them.
Human Rights Watch - along with many other organizations - has worked for years to overturn these restrictions in the US, South Korea and globally, arguing that restrictions based on HIV status are violations of human rights and ineffective public health policy.
So surely we are celebrating the progress in these two countries, right?
In South Korea, not as much progress has been made as it might appear. The Korea Times explained in the fall of 2009 that despite the announced policy change, HIV testing would still be required for work visas. The change, according to a Justice Ministry spokesman is a shift in implementation, rather than law, allowing greater flexibility in deportations of foreigner workers testing positive for HIV:
If foreigners who work here test positive, we would not immediately deport them. ... If foreigners who test positive could be treated in Korea, we will let them stay. But as for foreigners who are judged by medical centers as highly dangerous, we will impose restrictions on them.
Korean human rights activists have filed complaints with the National Human Rights Commission of Korea, but until the courts declare restrictions based on HIV status unconstitutional, the government may still deny access and care to those who are HIV positive.
In the US, the lifting of the ban is a more unqualified success, but there is still a lot of work to be done to end HIV-related discrimination and ensure universal access to care.
First, the US needs an AIDS strategy. Two and a half years ago in this space I wrote:
...despite half a million deaths and 1.5 million HIV infections over 26 years, there is still no strategic national plan to eliminate HIV/AIDS domestically. Although we are spending $16 billion per year, the money goes to an ad-hoc array of national, state and local programs with no consistent monitoring, benchmarks or review. This lack of coordination results in inconsistent access to prevention and treatment programs. For example, federal AIDS Drug Assistance Program (ADAP) funding and eligibility guidelines differ by states, so that the program that is the safety net for low income persons ineligible for any other coverage may or may not be available depending on where you live. And as of March of this year there were 571 people on waiting lists for drugs in 4 states. In 2006, 4 people died while on the South Carolina waiting list.
There is no national plan to address the crisis in the African-American community, which accounts for one half of all new HIV infections, even though blacks are only 12 percent of the US population. Latinos have the second highest AIDS case rate in the nation and Latino adolescents have 3.5 times the case rate of adolescent whites. Yet, current US AIDS efforts regularly ignore the issues which make these groups vulnerable and affect their access to health care, such as housing, education and employment, and focus instead on simplistic strategies like "National HIV testing day" (June 27th).
Sadly, little has changed, other than more deaths and infections. In Washington, D.C. at least 3 percent of the population is infected with HIV, a prevalence rate comparable to those of many countries in sub-Saharan Africa.
Although President Obama has announced a commitment to develop a national AIDS strategy, and convened a series of public meetings, much work remains before we have coordinated, adequately funded, and fully accountable federal HIV care and prevention.
Immigration is a particular area of concern. In December 2007, Human Rights Watch issued a report, "Chronic Indifference," which described the failure of US Immigration and Customs Enforcement (ICE) to ensure that immigrants have access medical care and to protect HIV-positive immigrant detainees from stigma and discrimination. Care for immigrants in detention centers is substandard.
Our 2009 report entitled "Discrimination, Denial, and Deportation" describes how deportations from the US result in interruptions in anti-retroviral medicines. It's not enough to end entry restrictions against people living with HIV if detention and deportation policies endanger the lives of immigrants.
Another policy that needs to change is the segregation of HIV-positive prisoners. In the second decade of the 21st century, it is shocking that three US states continue to segregate all HIV-positive prisoners, forcing disclosure of their health status and denying them equal access to jobs, programs and re-entry opportunities. A joint report issued by Human Rights Watch and the ACLU National Prison Project in 2010 will describe the policies in these three states, Alabama, South Carolina and Mississippi, and their consequences.
I'd like to celebrate the New Year and the end of discriminatory HIV laws. Unfortunately, I still see much that needs to be done. President Obama is right - these policies reflect fear rather than science, and in too many parts of the globe fear still reigns. I'll hold my champagne for now.