Monday, April 16, 2007

Should Australia Ban Immigrants with HIV?

Prime Minister John Howard said on Friday that Australia should deny entry to refugees and migrants who carry the HIV virus. Howard said people infected with tuberculosis (TB) were already prevented from coming to Australia.

As a recent resident myself, i had to undergo an extensive medical to gain residency status. This comprised screening for TB, Hepatitis, HIV and obesity.

The Department of Immigration and Multicultural Affairs lists three reasons for the need for immigrants to undergo such a medical;

i) To minimise public health and safety risks to the Australian community
ii) To contain public expenditure on health servies
iii) To maintain access of Australian residents to health services

I had assumed that if i was found to have one of these four conditions, my visa would be denied, but this is apparently not so, as the Dept also details the consequences of a prospective applicant found to have one of these conditions;

i) TB - "precludes the issue of a visa but opportunity is given to enable an applicant to undergo treatment."

ii) Hepatitis - "your application will not neccesarily be rejected although further tests may be required"

iii) HIV - "a decision on your application is considered on the same grounds as any other pre-exiting medical condition, i.e the cost of the condition to Australia's health services. A positive HIV test will not necessarily lead to a visa being denied."

iv) Obesity - "some exploration of related medical conditions will be made. These include diabetes, heart disease, hypertension and arthritis. Such conditions may mean you are assessed as not meeting the health requirement."

I am surprised at the heated level of debate on this issue as in most countries being an HIV carrier is an automatic disqualifier for immigration. Readers of The Australian's Have Your Say forum are split and very emotional on the issue.

The arguments of those against Howard's ban are summed up by Chris Lemoh, an infectious disease specialist, researching HIV-AIDS among African immigrants in Victoria

"It's a hysterical overreaction, it mixes racism with a 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."

Whilst i am extremely sympathetic to HIV sufferers (waiting for the result of my HIV test was one of the most frightening experiences of my life and one i would not wish on my worst enemy), these arguments are mainly emotional and do not stand up to analysis.

i) HIV, unlike TB, is not easy to catch, hence is a very different proposition
TB is spread by breathing. Since it is somewhat draconian to ask people to stop breathing, it is understandable for the need to quarantine and even ban sufferers. However just because the HIV virus is spread in a different manner, and the virus is a poor transmitter of itself, does not make the disease any less serious.

ii) John Howard is a heartless soul who should realise that Australia has a humanitarian duty to care for HIV-infected foreigners

No, it doesn't. Harsh though this may sound, Australia's only duty is the care and welfare of its own citizens. He may be heartless but his elected mandate is the welfare of Australians and the state of the country's healthcare system, not to act as an AIDS charity.

iii) Why pick on HIV? Since smokers and fat people are the biggest drain on the health system, shouldn't the system screen for them first? Isn't this just discriminatory toward AIDS sufferers?

Well, obese people are screened and may be turned away. But the reality is that it is almost impossible to screen for smokers because they can give up or take the habit up again, and it is impossible to determine a smoker from a medical.

iv) HIV is not so dangerous these days and many AIDS sufferers go on to lead long and healthy lives.

This is the most pernicious and dangerous rationale. If this really is the case, then why is the West spending so much foreign aid combatting the disease in third world countries? Shouldn't we just stop the program now? Of course AIDS is a serious disease and suggesting it isn't is highly offensive to sufferers and deeply ignorant.

v) How will it make existing AIDS sufferers feel? Won't it turn them in to a leper colony?

I imagine it will make not a jot of difference to existing sufferers. A ban is not equivalent to declaring AIDS sufferers as "unclean", but a way to ensure that the spread of this awful disease is slowed down.

I suspect most of the most vociferous opponents of Howard's idea are the sort who would stand up and denounce him if he stood up and declared that 'two plus two equals four'.

Sadly the sceince of AIDS afer years of publicity is still largely mis-understood. Even Senators such as Andrew Bartlett ignorantly write on their blog that HIV is a non-contagious disease. Education is perhaps the best policy.

Disclaimer; i studied Biochemistry at Uni, specialising in Virology in my final year. Hence unlike most of the journos and politicians who feel free to comment on this emotive issue, i actually know what i'm talking about.