Editorial: HIV entry ban repealed

Published in The Hindu on November 30, 2009

By announcing the end of a 22-year-old ban on the entry of people with HIV into the United States, President Barack Obama has once again shown that scientific considerations alone would shape decisions concerning science. The U.S. Department of Health and Human Services (HHS) has followed up promptly, by publishing the rule in the Federal Register. The U.S. was one of a dozen countries that have archaic laws barring the entry of people infected by HIV. Although President George Bush amended the Immigration and Nationality Act last year, the HHS did not remove it from the list of communicable diseases. The ban in the U.S. was enacted in 1987 amidst widespread fears that HIV, like tuberculosis, was a communicable disease and spread through physical or respiratory contact. Accordingly, HIV infection was enlisted as a “communicable disease of public health significance” and the entry of visitors and immigrants with the infection banned. Despite the aetiology and routes of transmission of HIV becoming clearer over the last two decades, and UNAIDS and the International Organisation for Migration (IOM) concluding, in 2004, that “HIV/AIDS-related travel restrictions have no public health justification,” the irrational bar remained.

In fact, the illiberal law has not served the purpose of containing the spread of a virus that has become endemic in the U.S. The Centers for Disease Control and Prevention (CDC) estimates that the virus has infected about one million people. The entry ban has also ended up creating stigma and discrimination against people living with HIV/AIDS, and this in turn has kept people away from getting tested. According to the CDC, about one in five are not aware of their infection status and are responsible for 50-70 per cent of all new sexually transmitted infection cases. The fear of discrimination is one reason why the CDC 2006 recommendation that everyone between 13 years and 64 years should be routinely tested for the infection in medical encounters has not been heeded. An offshoot of the ban is that no international HIV/AIDS scientific conference has been held in the U.S. for the past 20 years. All this is likely to change. The U.S., which has played a pivotal role in fighting the war against the virus in Africa, can now set its house in order. Nearly half a dozen sexually transmitted diseases such as syphilis and gonorrhoea have been wrongly classified as communicable diseases of public health significance. The CDC may remove them from its list in due course after a scientific review.