Migrants with HIV: 87% get in Finding raises questions about value of testing
By Michael Friscolanti National Post (Canada), May 13, 2004

Canada last year welcomed nearly three times as many HIV-positive immigrants and refugees as it did the year before, according to government figures that also show how rarely an infected person is rejected.

Since January, 2002, when the federal immigration department adopted mandatory HIV screening for prospective new arrivals, 953 people have tested positive for the AIDS virus. Of those, 677 were diagnosed in 2003, a hefty jump from the 276 people who tested positive in the first year. The newly released data shows that being HIV-positive rarely hinders people from entering the country. Overall, only 13% of the infected applicants -- approximately 124 people -- were deemed medically inadmissible on the grounds that they would pose an extreme burden on the health care system.

Most of the approved cases were HIV-positive refugees, who, according to regulations, cannot be rejected based on their condition. It is unclear whether any of those applicants were later deemed ineligible for unrelated reasons. HIV testing of newcomers has been controversial since it began. While the government defends the program as necessary to ensure public safety and the wise use of scarce health resources, some critics say it unnecessarily discriminates against people with HIV. Others argue the program is not tough enough and say the huge percentage of HIV-positive applicants who still manage to enter the country every year is proof of that. "It's a fair debate," said David Cohen, a Montreal immigration lawyer. "Is there risk? Yes. Is it acceptable risk? This is something that each individual has feelings on one way or another."

When the testing program was first considered four years ago, the federal government suggested it would bar all foreigners who have the virus. The government has since softened that stance, denying entry only to those people who, according to the Immigration and Refugee Protection Act, are "likely to be a danger to public health" or "might reasonably be expected to cause excessive demand on health or social services." Ottawa did exempt some applicants, including refugees, family-class sponsored spouses and their dependent children. These people must undergo blood tests, but even if they have the virus, they cannot be deemed medically inadmissable regardless of how much their treatments may cost the Canadian health care system.

HIV-positive applicants who do not fall under the exempt categories are assessed according to the yearly health care costs of the average Canadian, which is approximately $3,500. Like anyone who is found to have a serious illness, if someone's HIV treatment will likely cost more than that average amount (the costs are weighed over a five-year period), his application is rejected.

But that rarely occurs, according to the data, which show that 87% of HIV-positive applicants are deemed medically admissible. That is largely because most of the infected newcomers -- refugees (341), refugee claimants (320) and family-class applicants (150) -- come from the exempt classes.

According to an internal memo written by the Director-General of Medical Services for the Department of Citizenship and Immigration, the "marked increase" between 2002 and 2003 does not necessarily mean that Canada saw a large spike in infected newcomers last year.

"Many [refugees] would have had their initial medical examinations prior to the HIV testing requirements," Dr. Brian Gushulak wrote in the note, obtained by the National Post under the Access to Information Act. "The second medical examination, conducted because the initial medical validity has expired, is revealing their HIV status."

Still, the fact that most infected applicants are exempt from rejection is a concern to some observers, who wonder why Ottawa even bothers testing people if most are allowed in anyway. "I would have thought that once the testing came in, someone with HIV simply would not be able to meet the medical requirements," said James Bissett, a retired senior Foreign Affairs official who lobbied for the tests. "The long-term cost of an HIV-positive person is staggering."

It is estimated that the cost to the Canadian health-care system of treating an HIV patient is $150,000 over his or her lifetime. Martin Collacott, a former Canadian ambassador and a harsh critic of Liberal immigration policies, said the government should make the fight against AIDS a high priority, and he applauded Ottawa's recent $170-million commitment to help combat the disease worldwide. However, he said the solution to the problem is not to welcome a large number of new HIV cases into Canada.

"We feel sorry for people with major health problems, but why should we bring them here to complicate our system?" he said. "We have enough problems with our health system as it is in terms of taking care of Canadians." Approximately 56,000 people in Canada are infected with HIV, with about 4,000 new cases every year.

Those who object to the immigrant testing program say Canadians should not be alarmed by the hundreds of additional infected people who move here every year. Not only do they represent a small number of the total HIV cases in Canada, but they account for an even smaller percentage of total newcomers.

Tens of thousands of immigrants and refugees have come to Canada during the two years in which the government found 950 HIV-positive applicants. It is also outrageous to assume that a person with HIV does not make significant contributions to society, said Ralf Jurgens, executive director of The Canadian HIV/AIDS Legal Network. He has long criticized Ottawa for not considering people's potential contributions to the economy when it assesses how much of a taxpayer burden they will be.

"If Albert Einstein was living with HIV and on anti-retroviral treatment, meaning he could live very well for 20, 30 years and be a very productive member of society, he would still be rejected under the current system," he said. Mr. Jurgens also noted that while some Canadians may be worried about the sharp rise in HIV-positive newcomers, their initial fears will likely subside when they realize most are legitimate refugees trying to escape hardship. "I would hope that every Canadian understands that these people are threatened with immediate harm to their lives and that's why they're coming to Canada," he said.

Dr. Philip Berger, who treats HIV patients at Toronto's St. Michael's Hospital, said if Ottawa is testing immigrants for the AIDS virus, it should also test for high cholesterol or cigarette smoking. Both are just as much of a potential burden on the health-care system as HIV, he said.

"One cannot have an immigration policy that is discriminatory in nature, which this has been from the beginning," he said. He agrees that the government must test people for highly contagious airborne ailments such as tuberculosis, but he said people with HIV hardly pose the same health risk to other Canadians. "What it says is that immigrants are less responsible than other people," he said. "It also defies the most long-standing public health message in HIV prevention, which is that people have to protect themselves. You can't rely on the state to protect you."

Claire Despins, an Immigration spokeswoman, said although the key goal of the tests is to prevent excessive burdens on the health-care system, they are also aimed at helping infected people receive treatment. Those who test positive for HIV are supposed to be provided with counselling. She also said that of the approximately 150 people denied entry under the medical inadmissibility clause, not all are HIV patients. "A CIC medical officer may request additional testing for any other disease or condition where there are indications that a condition may be present," she said. "For example, there may be many conditions that we do not necessarily screen for but that become apparent during the medical exam and may result in refusal based on excessive demand."