Barrier to Entry

Laura Bisaillon, a health studies prof at U of T Scarborough who studies HIV and immigration, says the way potential immigrants to Canada are screened for the virus is unfair. She is calling on Ottawa to review its testing policy, and to make the whole process more transparent, with better information on HIV and immigration available via the government’s website.

Since 2002, nearly all potential immigrants to Canada have been required to undergo an HIV test. Canada doesn’t bar applicants with HIV, but it does make immigration more difficult. And with the exception of a few refugees and certain sponsored applicants, who cannot be barred for reasons of health, some applicants who test positive are, in the end, unlikely to be granted permanent residence in Canada.

For her doctoral research, Bisaillon interviewed 61 people from all sides of the immigration process, including doctors, nurses, bureaucrats and 33 applicants, of whom 29 had tested positive. Most of the applicants were not told they were being tested for HIV along with other conditions and most were dissatisfied with their treatment following diagnosis. The sort of intensive pre- and post-test counseling that is common for Canadians was often cursory. Because the test is mandatory for any applicants for permanent residence in Canada, (as well as for two specific types of temporary residents), there is no way applicants can be said to have given “consent,” says Bisaillon. Even the usual expectation of medical beneficence – putting the patient’s care first – doesn’t apply, because the person is not taking the test for medical reasons. “This encounter is not about patient care or therapeutic treatment,” says Bisaillon. In this context, “The doctor is an administrative data collector; an agent of the state.”

Bisaillon, who holds a PhD in population health, was a caseworker in a sexual health organization in Montreal. There, working with HIV-positive women who were refugees to Canada, “I discovered that HIV was a mandatory test within the Canadian immigration program,” she says. “You wouldn’t be able to test a Canadian citizen or a permanent resident for HIV without their full consent,” she says, except in rare circumstances and usually by court order.

While Canada has a long history of testing potential immigrants for medical conditions, HIV is treated exceptionally. It is the only disease to which a separate policy is attached. And it is one of only three diseases for which doctors must test, along with syphilis and tuberculosis. The government’s rationale is economic. The cost of treating HIV/AIDS is said to place an “excessive demand” on the public health system.Applicants must also disclose any other serious medical condition, triggering an investigation into its potential health-care costs. Yet as Bisaillon points out, Canada doesn’t pre-test for these conditions, such as cancer or diabetes. Unlike those diseases, HIV is communicable, but, she says, HIV is “100 per cent preventable , transmitted within specific conditions and relations.”

The number of new cases of HIV in Canada has been declining steadily, and in 2012 reached the lowest level since reporting began in 1985. “The de facto position and language, where persons with HIV are considered burdensome to the public health system, is a problem,” says Bisaillon. “People with disease and disability make all sorts of contributions to the societies they inhabit.”