Congressional renewal of PEPFAR, President Bush?s EmergencyPlan for AIDS Relief, repeals a travel ban that was enacted in 1986 when it wasbelieved that HIV-infected travelers intrinsically posed a danger of infectingthe general public.Over time,attitudes have changed with a greater understanding of the sexually transmitteddisease. But it took a persistent lobbying effort by a coalition of 160activist groups to convince legislators that the laws had to change.Rachel B. Tiven of New York-basedImmigration Equality helped lead the repeal campaign in Congress.She says that lifting the ban sends a particularly strong signal to manyAfricans who until now have been excluded from entering the United States.
?Theimpact has been tremendously negative.It?s very difficult for people from Africa to enter the UnitedStates.There?s a high level ofsuspicion about the HIV status of people entering from Africa.The presumption really reflects a set ofstereotypes and biases that people who are HIV-positive find that they can?tattend medical conferences.They can?tattend activist conferences.They can?tvisit the United States to see family or to go to a wedding or to go to schoolif they are HIV-positive.And it reallyjust sends a message that is completely counter to what the United States hasbeen claiming it?s interested in propagating on the continent,? she said.
The2008 PEPFAR legislation elevates earlier US funding of AIDS treatment, medicalservices and research programs around the world from a sum of $30 billion overfive years to $50 billion through 2013.However, a significant portion of the increase will fund campaignsagainst malaria and tuberculosis, two other afflictions widespread acrosssub-Saharan Africa that physicians say can compound and weaken the alreadyfragile health of AIDS victims. Tiven notes that in repealing the travel ban,legislators have taken major steps to remove discrimination, deal more honestlywith how HIV/AIDS is spread, and raise priorities on curbing the transmissionof other communicable diseases like TB, which she notes can be readily carriedacross borders.
?Weno longer are subject to the myths and misinformation that really gripped thepublic consciousness in the late 1980?s and early ?90?s, and that the kinds ofanachronistic misunderstandings about HIV, how it was transmitted, are thingsthat in the US are, thankfully, something in the past.We know that you don?t get HIV sitting nextto somebody on an airplane; you don?t get HIV from sharing a bathroom withsomeone.These reflect a reallyignorant and anachronistic set of beliefs.That?s what made it possible for the US to finally change its policy,that Congress recognized that we know that that?s not good public policy,? shesaid.
WhenPresident Bush signs the 2008 PEPFAR bill into law, HIV-positive foreignapplicants will no longer be subject to what Tiven calls discriminatoryexclusion, but will still be subject to US Department of Health and HumanServices (HHS) oversight on an individual case basis of the possible risks theypose.Tiven cautions that it is fallaciousto think that a tightening of government surveillance of AIDS patients willserve to protect the public from an added safety threat.
?Weknow in fact that the public health is not benefited by a series of measuresthat encourage people to hide or fail to disclose their status or that create asituation in which people who are already in the United States are reluctant toseek treatment because they are concerned about the impact that will have ontheir immigration status.We know thatencouraging people to be open and honest about their health care is the waythat we avoid further transmission of the disease,? she says.
Tivenpoints out that historically, US immigration law is concerned with publichealth in terms of diseases that are easily transmissible in travel and in thegeneral population. For example, she says, ?tuberculosis is a long-term concernfor the immigration system, and historically, that has been a disease that hasbeen on the list for a long time. And we?ve seen in recent years concern aboutTB travelers not being careful and responsible about their behavior when theytravel the globe.But tuberculosis isan airborne disease.HIV is not.?