By Jirair Ratevosian and Amy Hagopian
The first cases of human immunodeficiency virus (HIV) were diagnosed 25 years ago, opening a new tragedy in human history and changing the way the world thinks about public health.
While HIV, the virus that causes acquired immune deficiency syndrome, or AIDS, has killed 25 million people and ravaged many parts of the world, it has been relatively less serious in Armenia, which has
reported fewer than 500 people with the HIV virus, only 30 percent of whom progressed into the full AIDS disease, and only 42 of whom have died. In contrast, approximately 33.2 million people—about 1 in every 200—are living with HIV worldwide.
Armenia has organized a relatively progressive and reasonably effective response to the national epidemic by providing free testing and drugs for AIDS treatment through its National Centre for AIDS Prevention. However, there is still one important human rights issue to be addressed at the national level: removing the travel ban that prevents people living with HIV from entering the country.
At the International AIDS Conference in Mexico this month, HIV-related travel restrictions in a handful of countries worldwide—including Armenia—drew sharp criticism from participating officials and civil
society. Armenia remains one of only 12 countries (including Brunei, China, Iraq, Qatar, South Korea, Libya, Moldova, Oman, the Russian Federation, Saudi Arabia, and Sudan) that bar people with HIV or AIDS from visiting or immigrating to the country. Further, the European AIDS Treatment Group reports that according to the Armenian Ministry of Health, non-citizens who fall ill in Armenia may be deported.
Banning the entry of people with HIV into Armenia, whose strong people have withstood so much enmity and hostility in its history, does not do us proud. While it is true that the majority of people with HIV have spent some time in the Russian Federation or Ukraine, the citizenship status of those people is not known and it is not clear that banning their entry will have any positive effect on the spread of the disease. The American Public Health Association has stated, “There is no scientific evidence to support the claim that the ban is an effective way to prevent the spread of HIV or that it reduces costs to the public healthcare system.”
Travel restrictions violate the human rights of people living with HIV, and, further, they may actually do more harm than good. People forced to hide their HIV status, however, may behave in ways that
threaten the health of themselves and others. Travel bans perpetuate stigma and discrimination that lead people to hide their status and avoid seeking the care they need.
When HIV was identified in the early 1980’s, many countries established travel restrictions—out of ignorance and fear—to prevent the virus from entering their borders. Now that the virus is no longer
a death sentence, but rather a manageable disease with the proper diagnosis and treatment, most countries have lifted their bans.
Some may be concerned that lifting the travel ban could encourage HIV positive people to cross Armenian borders in search of treatment. Other countries have not had that experience, however. Brazil, for example, with its universal access to treatment, has dropped HIV travel restrictions and has not had either short or long-term migration problems.
The World Health Organization, UNAIDS, and the United Nations Office of the High Commissioner for Human Rights oppose the use of HIV and AIDS-related travel restrictions. These agencies say HIV and AIDS do not pose a threat to public health because, although it is infectious, HIV cannot be transmitted through casual contact (through the air, or from common vehicles such as food or water). HIV is transmitted through specific behaviors that are almost always private. The primary
vehicle for HIV transmission among Armenian men is injection drug use, while women tend to acquire their disease through sexual transmission.
In the age of globalization, and in the setting of dramatic improvements in HIV care and treatment, HIV-travel restrictions are archaic and highly inappropriate.
Just this month, the United States government made a $48 billion commitment to helping other nations fight the AIDS epidemic. The new law also dropped the outdated and discriminatory provision of the U.S. Immigration and Nationality Act that had declared all non-citizens with HIV inadmissible to the United States. The U.S. action to repeal the HIV entry ban is in keeping with international momentum toward policies based on human rights and public health.
We call on the government of Armenia to consider the widespread consensus among medical and public health professionals regarding the lack of evidence to support HIV-related travel restrictions and to reverse the policy. This law represents an unreasonable restriction on the freedom and human dignity of people living with HIV and must change if international commitments to universal access to HIV prevention, treatment, care, and support are to be met.
In this 60th anniversary year of the Universal Declaration of Human Rights, Armenia should not keep company with the few nations who cling to a travel ban on people living with HIV or AIDS. The Armenian people have survived several treacherous decades, and have successfully reconstituted a nation (against all odds), while maintaining an abiding commitment to justice and a resilient spirit. By protecting the rights of people living with HIV and AIDS and promoting an attitude of care and solidarity, we continue this history of protecting our dignity as human beings. It is time for Armenia to join hundreds of counties, including (finally, now) the United States, in repealing the travel and immigration ban against HIV-infected non-citizens. It is the right thing to do and it is long overdue.
Jirair Ratevosian, MPH, is the U.S. field coordinator for the Health Action AIDS Campaign of Physicians for Human Rights.
Amy Hagopian, Ph.D. teaches at the University of Washington School of Public Health in Seattle, Wash., and chairs the International Health Advocacy Committee of the American Public Health Association.