Singapore?s HIV/AIDS Immigration Policy : A Critique

By Abhinav Deshmukh

Edited by Liz Maria Kuriakose, Associate Editor, The Indian Economist

Let us perform a thought experiment. You get admitted in a local hospital for a surgery. As per the routine pre-operative procedure, your blood is tested for HIV/AIDS. The test results show that you are HIV positive! The shock and the emotional trauma for your immediate family would be considerable, but there is more to come. The hospital is legally required to inform Singapore’s Ministry of Health of your HIV status. The long, unforgiving arm of the law comes into play and if you are a foreign immigrant, it will be a matter of time before you are deported, never to return. Your contribution to the economy, the community structures that you built in your new home, and your ability to financially support yourself all come to naught in the face of a draconian law which condemns you for a virus which does not spread through casual contact and whose effects can be managed.

This is no hypothetical scenario. It is reality, and it plays out in countries like Uzbekistan, Saudi Arabia, Iraq, and Russia to name a few. It can also play out in the affluent, high HDI, first world, city-state of Singapore. Singapore’s Immigration Act currently declares any individual suffering from the Acquired Immune Deficiency Syndrome or infected with the Human Immunodeficiency Virus as a ‘prohibited immigrant’.

Singapore’s rationale for this policy is grounded in an archaic concept of ‘public health safety’. The thread of this argument runs as follows: Singapore is a magnet for immigrants from countries with a relatively high incidence of HIV/AIDS ergo they need to be screened as they might engage in unsafe behaviour. This stand assumes that incoming immigrants will engage in irresponsible behaviour. It is also based on a premise that the primary vector of transmission is immigrants. The natural implication is that HIV is a disease foreign to Singapore, one which can be controlled by simply by screening immigrants. By not applying the same standard to the returning locals from the high risk regions like the Indonesian island of Batam, the selective nature of the policy makes it, at best, ineffective, if not xenophobic and counterproductive.

Moreover, by making HIV/AIDS the sole criterion for an action as drastic as deportation, the stigma surrounding the virus increases exponentially. This gives individuals at risk a strong incentive to go underground and avoid treatment. Denial of one’s HIV status as well as avoidance of health workers and immigration officials is a natural extension of this. In effect, the people in dire need of relevant assistance and education are cut off from the formal healthcare system. The current treatment methodology has been shown to decrease infectivity. But currently, statistics of the MoH show that nearly 48% of HIV cases diagnosed in Singapore are in the later stage of infection. Stigma surrounding a condition results in a delay in seeking treatment that can reduce the risk of transmission of the virus. Singapore’s immigration policy feeds into this stigma. A policy which incentivises delay in critical treatment is not only ineffective, it is counterproductive.

HIV is not a condition like yellow fever which is endemic to specific parts of the world. Nor is it a condition like SARS which is acute and spreads through casual contact. Imposing travel restrictions during outbreaks of highly contagious diseases with a short incubation period and progress is an effective method.In Singapore, HIV is transmitted through very specific sexual behaviour which requires consensual action from both parties involved. It has an incubation period that can be as long as a decade. Moreover, HIV is pandemic and has a footprint in Singapore. Policies which suggest otherwise are misleading and provide a false sense of security.

Dr Amy Khor – Singapore’s acting Chairman of the National HIV/AIDS Committee – has also been quoted publicly drawing a parallel between Singapore’s immigration policy and that of other first world countries like Canada and Australia. Dr Khor’s comparison is incorrect. Canada does not view people with HIV/AIDS as a threat to public health. During immigration, it does consider whether the prospective immigrant may place an ‘excessive demand’ on the publicly funded healthcare system. But this applies to anyone with a medical condition that may place demands on the welfare system and not just people with HIV/AIDS in particular. Australia has recently taken a more pragmatic approach and is easing restrictions on HIV/AIDS to meet skill shortages.

Singapore may do well to take a leaf out of Iceland’s approach to immigrants with HIV/AIDS. Iceland requires an HIV test to be undertaken when applying for permanent residency, but for a different reason. If you happen to be HIV positive, then on getting permanent residency you are immediately enrolled into the national healthcare service and the standard six month residency requirement is waived.

Singapore is often criticised by organisations like Amnesty International for its poor human rights record. Discriminating against individuals solely on grounds of a health condition which is not highly contagious, which will not pose an additional burden on the state exchequer and where the viral pool already exists in the country is fair ground for violation of human rights.

The irony of such a discriminatory policy is that Singapore is well aware that managing the stigma associated with AIDS is the root to managing the outbreak. The late Dr Balaji has stated on the floor of the UN General Assembly in the context of the fight against AIDS that Singapore was working “actively towards reducing stigma and discrimination through education of our community” and that Singapore’s control measures would not work “if people do not engage in frank, open discussions about the disease and about sexual behaviour”. It is pity then that these laudable views are not implemented in practice.

As a sovereign state, Singapore is well within its right to deny entry to immigrants if it finds that their presence is not an asset to the nation. However, to issue blanket restrictions on even short-term entry of immigrants with a virus which is not highly contagious and which already exists in the viral pool is baseless paranoia reminiscent of a bygone era of discrimination that have no place in the 21^st century.

The United States of America removed AIDS related entry restrictions in 2009 with President Obama opining that they were “rooted in fear rather than fact”. China followed suit in 2010 proclaiming that the travel ban was grounded in”limited knowledge of HIV” and was proving to be “inconvenient” for China. On March 14^th this year, even Tajikistan lifted all entry restrictions on the residence of people with HIV. Maybe it is time for Singapore to evaluate the effectiveness of its current immigration policy; after all, there really is no battle to be won by swimming against this tide.