The global debate over HIV-related travel restrictions: Framing and policy change

Abstract

In 2010, the US repealed Section 212(a) of the Immigration and Nationality Act, which stated that a non-citizen determined to have a ‘communicable disease of public health significance’, is not admissible into the country without a waiver. This included HIV+ non-citizens. In the same year, several other countries, including China and South Korea, removed similar restrictions. This paper examines the global debate over HIV-related travel restrictions that has been ongoing since the mid-1980s and attempts to account for these recent policy changes. Entry restrictions have almost always been justified as necessary in two ways: to protect public health from the supposed threat posed by the entry of people living with HIV, and to limit the costs HIV+ migrants impose on domestic health systems. Opponents of these restrictions have consistently sought to challenge the evidence underpinning these claims and also to re-frame the issue in rights terms. However, in this paper I argue that this re-framing was not in itself sufficient to bring about policy change. Contributing to the literature on norm building and transnational advocacy both within and beyond global health, this article argues that some other crucial factors also have to be taken into account, including the changing political context (both domestic and international) and the network building strategies employed by opponents of the restrictions from 2008 onwards.

Keywords:

• HIV
• travel restrictions
• advocacy
• global health
• public health
• framing

Acknowledgements

I am grateful to Joe Amon and to the reviewers of Global Public Health for their helpful comments on earlier versions of this paper. This research has been made possible through funding from the European Research Council under the European Community's Seventh Framework Programme – Ideas Grant 230489 GHG. All views expressed remain those of the author.

Notes

1. See http://www.hivtravel.org.

2. There was a temporary lifting of the ban for the 2008 Beijing Olympics.

3. Similarly the same report named the US as one of only 26 countries, which deport people once their HIV positive status becomes known (UNAIDS 2009a, p. 8).

4. The IAS had earlier succeeded in persuading the Canadian government to change its immigration regulations by threatening to cancel the 2006 International AIDS Conference in Toronto unless changes were made (Mellors 2008).