By Paul Weinberg
TORONTO, Jun 28 2002 (IPS)

Canada’s new mandatory HIV testing of all incoming immigrants and refugees appears aimed at areas of the world like sub-Saharan Africa where there is a higher prevalence of HIV and AIDS.

So states Philip Berger, chief of the department of family and community medicine at St Michael’s Hospital herein Toronto.

The Canadian government’s “discriminatory” policy, according to Berger, “will disproportionally affect black Africans and my view is, why aren’t they testing for illnesses routinely that affect white Europeans, like cholesterol levels? What about smoking?”

Canada has singled out refugees and immigrants for HIV testing, even though there is no evidence that they engage in more reckless behaviour leading to HIV (such as sharing needles or engaging in unprotected sex) than the average Canadian citizen, says Berger. “So, to raise the argument (that) this is somehow going to protect the public health of Canadians is ludicrous.”

A positive test for HIV by a person seeking permanent residence in Canada is in almost 90 percent of the cases going to lead to his/her rejection by a Citizenship and Immigration officer, says Darrell Kloeze, a lawyer with the HIV & AIDS Legal Clinic of Ontario.

Susan Scarlett, a spokesperson for the Canadian department of Citizenship and Immigration, disagrees.

Until January this year, HIV testing was an optional component of the official medical examination that each person seeking permanent residence in Canada had to take. Tests were conducted at the discretion of a Citizenship and Immigration doctor.

Out of the more than 400,000 people applying last year for either temporary or permanent residence, only about 1,500 were deemed inadmissible because they had a medical condition that would place “an excessive demand” on the Canadian healthcare system. An estimated 250,000 immigrated to Canada last year, close to half of them women.

Scarlett does not have a breakdown of how many of the 1,500 had HIV/AIDS versus other contagious diseases like tuberculosis. But she is confident the rejection rate for immigrants will not start climbing with HIV testing added to their medical exams.

Under new regulations, both refugees and those in the family class sponsored by Canadian residents (including spouses, children, and relatives) who are HIV positive can remain in Canada.

But the new policy still leaves the large number of independent immigrants likely to be turned down if they are found to be HIV positive, charges critics like lawyer Alana Klein, a spokesperson for the Montreal-based Canadian HIV AIDS Legal Network.

The Citizenship and Immigration department has its own formula to determine if a prospective resident’s health condition is serious enough that it would over the next five years tax the resources of the universal Canadian healthcare system – which provides free hospital and doctor care for all citizens and landed immigrants in Canada.

One problem with this formula approach, says Klein, is that with HIV/AIDS it is very difficult to predict in five years what a person’s condition is going to be or what treatments may be developed.

“My understanding is that (Citizenship and Immigration’s excessive demand formula) is based on today’s treatments because they can’t anticipate what treatments are going to be developed in five years, how much they are going to cost. Nor can they determine how healthy a person is likely to be after they get those treatments.”

Adds lawyer Kloeze, the criteria fails to take into account the skills and talents that an immigrant who is HIV-positive can offer. “What irks me is the automatic assumption that anybody with HIV is going to be a hugely excessive burden on our social system, without looking at other considerations.”

The Canadian HIV AIDS Legal Network has received reports that the foreign medical practitioners who are testing prospective immigrants to Canada in the home countries are not always following appropriate procedures.

These doctors, selected and approved by Citizenship and Immigration are not always giving appropriate pre- and post (HIV) test counseling and sometimes there is no informed consent, says Klein.

“Just last week, I got an email from someone who had been through the Canadian immigration system recently and had a doctor, even in Canada, who did not really give her the chance for informed consent because she had to sign the consent form, whether she wanted to or not,” adds Klein.

Informed consent – an internationally recognised right to say no to a medical test or procedure – cannot exist under these circumstances if a mandatory HIV test is imposed on immigrants or refugees, says Janet Dench, executive director of the Montreal-based Canadian Council for Refugees.

Berger says it is disturbing that immigrants and refugees are forced to use a doctor chosen by the Canadian government. Any doctor should be able to do HIV tests, states Berger, and immigrants and refugees “should be able to see the doctor of their choice, not some immigration listed physician.”

Circumstances may arise where immigrants with HIV/AIDS will be sent back to a country like Haiti where no reliable health care infrastructure or access to proper medication exists and they face certain death.

To what extent should Citizenship and Immigration be required to examine the medical services in their home country before an inadmissible person is sent back is still an open legal question and not yet determined by the Canadian courts, says Kloeze.

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