2019 10 Ideas Submission – Discrimination Against HIV+ Non-Singaporeans

Memo proposal submitted to the Roosevelt 10 Ideas Journal. Written by the Healthcare Policy Centre, Roosevelt Institute @ Yale-NUS College.


Reforming Discrimination Against HIV-positive non-Singaporeans

Currently, HIV-positive foreigners are denied long-term visas to Singapore. This policy contributes to: (1) family separations, (2) loss of economic opportunities both for individuals and Singapore, and (3) institutional stigma and a climate of fear which prevents HIV-positive individuals from seeking treatment. As such, Singapore’s Parliament should modify its archaic law of denying long-term visas to HIV-positive foreigners if they can prove that they are on antiretroviral medication.

Background and Analysis

In 1998, at the peak of global fear and hysteria surrounding the HIV and AIDS epidemic, Singapore passed legislation 8(3)(ba) of the Immigration Act prohibiting foreigners with HIV or AIDS from entering Singapore.[1] At that time, Singapore was experiencing dramatic rises in new HIV infections, from 61 instances in 1985 to 200 instances in 1990.[2] Furthermore, the government found that an alarming 2813 foreigners residing in Singapore then were HIV-positive[3] at a time where there were no cure or medication for HIV. Thus, this law was implemented due to the fear generated by the HIV epidemic.

Developments since the inception of the law has rendered the legislation archaic. Firstly, extensive medical research has improved knowledge of how HIV is spread. Since we now know that HIV cannot be transmitted through casual contact,[4] laws on travel restrictions point to a misunderstanding of the communicability of the disease. Secondly, the development of antiretroviral medication prevents the growth and spread of the HIV virus.[5] Antiviral medication can reduce the virus to undetectable levels in the blood, enabling the immune system to recover and function almost normally.[6] More importantly, this medication prevents the transmission of the virus, enabling HIV-positive individuals to live life normally.

Singapore recently lifted the ban on short term visas for HIV-positive foreigners in 2015.[7] We believe that due to the reasons outlined above, Singapore should also allow HIV-positive foreigners on antiretroviral medication to obtain long-term visas to enter Singapore for employment or family.

Talking Points

  • This archaic law reinforces institutional stigma towards HIV and thus contributes to a misunderstanding of HIV, which might discourage people from getting tested or seeking treatment for HIV.
  • Singapore has already relaxed its laws on issuing short-term visas to HIV-positive foreigners in 2015 and it is principally consistent to remove restrictions on long-term visas for foreigners who can prove that they are on antiretroviral medication.
  • Ultimately, changing this law can lead to better health outcomes for Singaporeans, improve Singapore’s international image, and create economic opportunities by enabling HIV-positive foreigners to work in Singapore and boosting HIV-related medical tourism.

The Policy Idea

Singapore’s Parliament should amend the legislation 8(3)(ba) of the Immigration Act by allowing foreigners on antiretroviral medication (such that they are unable to transmit the virus) to obtain long-term visas. To circumvent Singapore’s worry that HIV-positive foreigners might pose a burden on its healthcare system, these HIV-positive foreigners should prove that they have the financial means to afford antiretroviral medication and undergo monthly tests to ensure their viral load count is acceptable.. Ultimately, amending these restrictions is also a symbolic act by the government and provides extensive public discourse that can help de-stigmatise HIV.

Policy Analysis

The proposed amendment would benefit Singapore’s image and interests while costing Singapore very little. Like many modern economies, Singapore is facing a declining population. The sustainability of Singapore’s growth depends greatly on the inclusion of international migrants. By excluding internationals who are HIV-positive from entering Singapore, Singapore loses out on potential talents and economic opportunities. Moreover, this legislation means that families would be separated if one member has HIV, resulting in emotional trauma or families avoiding Singapore entirely. This law is thus unfavourable to Singapore’s image which might affect its political and economic interests. The proposed amendment is a step forward for equal human rights that might foster greater diplomatic relationships with other developed states. Also, the inclusion of this amendment would destigmatize HIV, decreasing the climate of fear around getting tested and seeking treatment for HIV.

This policy would most likely enable high-income, professional expats on antiretroviral medication to obtain long-term visas in Singapore, which means that the risk of Singaporeans contracting HIV is virtually zero and the healthcare burden minimal. As such, these skilled foreigners would likely be perceived favourably by the state, meaning that parliament might be more inclined to enact this policy change.

Next Steps

In the context of Singapore, we recognize that any changes to the policy needs to be approved by parliament. As such, we have highlighted the benefits to Singapore’s economy and international image, which might hopefully better convince parliament to enact change.

We plan to work with advocacy groups such as Action for AIDS (AFA) and other community partners in campaigning for a change to the law. By organizing a petition, we hope to bring parliament’s attention to the policy which might enact change. We also understand that Singaporeans might be opposed to such a change, that there might be a push-back against immigration and/or fear of HIV-positive individuals. As such, part of our campaign with AFA would also entail educating the public on how medication can inhibit HIV and its transmissivity.

However, changing this law is only the first step in tackling discrimination against HIV-positive individuals. In the future, when antiretroviral medication becomes readily accessible to all, it would be ideal if the law was abolished.

Key Facts

  • In 2010, all restrictions on HIV-positive individuals from entering or migrating to the United States were lifted, and people were no longer be required to undergo HIV testing as part of the required medical examination.[8]
  • In 2015, Singapore lifted a ban on issuing short-term visit passes to HIV-positive foreigners.
  • In 2017, 434 new cases of HIV infections were reported among Singapore residents, and about 41% had late-stage HIV infection when they were diagnosed, signifying that they were getting tested late.[9]
  • The number of new HIV cases among Singaporean residents has remained consistent at about 450 per year since 2008.[10]

Action Plan Snapshot

Firstly, we propose working with HIV advocacy groups such as Action for Aids (AFA) to create awareness regarding this archaic law. This campaign would also entail spreading knowledge of how HIV is transmitted, HIV preventative measures, and the availability of antiretroviral medication. The campaign should emphasize how changing the law can improve knowledge of how HIV is transmitted, leading to better health outcomes for Singapore.

More importantly, we want to collect signatures that support a change to the law which would then be brought to parliament’s attention. In the context of Singapore where there are no political lobbies and very little ways for an individual to enact change, we recognize that we should first work extensively with AFA and their community partners to collect signatures for a petition. Afterwards, we can approach a Member of Parliament (MP) regarding the possibility of raising this issue up in parliament. We also propose contacting the Ministry of Health (MOH) to formulate a plan on how HIV-positive foreigners can establish a regular check-up plan at government clinics or hospitals and the Ministry of Foreign Affairs (MFA) regarding how such a change to policy can be made known to Singapore’s diplomatic partners.


References

[1] Ratnala, Naidu. 2003. “National AIDS Control Programme.” Infopedia. Accessed November 26, 2018 (http://eresources.nlb.gov.sg/infopedia/articles/SIP_372_2004-12-23.html).

[2] Ibid

[3] Ibid

[4] 2018. “HIV/AIDS: The Basics Understanding HIV/AIDS.” National Institutes of Health. November 06, 2018. Accessed November 26, 2018 (https://aidsinfo.nih.gov/understanding-hiv-aids/fact-sheets/19/45/hiv-aids–the-basics).

[5] Ibid

[6] Ibid

[7] Han, Lim Yi. 2016. “Ban on Entry into Singapore Eased for Foreigners with HIV.” The Straits Times. Accessed November 26, 2018 (https://www.straitstimes.com/singapore/ban-on-entry-into-singapore-eased-for-foreigners-with-hiv).

[8] “United States of America – Regulations on Entry, Stay and Residence for PLHIV”. The Global Database on HIV related travel restrictions. Accessed November 26, 2018 (http://www.hivtravel.org/Default.aspx?CountryId=12&PageId=143).

[9] 2018. “UPDATE ON THE HIV/AIDS SITUATION IN SINGAPORE 2017.” Ministry of Health. Accessed November 26, 2018 (https://www.moh.gov.sg/resources-statistics/infectious-disease-statistics/hiv-stats/update-on-the-hiv-aids-situation-in-singapore-2015-(jun-2016)).

[10] Ibid

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