Stigma soup: HIV testing at the borders

Can you protect your nation from HIV by testing immigrants for the virus? Even the United States now thinks that’s a daft idea; it finally dropped its HIV testing requirements for immigrants earlier this year. Now South Korea has followed suit, sort of. The country will drop HIV testing for some, though it has announced different rules for teachers and entertainment industry workers.

Should the International Union of Sex Workers start girding their loins to fight for equal rights for hookers? No. Seoul has decided that people applying for entertainment industry visas do not need to be tested for HIV. People wanting to teach English do. An official of the Ministry of Education, Science and Technology explained the decision thus: “Education is considered a very intimate relationship. According to an unofficial survey by the Prime Minister’s Office, the majority of parents wanted solid evidence of their children’s teachers’ HIV status.”

The implication — that English teachers from Wisconsin are more intimate with their clients that hookers from Vladivostock are with theirs — is clearly absurd, and the Korean authorities are squirming a bit about the silliness. But it reminds me of a piece of ancient history in the HIV industry’s cooking up of Stigma Soup.

Many years ago, we were trying to come up with ways of measuring HIV-related stigma in international surveys. We suggested three questions: Should HIV infected nurses be allowed to treat patients in hospital? Should HIV infected teachers be allowed to teach? Would you buy cooked food from someone with HIV? To everyone’s surprise, a lot of respondents in African surveys replied no, no, yes. So was HIV stigmatised, yes or no? A bit of qualitative work shed more light. HIV-infected nurses shouldn’t be allowed to treat patients because they had compromised immune systems and it was better for them not to be around sick people. Not all that stigmatising, then. Food sellers? What? Everyone knows you can’t pass on HIV in a pot of stew! No stigma there, either. But teachers, what about teachers? Well they’re always having affairs with the pupils; we don’t want our daughters to get anywhere near a positive teacher. It strikes me that’s stigmatising of teachers, though not necessarily of HIV.

While we’re on the subject of HIV and immigration, I do think it remains the great untouched subject of the UK HIV epidemic. A first glance at figures provided by the soon-to-be late and very much lamented Health Protection Agency shows us a great wave of heterosexual infections in the UK.

If you take away the infections that are diagnosed in people who were born in a sub-Saharan or Caribbean country with high HIV prevalence, the picture looks very different indeed:

The difference is assumed to be the infections that are “imported”. In fact, there may well be quite a bit of transmission within communties of African-born people in the UK. But there’s virtually no effective targeted prevention programmes for that group, because we’re all so scared of two things. [Note comment on this point] Firstly, the Daily Mail getting hold of the issue and beating up support for a “test the immigrants” campaign. Secondly, the idea that targeted prevention would be stigmatising. Imagine, it might engender a backlash from all those Pentacostal Churches in East London. And then we’d be in the same situation that so many African countries are in: community leaders choosing to deny a problem rather than help their people by dealing with it.

This post was published on 28/10/10 in Science, The sex trade.

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  1. Comment by Gary Hammond, 29/10/10, 03:10:

    Dear Elizabeth,

    Always enjoy coming here and seeing your direct opinions on subjects but seldom feel the urge to comment.
    Excuse me for being pedantic but doesn’t the first table show us a wave of diagnoses in the UK rather than a wave of infections in the UK? Also I would be interested to see the tables if we were to also remove those people who were identified as white (or for who there was no data), to see how this would change the wave and by how much.

    Although your key point is perfectly valid that there are infections happening amongst Africans living in the UK I must respectfully disagree about the lack of targeted interventions within this group. We do have a functional HIV sector which is targeting African people in the UK. The National African HIV Prevention Programme (funded by the Department of Health) are currently engaged in a whole host of activities targeted specifically at UK African communities. There are a lot of people who are doing some great work to address HIV prevention needs within this population.

    One of the fundamental reasons for the lack of such high profile campaigns is not to do with the more salacious media representation of such interventions but more to do with a historical under investment in funding such initiatives. Also we have had for a number of years a framework to work within in terms of HIV prevention needs of gay men, which has enabled a certain degree of interagency mutual understanding to strive towards a common goal. Thankfully there now exists the same for the African HIV prevention sector and a website to encourage better targeted interventions:


    However your point about UK faith leaders and their role in this epidemic IS a valid point and would perhaps be best served by a whole post of its own!

    Best wishes

  2. Comment by elizabeth, 29/10/10, 03:21:

    Thanks for this. Of course you’re right about diagnoses rather than infections.

    Funnily enough, I was on the Sigma site this morning and just saw for the first time the link to the new African prevention site. I’m very glad to see it. My comments about the absence/insufficiency of such initiatives were based in part on a discussion with a provider of HIV services in my borough, Hackney, where the epidemic is overwhelmingly among people of African origin.

  3. Comment by Muscleguy, 30/10/10, 04:27:

    I just wonder with the figures in the graphs where the national education campaigns on HIV are these days? Perhaps I just consume the wrong media but there seems to be very little and what there is is not scary enough.

    The young in particular seem very blasé. The recent Hospital series on iirc C4 had one teenage lass who had sex once and is now HIV positive. The same program (in a South London sexual health clinic) showed teenagers of both sexes being infected repeatedly and just expecting to be fixed by the medics. Ignorance kills and it seems to be doing so. Sure the modern drugs mean more slowly but it also means more spread.

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