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New book documents what HIV testing and medical examination of immigrants looks and feels like

A nurse draws blood from a patient

The Canadian state’s ideological work with regard to HIV policy and mandatory screening involves a set of institutional practices that are highly problematic for immigrants living with HIV, argues a new book by a professor at UTSC’s Department of Health and Society.

In Screening Out: HIV Testing and Canadian Immigration Experience, Laura Bisaillon explores the medico-legal and administrative practices governing immigration to Canada, following the application process of a woman from sub-Saharan Africa and her interactions with doctors and state officials and bureaucrats.

Prof. Bisaillon presents this story in the form of a narrative, based on stories and situations from a number of different people she met during her ethnographic fieldwork.

In 2002 the federal immigration department, in consultation with the Health Canada, put into place a mandatory health screening policy, it had been part of the larger study of prospective changes to the immigration system. The first proposal was to screen all applicants and exclude all applicants with HIV full stop. When that was made public there was an outcry led by the HIV Legal Network, and its allies in legal and social services communities.

“They argued it was bad, ethically, morally, and legally and there was no public health justification to introduce this policy,” says Prof. Bisaillon. In the end, the government relented on excluding HIV+ people, but succeeded in establishing mandatory testing. This mostly takes place in the applicants’ country of residence, but can also happen in Canada.

“What that’s designed to do is to filter out people with HIV,” explains Prof. Bisaillon. “The very existence of an HIV policy, the purpose of this policy is to separate people into normal and abnormal. You’re sorting people who have HIV from those who haven’t. What that then triggers, with an HIV diagnosis is more administrative attention than any other diagnosis. There are more documents, more regulations, more functions, more guidelines. This inordinate attention provides the basis for interventions on people with HIV footed in prejudice.”

While things have changed in recent years, notably in 2018 when the government increased the threshold at which the cost of medical care would make a person inadmissible, and also tweaked the social services costs requirements to remove special educations services (a change that would benefit applicants with conditions like autism and Down’s syndrome) Bisaillon points out that a legal fact remains: the immigration medical system takes place through discriminatory practices directed to people the state deems “abnormal.”

“Calculating a person’s so-called value, or human ‘worth,’ using a cost matrix, regression analysis, and deductive reasoning as tools, which is currently the practice, is degrading to the human lives that are textually represented in immigration application documents,” she writes in her book.

Additionally, in some cases people coming from OECD countries for periods of over 6 months will have the need for mandatory screening waived. Bisaillon argues this presents inequality as it provides tangible hurdles for applicants from less affluent countries.

As well, many countries such as Sudan and Russia have automatic deportation policies, so that people receiving an HIV+ diagnosis in such countries can find themselves in real trouble there, too. Not to mention the fact that more often than not, people applying to Canada are unaware they are being tested for HIV.

“Canadian domestic immigration law and its policies reach far into people’s intimate lives all over the world,” says Bisaillon.

Screening Out: HIV Testing and Canadian Immigration Experience is available now from UBC Press.