Global strategies to control infectious disease have historically included the erection of barriers to international travel and immigration. Between 29 and 50 countries are reported to have introduced border restrictions on HIV-positive foreigners, usually those planning an extended stay in the country.
The country with the broadest policy of testing and excluding foreigners is the United States. The U.S. policy has been sharply criticized by national and international organizations as being contrary to public health goals and human-rights principles. The Immigration and Nationality Act requires the Public Health Service to list “dangerous contagious diseases” for which aliens can be excluded from the United States. By 1987 there were seven designated diseases—five of them sexually transmitted and two non-venereal. On June 8, 1987, in response to a Congressional direction in the Helms Amendment, the Public Health Service added HIV infection to the list of dangerous contagious diseases.
A just and efficacious travel and immigration policy would not exclude people because of their serologic status unless they posed a danger to the community through casual transmission. We support well-funded programs to protect the health of travelers infected with HIV through appropriate immunizations and prophylactic treatment and to reduce behaviors that may transmit infection.
We recognize that treating patients infected with HIV who immigrate to the United States will incur costs for the public sector. It is inequitable, however, to use cost as a reason to exclude people infected with HIV, for there are no similar exclusionary policies for those with other costly chronic diseases, such as heart disease or cancer.
Rather than arbitrarily restrict the movement of a subgroup of infected people, we must dedicate ourselves to the principles of justice, scientific cooperation, and a global response to the HIV pandemic.In referring to the "costs" incurred by the public, the authors apparently mean