VANCOUVER - Immigrants with HIV account for a large portion of new infections of the disease in Canada and they're slipping between the health-care cracks, warns a recent report.
Although Citizenship and Immigration Canada is considering making HIV a reportable disease, currently it is not,meaning it is not considered a public health risk and it is not mandatory to report infections to public health officials.
The recent report by the B.C. Centre for Disease Control found that about 16 per cent of all new infections in Canada are linked to people from countries where HIV is prevalent, yet they make up only 1.5 per cent of the Canadian population.
The 2005 figure means the infection rate was almost 13 times greater for immigrants - or those connected to them - from HIV-endemic countries than for Canadians.
Tuberculosis and syphilis are considered reportable diseases by Citizenship and Immigration but HIV has only been designated a "notifiable" disease. There are no mandatory conditions for follow-up for immigrants who test positive for HIV.
"Targeted testing of immigrants, therefore, will increase the opportunity to ensure that HIV-positive immigrants are made aware of their status and support expedient counselling, prevention and treatment," said the report, titled Trends in HIV-Positive Immigrants and Reporting by Citizenship and Immigration Canada.
But critics say making HIV a reportable disease is an unnecessary intrusion on privacy.
When a disease is designated "reportable," all health care professionals must immediately report any incidence because it's considered a public health risk. The source of the disease is investigated to prevent others from getting infected and transmitting the disease.
Dr. Mark Gilbert, co-author of the report, said the goal would be to connect with immigrants who are new to the country and who may not know that help is available for treatment and counselling.
"From a public health perspective, if HIV were treated as a reportable infection through Citizenship and Immigration Canada, that would be one way of improving the timeliness of connectingwith these folks when they come to Canada," Gilbert said in an interview.
Every province and territory in Canada lists HIV as a reportable disease but the federal department currently does not.
Karen Shadd, a spokesperson for Citizenship and Immigration, said officials have read the report and its recommendations
"It is under consideration, but we're in discussions on the issues that were raised in the report," she said.
Since 2002, Citizenship and Immigration has required a medical examination for all immigrants and certain visitors to Canada including an HIV test for those 15 years and older.
Those examinations include physician counselling if a person tests positive for HIV.
Michael Battista, a Toronto lawyer who focuses on immigration and refugee law, said people are counselled about the dangers of spreading the disease.
"Citizenship and Immigration Canada wisely decided that people with HIV do not pose a danger to public health or safety," Battista said.
"And so I think it's on that basis that Citizenship and Immigration Canada doesn't have a strong connection to provincial health authorities in terms of reporting newcomers with HIV."
Battista believes the follow up from provincial health officials is an intrusion.
"I think there are huge privacy concerns that are raised when people with HIV go through the system, particularly given the fact that HIV is not something that is easily spread," said Battista.
Between 2002 and 2006 there were 2,567 immigration applicants who tested positive for HIV during their medical examinations among the 1.2 million immigrants to Canada accepted during the same period.
Of those HIV-positive applicants, 89 per cent were determined to be medically admissible to the country.
A person with HIV has an added burden compared to other Canadian immigrants getting into the country.A person with HIV is not inadmissable outright, but it is very difficult for HIV-positive immigrants or refugees to gain admission.
A foreign national can be considered inadmissible on health grounds if they're likely to be a danger to public health or safety or could be expected to cause excessive demands on health or social services.
Richard Elliot, of the Canadian HIV/AIDS Legal Network, is also concerned about privacy issues and said Citizenship and Immigration would have to tread carefully when advising health authorities about a person's HIV status.
"We don't want people to fall between the cracks," Elliot said. "But I know there have been concerns expressed over the years of CIC not doing a particularly good job in how they communicate an HIV-positive diagnosis to people."
Elliot said some people have been told they're HIV positive in a letter that included a handout with outdated information.
"So I think there's certainly room for improvement about connecting with care and treatment," he added.
Shadd said Citizenship and Immigration already notifies provincial and territorial health officials about HIV-positive newcomers for statistical, educational and resource planning purposes.
