| HIV Travel Ban Speech
Delivered by Charles King
Speech delivered on August 16, 2009, at
Rally To Support Lifting U.S. Ban On HIV-Positive Immigrants And Visitors.
Peace Arch Park, Surrey, British Columbia, Canada.
"Good afternoon! Thank you, Martin Rooney and company for organizing this important demonstration against the US travel ban on people living with HIV and AIDS. Thank you as well for your fine Canadian hospitality. I want you to know that I was able to cross the border from the United States to Canada with my HIV medications in hand, without the slightest worry that I would be barred from entry. I am ashamed to say that it would not be the same if I were an HIV+ Canadian going in the other direction.
That is just one of the reasons that I flew here yesterday straight from a two week trip in Haiti and the Dominican Republic, without even a chance to drop off my dirty laundry. Not only am I ashamed of my country for the persistence of this counter-productive, reactionary, retrograde and regressive policy, but I am also ashamed that so few citizens of the United States, many just a few miles from here, thought it important to be here in solidarity with you today.
After all, the travel ban is much more than just an inconvenience and humiliation for Canadians seeking to visit the United States. It is also a ban on residency. As such, it has a profound impact on persons in the United States living with HIV who seek political asylum, on undocumented immigrants who would obtain legal residence, and on legal residents who would become citizens. It separates families and keeps people out of treatment and care even within the United States.
Now I am sure most of you are well aware that the Centers for Disease Control, responding to action by the United States Congress 13 months ago, has finally promulgated proposed regulations that would permanently lift the ban on HIV+ foreigners entering the United States. I have no doubt that some change in regulation will happen..though I must note that the proposed rules leave open the question of requiring an HIV test of persons entering the country or seeking residency in the United States. (I should also warn you that a final rule will take months to promulgate because of the bureaucratic review process that will continue after the government receives all comments tomorrow.) But the fact that the U.S. government has initiated a rule change is no excuse for our inaction.
The fact of the matter is that this ban was illogical, illegal and ill-considered from its inception. Yet it has persisted now for some 22 years in a nation that claims to be a global leader in the fight against AIDS, thus setting the worst possible example for some 65 other nations that perpetuate this stigmatization of people living with HIV in some form or another. So, not only is it important for us to rally today in support of lifting the ban in the United States, but we must demand that every country of the world eliminate any and all travel, stay, and residency restrictions based on HIV status or identification as a member of any so-called high-risk group.
As Chris Breyer, the Director of the Center for Public Health and Human Rights at the Johns Hopkins Bloomberg School of Public Health, noted in his keynote presentation at the International Summit on Homelessness and AIDS this last June, HIV related restrictions on entry, stay, and residence have never had any basis in public health science or policy.
Their only basis is fear and prejudice that limit the right to non-discrimination, the right to equality before the law, the right to privacy, the right to security of person, the right to protection of the family, the right to withhold consent for treatment, the right to information, and the right to the highest attainable standard of care. Not only are these policies humiliating, degrading, and in violation of international law, but they fuel the epidemic by increasing fear, stigma, and discrimination.
So it's well and good that the U.S. ban may soon be lifted, but that really isn't enough. Because the truth of the matter is that lifting the ban would only be one small step forward. And it doesn't mean we have by any means addressed the underlying basis of fear and prejudice. The truth is that the core prejudices that fuel this epidemic remain rampant, not only in the United States, but also in Canada and around the globe.
Yet, I am afraid, all too many of us in North America, on both sides of the border, have become complacent. After all, we have our medications, HIV for most of us has become a reasonably manageable condition, and, here in Canada and a few states down south, we even have gay marriage, proving that progress against the prejudices that have fueled this epidemic is inevitable. Of course, here in our own countries the epidemic continues to spread, particularly among the most marginalized people, at way too high a rate, and around the globe, scores die of AIDS every day with no hope whatsoever.
In fact, the election of Barack Obama as President of the United States has only increased our complacency, probably on both sides of the border. It was easier to get people to march when bigotry was so publically endorsed at the highest levels of government. It's so much harder now when the "leader of the free world" is saying all the right things: Universal health care, a national and global AIDS strategy, a commitment to prevention that follows science and sound public health policy including federal funding for needle exchange, an end to homophobia and all the rest.
But the truth of the matter is that the election of Barack Obama does not mean an end to the AIDS epidemic or even that the promises made in the heat of the campaign will ever be kept. If anything, without our active engagement, an Obama administration will lead to incremental change in US policy at best and, at worst, self satisfaction that actually leads us all backwards.
So let's take a look at some of the things we really ought to be doing if we really want to end the AIDS epidemic. Five years ago, the Campaign to End AIDS distilled it down to four simple things:
Provide treatment, services and care, including housing, to every single HIV+ person who needs it;
Implement prevention strategies that follow science and not ideology;
Ramp up research, not just for a cure or vaccine, but also for innovative prevention strategies such as vaginal and anal microbicides; and
End stigma against people living with AIDS and HIV.
Since the Campaign to End AIDS developed this four-point platform, the research has advanced on several fronts. First, there have been a number of important studies released on the impact of early treatment. Two studies, released in the last four months, indicate that initiation of ARV's among people infected with HIV before the t-cells decline below 500 copies reduces mortality by more than 90%. This begs for a new standard of care that would require providers to offer HIV medications as soon as one is diagnosed.
Yet that is not the standard anywhere in the United States, Canada, or anywhere else in the world, notwithstanding a recommendation to that effect last summer by the US Section of the International AIDS Society. In the long run, implementation of this standard would save billions of dollars in treatment cost by prevention of opportunistic infections, but in the short term, it would make the cost of treatment soar. So we have yet to see advocates even begin to call for it here in North America, much less in developing countries where the current standard of care is to withhold treatment until t-cells have fallen below 200.
As for services, they continue to be rationed, not along some rational mechanism, but most irrationally based on formulas that were developed nearly two decades ago. And what about housing for every person with HIV who needs it? For people living with HIV, housing is treatment! The studies are legion. There is no longer any debate: Housing, especially when coupled with psychosocial case management, dramatically increases engagement in primary care and adherence to medication. It's really that simple.
Similarly, there is now plenty of data proving that housing is prevention. First of all, let's talk about homelessness as a risk factor. Here is what the research shows:
Rates of HIV infection are up to 16 times higher among persons who are homeless or unstably housed, compared to similar persons with stable housing; and over-time studies show that among persons at high risk for HIV infection due to injecting drug use or risky sex, those without a stable home are more likely than others to become infected.
Over-time studies show a strong association between change in housing status and risk behavior change, and access to housing also increases access to appropriate care and antiretroviral medications which lower viral load, reducing the risk of transmission.
Now, let's take that last point and couple it with what I said about offering ARV's. Imagine what would happen if we were offering housing or rental assistance to every single HIV+ person who needed it, and offering every single person who is HIV+ access to ARV's. Just with those two structural interventions, plus one other, you could bring the epidemic to a screeching halt even before we had a vaccine or a cure. Why, because the vast majority of people who go on ARV's before their immune systems are destroyed and are reasonably adherent.not perfectly, just reasonably.the viral load is reduced to an undetectable level.
What does that mean? Well, it means that particularly in sexual interactions, even without condoms, it becomes very difficult to transmit the virus. As one Canadian-authored study found, by getting 75% of HIV+ people on ARVs, we would dramatically reduce the viral pool, and end epidemic rates of HIV transmission. This could end our failed reliance on changing individual behaviors in moments of passion and ecstasy, whether natural or chemically induced, as the principal vehicle for preventing transmission. Couple that with clean needles for IV drug users, Fully funded hormones for transgenderèd folk, and treatment for HIV+ pregnant women, particularly at time of delivery, and we would have cut off just about every means of viral transmission. Now that is prevention that follows science!
But don't expect that kind of initiative to be led by the Obama Administration, because we will have spent so much money on war in Afghanistan and its neighbors, bailing out the banks, saving Chrysler and General Motors, and tinkering with health care reform, that ending AIDS will just be too expensive and looking at the life-time costs of infections averted will seem too remote and hypothetical.
By the way, earlier I said there was one more piece to the equation. That's ending stigma. As you all may know, in the U.S. the Centers for Disease Control and a number of states have recommended or adopted policies and legislation calling for universal testing, and to make that more likely, the lifting of laws that require informed consent to be tested. As David Holtgrave at Johns Hopkins University has pointed out, in a study the CDC paid him to do, "what a colossal waste of resources." Sorry, my paraphrase! We know that the epidemic has really dug its way into certain marginalized populations. Talking about a generalized epidemic is good public relations, but it just isn't true. Even in the District of Columbia, with the highest rate of infection in North America, the epidemic is overwhelmingly African American and/or gay. And among African Americans, it is men who have sex with men, IV drug users, and their sexual partners. Hello?
Want to get more people tested? End stigma. (Criminalization of HIV transmission, as has been done both in certain Canadian provinces and some of the states, is certainly not a way to end stigma or encourage testing.) But I am not just talking about stigma about HIV. I am talking about homophobia. I am talking about stigma about drug use. And I am talking about our prudishness about SEX!
How many women in North American go every year faithfully putting their feet in the stirrups for their annual pap smear without ever being told that it's a test for a sexually transmitted disease, much less being asked by the gynecologist about their sex life or having it suggested that they should have an anal pap smear too, because some 50 percent of North American women have had anal sex, and that's not counting finger play. Hey, guys, I'm not just talking to the gay men now, have you ever had anyone stick a finger in your ass? Did anyone ever suggest to you that you might ought to have an anal pap smear for HPV, which just happens to be a precursor to rectal cancer in men and women?
I've got no problem with universal HIV testing every year or six months if the government or the insurance companies want to pay for it, but how about if we just trained medical professionals to have honest conversations with their patients about sex and drug use and then offered the test where indicated? We could then use the money we save to make universal offerings of voluntary testing not just in prison, but in pre-arraignment detention centers, in mental health programs, in shelters for homeless people, in low income communities with high addiction rates and to men who are hooking up with other men. You get my drift.
The point is this: We know what we need to do to end the AIDS pandemic both here in North America and around the globe. It's not rocket science. It's common sense. The reason we are not doing it is not a lack of resources. It is, plain and simple, we are not doing it because we lack the political will. And that lack of political will is driven by in principal part by homophobia, racism and sexism, coupled with stigma against IV drugs and users, fueled by a misguided fifty-year old western-led war on drugs and on people who use drugs...except alcohol and cigarettes, which are good drugs because we can levy heavy taxes on them and people keep on drinking and smoking.
My friends, President Obama isn't going to change this. At his very best, he is just going to manage at the margins, unless we do something big. And all of our outreach and prevention efforts are going to be like trying to empty the ocean with a sand bucket unless we take seriously our responsibility to build a new and reenergized AIDS activist movement that demands what we need to at long last bring this epidemic to an end.
Some of you are perhaps too young to remember, but here at this rally, you should know that nothing that is available for prevention, services, or treatment came about because some politician woke up one morning and said I have a great idea that I am going to put into law today. Everything we have, we owe to brave men and women fighting for their lives, who took to the streets with creativity and flair, going to jail time and time again in non-violent acts of civil disobedience, marching, going on the hill, getting in the face of the news media and anyone else who had influence to demand that our government address that which was killing us.
We desperately need that very same kind of activism today. We need new leaders to rise up, new voices to join the chorus. whether eloquent and rude.to demand, loud and clear, to demand that our political and civic leaders do what it takes to end this plague.
Yes we need to demand an end to discriminatory travel restrictions based on HIV status. But we also need to demand universal access and offering of ARV's to every single person who is infected with HIV. We need to demand HIV services, not made available based on the happenstance of geography, but as an entitlement of every person who is infected.
We need to demand housing, not just for every person living with the virus, but as a basic human right, as recognized in the Declaration of Human Rights decades ago.
We need to demand an end to laws that criminalize sexual behavior among consenting adults.
We need to demand an end of sexism that allows women's health and well being around the globe to be treated as a low or even non-existent priority.
We need to demand an end to homophobia that continues to put men who have sex with men at the highest risk of HIV infection of any social group throughout the world.
And we need to demand an end to racism and ethnic prejudice that so often serve as the epidemic's sustaining fuel.
And finally, we need to demand that we treat AIDS outside the United States and Canada with the very same level of commitment to human life and dignity as we treat it at home.
This may sound like way too much to ask of a small handful of people who came out on a summer Sunday morning to demand their right to travel across the border to the United States. But let me conclude by quoting Barack Obama, when as a candidate for president of the United States, he said: "I'm asking you to believe," he said. "Not just in my ability to bring about real change.I'm asking you to believe in yours."
"We are the ones we've been waiting for. We are the change that we seek..We are the hope of the future; the answer to the cynics who tell us our house must stand divided; that we cannot come together; that we cannot remake this world as it should be.
Because we know what we have seen and what we believe - that what began as a whisper has now swelled to a chorus that cannot be ignored; that will not be deterred; that will ring out across this land as a hymn that will heal this nation, repair this world, and make this time different than all the rest - Yes, We Can."
Friends, please join me in making today's action just the first step in a renewed commitment to activism to bring the AIDS pandemic to an end."
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About Charles King:
Charles King is one of the founders and the President of Housing Works, Inc. a minority-controlled, community- based, not -for -profit organization that provides a full range of services including housing, health care, mental health services, chemical dependency services, legal advocacy, and job training and placement for homeless men, women, and children living with HIV/AIDS. Housing Works is the largest community-based AIDS services organization in the Untied States and currently services over 5,000 people every year.
Charles has combined his background as a minister and lawyer to develop and articulate the vision of Housing Works as a self-sustaining, healing community based on aggressive advocacy, mutual aid, and collective empowerment. This has included the development of entrepreneurial ventures which consist of a chain of upscale thrift shops, a used book café, a food service business, a property management company, a consulting and lobbying firm, a management services company, and a health maintenance organization. Housing Works operational budget this year is $41 million, one third of which is revenue from the organization's entrepreneurial ventures, and 80 percent of which is earned income.
For over a decade, Charles has traveled North America encouraging the development of social enterprise as a vehicle for social change. More recently, Charles has traveled to various states meeting with activists, providers and people living with HIV/AIDS in over 100 cities on the behalf of the Campaign to End AIDS in an effort to build a new AIDS activist movement committed to ending the AIDS epidemic around the globe.
Prior to the incorporation of Housing Works in June 1990, Charles served as Staff Attorney to the New York Coalition for the Homeless; as Assistant Pastor to Immanuel Baptist Church in New Haven, CT; as Director of an emergency center for abused children in Roundrock, TX; and as Minister of Street Ministries at First Baptist Church in San Antonio, TX. Charles holds both a Law Degree and a Master of Divinity from Yale University, and is an ordained Baptist Minister.
Charles King,
President and CEO of Housing Works
Housing Works, Inc.
57 Willoughby Street
Brooklyn, New York, U.S.A. 11201
347-473-7401 - direct
347-473-7464 - fax
About Housing Works:
Housing Works was founded as an outgrowth of the activist group ACT UP and remains true to those roots. Whether staging a die-in to protest local AIDS funding cuts, bringing clients to lobby Albany legislators or grooming new activists through the national coalition the Campaign to End AIDS, we push all levels of government to implement policies that will provide access to health care and HIV prevention for all people living with HIV/AIDS.
"Reproduced with permission - Charles King"
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