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Jan 7, 2008

Dear Doctor Robert I'm a 32 year old Brazilian hiv positiv male living in London. After 5 years in the UK I must say that I really admire their aproach to us positive people. We're treated by their government like anybody else if no better. I've traveled all over Europe and have never had a problem regarding my hiv status. I'd love to go to New York though, but I find it so hard because of your rules towards positive people. My question is: Why is the mainstream of hiv activism in America so silent about this matter? Why don't you people raise your voices to make sure that your next presitent fights against such totalitarian law. How come a people that think of themselves as the kingdom of freedom and an example to the world can accept it? I shall never see New York unless I hide my meds like a terrorist hides his bomb. How come you hiv positive people from America can so easily go on holiday to any other corners of the world? Thanks for your answer. Helio

Response from Dr. Frascino

Hello Helib,

I can assure you mainstream HIV activism in the U.S. has been far from quiet about the completely idiotic ban on HIV-positive visitors to the U.S. In fact, since the ban was put in place, we have refused to host international World AIDS Conferences here. The problem is our current science-phobic, common-sense-deficient administration. See below. We are all gleefully counting down the days left before we can kick Dubya out of the White House. I'm quite confident once Obama moves in, rational thought, common sense and morality will be restored to the Office of the Presidency and the travel ban will be lifted.

Dr. Bob

New Rules for HIV positive people travelling to the United States Dec 10, 2007

Hey Dr. Bob,

I heard the Bush Administration finally got around to changing the ban on HIV positive travelers wanting to come to the Unioted States. Is this too good to be true???


Response from Dr. Frascino


Dubya strikes again! Or should that be strikes out again?!?!

The new rules for HIV-positive folks wishing to enter the U.S. are even worse than the old rules!

People with HIV have been banned from entering the U.S. since 1987, but waivers are sometimes given for short visits. Dubya promised to "streamline" the process for getting these exceptions on World AIDS Day last year! So, one year later we have Homeland Security, which had handled the waivers on a case-by-case basis in the past, drawing up new rules that can be followed by consulates. The new rules are no better than the old ones and, in some ways, make visiting the U.S. even more difficult. Dubya, in typical fashion, is also trying to ram the new rules through without the usual time for public comment and consideration.

Basically the ban remains in place. The new rules apply only for exceptions to the ban. I should point out scientists have long ago concluded the ban is unwarranted and does absolutely nothing to protect Americans' health. Only a dozen other countries bar HIV-positive visitors. They are Armenia, Brunei, China, Iraq, Libya, Moldova, Oman, Qatar, Russia, Saudi Arabia, South Korea and Sudan. This is not exactly a stellar list when it comes to human rights! The ban stems from stigma and ignorance. (Hence the good fit with Dubya, eh?)

Current waivers to the ban have been very difficult to get and are issued rather capriciously. Under the old rules, the possibility of transmission and the danger to public health had to be minimal and no local, state or federal government agency could incur costs from the visit. The new system makes it more difficult to enter the U.S. by requiring more documents. The old system required very few papers, but under the new "streamlined" plan, visitors must document very private information about their health to bureaucrats. As an example, the new system would require the potential visitor to carry medications they might need for the entire stay. Someone who doesn't take any medications would have to get a doctor to certify to Homeland Security that meds aren't needed. Waivers would now also require that the visit be a maximum of 30 days and that applicants prove they are aware of their condition and under medical care. Plus they would have to prove they have health insurance that is accepted in the United States! Needless to say, these requirements are unjust, illogical and stigmatizing!

The new rules do call for waivers to be granted faster, but only if applicants agree to give up certain rights and opportunities they might have had under the old system. The quicker turnaround is expected because consular offices would be able to process the applications directly and the process avoids the abyss of the Homeland Security office. Basically what HIV-positive travelers would have to give up is the opportunity to change their visa status while here in the U.S., to seek legal permanent residency, to apply for a job and, in some cases, to conduct business while in the U.S. They also would no longer be able to seek asylum.

Dubya and his cronies are once again being disingenuous by claiming to make things easier for people living with HIV, but in reality compelling them to forfeit their rights.

So, is it January 20, 2009 yet???

Dr. Bob

Is still banned to get in USA with HAART? (TRAVEL RESTRICTIONS, ENTERING THE USA) Nov 7, 2007

Hi there, Id like to know if there has been any kind of improvement in order to let people using HAART to get into the country of freedom (USA I mean... :-( ) I need urgently to get there for job reasons but Ive been succesfully on the same combo for 8 years and I am extremely annoyed of the idea of put that in risk.. could i get my haart recipe and buy the combo in usa being from abroad? Thanks in advance Antonio

Response from Dr. Frascino

Hello Antonio,

Unfortunately no, Bush had promised to lift the ban, but apparently hasn't gotten around to it yet. Don't hold your breath. There may well be no action on this until he is run out of office and firmly ensconced in the history books as America's worst president. After all, to lift the ban would require common sense, compassion and an appreciation of scientific fact. Dubya has a severe deficiency of all three. At this point your only option would be to apply for a waiver.

I'll reprint some information from the archives below addressing this issue.

Dr. Bob

Travel to the US Sep 14, 2007


I am ravelling to the US for 1 week next month and am wondering if the HIV waiver is in place or not - should I take a treatment break, declare my status or simply risk bringing in my meds for the week without declaring.

I'm not willing to post my med in beforehand as many here in Australia recommend - just too difficult.


Response from Dr. Frascino

Hi David,

I do not recommend you take a treatment break. Just pack your meds in your carryon. You shouldn't have any difficulties. Bush vowed to lift the travel ban on World AIDS Day 2006. Whether he actually did so is another story. (See below.) But, I've not heard of anyone being turned away for quite some time.

Bon voyage!

Dr. Bob

Advocates take on U.S. HIV 'travel ban' NEWS Published 04/19/2007 by Bob Roehr

The U.S. "travel ban" on HIV-positive foreign visitors and immigrants is a vestige of the darkest days of the epidemic. It may be drastically modified or even eliminated completely if the organizers of an April 12 forum in Washington, D.C., have their way.

U.S. authorities always have had the power to bar foreigners who pose a public health threat from entering the country. That was interpreted to exclude a HIV-positive Dutch visitor traveling to speak in the U.S. in 1989. It sparked a protest at the International AIDS Conference in San Francisco in 1990 and the conference vowed not to return until U.S. policy changes. The World Health Organization has called the policy a violation of human rights.

But Congress codified the policy into law in 1993, despite objections from then-Secretary of Health and Human Services Louis Sullivan. It specifically prohibited foreigners from becoming immigrants or even obtaining a visa to visit the U.S. if they are HIV-positive. However, the provision may be waived on an individual basis if it is deemed to be in the best interest of the U.S. to do so. Blanket waivers have been issued for specific events such as the Gay Games in Chicago.

Attending the International AIDS Conference in Toronto last summer "brought home in a very powerful and real way that it is forbidden to have such a thing on U.S. soil," said J. Stephen Morrison, executive director of the Center for Strategic and International Studies. He said the U.S. policy "is misaligned with current realities and evolving U.S. interests;" and that it is time to consider a change.

Phillip Nieburg, co-author of a report that lays out the history of the policy and how it might be changed, said that the knowledge base around HIV has grown since 1993 and it is clear that HIV is not an easily spread contagious disease. There is no public health justification for the law, he said.

Helene Gayle has been a leading expert on HIV prevention at the Centers for Disease Control and Prevention and the Gates Foundation, and is now president of CARE, a large international charity working in the developing world.

She said the law is not consistent with the international leadership role on HIV that the U.S. has demonstrated with PEPFAR, the President's Emergency Plan for AIDS Relief.

"It is just one more thing where we are out of line and inconsistent with what we are trying to do," she said.

Critics of the waiver process for short-term visitors say that many persons do not know that they are HIV-positive when they apply for a visa. For those who do know, disclosing that to a State Department official runs the risk that the official or local support staff might disclose that medically confidential information. In many countries, that can lead to stigma and discrimination within the society. Furthermore, the application fee for the waiver can be prohibitive for persons with low incomes.

The Bush administration acknowledges the privacy concerns and on World AIDS Day, December 1, 2006, President Bush surprised AIDS advocates by quietly announcing that he would issue an executive order addressing those concerns.

Rising from the audience last week, Tom Walsh, with the Office of the U.S. Global AIDS Coordinator at the Department of State, told the forum, "The process is under way, it is complex, and I wish there was more that I could say." Others have said that delay is due to trying to work within the confines of the law so as not to require new legislation.

Supporters of the current law fear that people who are HIV-positive who enter the country either as immigrants or on short-term visas will stay and add to the burden of already stressed AIDS services. They can point to what happened after the International AIDS Conference in Toronto last summer; more than 150 HIV-positive attendees chose to remain in Canada and seek asylum. The claimants said they feared discrimination or worse in their own countries. The cost of drugs alone for those people would run about $1 million a year in the U.S.

Nieburg called that argument inherently discriminatory, given that other costly chronic health problems are not singled out for a blanket ban but are handled on a case-by-case basis.

"Moving Beyond the U.S. Government Policy of Inadmissibility of HIV-Infected Noncitizens" is available at

Entering the US Jun 4, 2006

Am I correct in saying that you can't enter the US period if you have AIDS or just immigrate to the US because I recently entered the US through SFO international on business for 3 days and I have HIV, not AIDS though since am on meds.

Response from Dr. Frascino


I've addressed travel restrictions several times in this forum. I'll repost a recent question from the archives below.

Dr. Bob

Living with HIV May 14, 2006

Dear Dr. Bob,

I am from Brazil, 26 years old and a handsome gay man. Your words are always very inspiring for me. I got HIV around three years ago, when a condom failed with me. The beginning was not easy... after 1 year my cd4 was around 200 but I was healthy. I started to take my meds since 05.05.05. It was very boring the side effects of efavirenz+lamivudine+azt, but now it is not anymore. However my cd4 is still around 240, however, the cd4 percentage has climbed from ca. 20 to 30 %. I am indetectable since Aug '05. I never forgot any pill. Is these number ok? My doctor and me are planning to move on kaletra (once a day). Do you think it should be a better option? I am finishing my phd and would like to go to USA for a post-doc. Is it possible for me enter in The States being poz? How is the medical care? I am worried because I have full and free assistance in Brazil. Again, thank you very much for your very kind words at this site. Best regards,


Response from Dr. Frascino:

Hello Bob,

Your current HAART regimen appears to have given you a good virological response (decreased viral load to undetectable levels), but only a suboptimal immunological response (minimal increase in absolute CD4 count from 200 to 240). I believe a switch from the non-nucleoside (efavirenz) to a protease inhibitor (Kaletra) is definitely worth a try.

Traveling to the US while being "virally enhanced" can be challenging! Despite absolute consensus among all experts that HIV travel bans are completely unnecessary (read this PDF file for more information), the U.S. still shuts its borders to visitors with HIV. The United States Citizenship and Immigration Service (USCIS) sometimes grants a waiver for HIV-positive visa applicants, but usually it's for those wanting to stay 30 days or less.

There is no actual HIV-testing procedure at the airport, but travelers carrying HIV-related literature or HIV medications can be turned over to an immigration official for further investigation. If a determination is made by the immigration officer that the traveler is HIV positive and traveling without the proper HIV-waiver clearance, he or she can legally be barred from entry into the U.S. ( I find this policy shameful!) Before making definitive plans, I suggest you consult with an immigration practitioner who is familiar with the HIV-travel restrictions. (You can call AIDS Law Project at 215-587-9377 for a consultation.) I'm hopeful that once we have a regime change here and Bush and his anti-science cronies are finally removed form office, common sense and science will once again reign and we'll be able to change some of these nonsensical laws.

Dr. Bob

Multiple time donator - first question ever

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