On Wednesday, November 22nd, 2017, United States citizen Daniel Williams (pseudonym) posted an open letter on his Twitter (https://twitter.com/DanWilliamsVisa) and mailed a hard copy to Mr. Qu Yunhai, the head of China’s Bureau of Exit and Entry Administration of the Ministry of Public Security of China.
 
Daniel spent years studying Mandarin as a second language. After graduating from a renowned university, Daniel dreamed of working in China. He passed a series grueling Chinese language interviews, and was offered his dream job with a large corporation in Mainland China.
However, Daniel’s dream came to a surprising halt when, as part of a routine physical exam required by the Chinese embassy, he learned that he was HIV-positive. In addition to the initial shock of his diagnosis, he later reached out to a number of visa consultancies and discovered that he would not be able to work in China because of a regulation titled “Provisions Concerning the Health Certificate for Foreigners” (关于来华外国人提供健康证明问题的若干规定) which forbids the issuance of health certificates to foreign people living with HIV, thereby banning them from receiving residence permits to work in China.  
 
Making matters worse, is the lack of transparency regarding China’s ban. Daniel explains “after receiving my diagnosis, I saw a number of conflicting reports regarding China’s ban, such as UNAIDS publications, placing China on a list of countries with no restrictions of travel and residence.” Confusion regarding China’s ban, resulted in the unnecessary disclosure of his health status to his potential employer. When the ban was confirmed, the organization withdrew their job offer. Daniel recalls “what happened was traumatizing and humiliating, and I now live in constant fear that discrimination will hold me back from achieving other goals in life.”
 
Despite his setback, Daniel is cautiously optimistic about the future. “When you see the miraculous advances that have happened in medicine, it’s hard not to be optimistic that bans on employment and residence initiated twenty to thirty years ago will soon be a thing of the past.” In addition to advances in medicine, during the past decade there has been steady legal reform in many other countries, as treatment has become a mode of preventing spread of the once deadly virus. Today, only a small minority of countries continue to ban employment of foreigners based on their HIV status. Dan reflects on his future with confidence “I am not going to let this get in the way of my career ambitions or my goal of staying healthy and eventually having a family.” 
 
Reflecting on his recently shattered dreams of working in China, Daniel emphasizes the uplifting direction of China’s treatment of people living with HIV. “China has made shown itself to be compassionate towards people living with HIV, in terms of health policy, antidiscrimination laws and the advocacy of its leaders.”  Estimates are that more than 600,000 people living with HIV in China have received free anti-retroviral treatment from the government.
 
While Daniel acknowledges that treatment costs and transmission risk could be a concern for countries such as China which have not yet lifted employment bans on foreign people living with HIV, Daniel emphasizes that “multiple studies have proven that people living with HIV who regularly take their medicine cannot transmit the virus – banning employment on this group of people, regardless of an individual’s ability to cover treatment costs through insurance or personal resources is discriminatory and stigmatizing.”
 
Highlighting the futility of its ban, in his letter Daniel highlights that more than 122 million Chinese citizens traveled overseas in 2016, while the total population of all foreigners living in China totals less than 1 million. Daniel emphasizes that “with such a broadly defined ban, there is a large opportunity for China to update its policies to reflect those of other major United Nations member countries.” 
 
Daniel ends his letter expressing hope that eight years after China lifted its ban on short-term travel, China could take the opportunity ahead of World AIDs Day – December 1st, 2017 to loosen its ban for foreign people living with HIV who seek to work in China.
 
“China wisely repealed its HIV travel ban in 2010, and if it wants to attract the best talent in the world, it should also repeal its work ban for people living with HIV. People with HIV can live long, productive lives, but will be working for companies based in Taiwan or Hong Kong if they are barred from work in Mainland China”, says Kate Krauss, Director of the AIDS Policy Project an international advocacy group working to impact the lives of people with AIDS (PWAs).
 
“China’s ban on residence permits – and hence work permits – for foreigners living with HIV is a relic from the past. It is also arbitrary and discriminatory. China lifted its travel ban for people living with HIV in 2010 – it makes no sense to prevent individuals from taking up residency, or working”, says Sophie Richardson, the China Director at Human Rights Watch.
 

Daniel Williams

 

Daniel.williams.visa@gmail.com

 

November 22nd, 2017

 

 

 

 

 

 

 

 

 

Qu Yunhai

 

Bureau of Exit and Entry Administration of the Ministry of Public Security

 

14 East Chang’an Street Beijing China 100741

 

 

 

 

 

Dear Mr. Qu Yunhai,

 

 

 

RE: China’s Ban on Employment of Foreign People Living with HIV (“PLHIV”)

 

I am writing to ask for your assistance in advocating for the removal of China’s ban on issuing work visas and residence permits to foreign PLHIV. This ban has remained effective since 1987 without amendment.  Removal of the ban is justified on the basis of dramatic advances in medicine and China’s increasingly influential role in the world, across culture, trade, business, technology, science, human rights for PLHIV, and HIV cure research. Removal of China’s outdated ban on foreign PLHIV, ahead of World Aids Day – December 1, 2017 would also be a monumental gesture, aligning China’s immigration policies with those of other United Nations members and countries of great influence. Lifting this ban would mark, what President Xi Jinpin calls a “New Era”, as outlined in his report delivered at the 19th National Congress of CPC on October 18, 2017.

 

       To make my case, I would like to share some personal details about myself and why removal of the ban is so important to me. I grew up in a small town in the US. While pursuing my undergraduate degree, a semester abroad took me down the path of becoming a lifelong learner and admirer of Chinese history, culture, and language. Since my first trip to China, I have studied Mandarin for almost a decade, including an extended period at one of China’s top universities. At the post-graduate level, I furthered my studies of Chinese language and history at renowned universities in the US. My professional life has been complimented by my devotion to studying China and Mandarin language. I have worked across Asia with large corporations for more than a decade, increasingly alongside colleagues from China. From these experiences, I have developed a deep respect for the ingenuity and spirit of Chinese people and the China’s economic miracle of the past forty years. In the culmination of rigorous studying and professional development in Asia, I have relentlessly pursued the goal of working in Mainland China.

 

I had been fortunate to have never faced discrimination as a US Citizen working internationally, but that changed when I tested HIV-positive during a medical examination for a Chinese visa. Prior to testing HIV-positive, I had not been aware that HIV travel and residence bans existed, nor did I consider myself as a high-risk individual for contracting the virus. Despite having no symptoms or ailments, follow-up tests confirmed my diagnosis. It makes no difference that I later discovered that the virus had been contracted from a long-term partner who had been unfaithful, the same could have happened to anyone – as I have learned, HIV does not discriminate against race, nationality, gender, sexual orientation, education, or socioeconomic background.

 

Following my diagnosis, I was encouraged by the dramatic advances in medicine. While in the 1980s an HIV-positive diagnosis was considered a death sentence, dramatic advances in medicine have made HIV a manageable chronic and non-infectious condition, similar to diabetes or high blood pressure.  Modern medicine (widely available internationally) has been proven successful at controlling the virus to undetectable levels, thereby making the virus non-infectious, and eliminating risk of disease progression.2,   As result, PLHIV are now able to live normal lives, with a life expectancy similar to uninfected individuals.2,   In 2009, the US Center for Disease Control (CDC) removed HIV from the list of “communicable diseases of public health significance”.   In Sep. 2017, the CDC announced that PLHIV who take medication daily and maintain an undetectable viral load have “effectively no risk” of transmitting the virus.  Looking forward, clinical trials underway in the US, Europe, and China for a new wave of treatments which could serve as a functional cure. 

 

Despite the encouraging state of medicine for PLHIV, I could not be more discouraged by the consequences of my diagnosis on my employment prospects in Mainland China. To take a step back – the reason I undertook a medical examination was that I had received an offer to work in Mainland China. The process of obtaining that offer was incredibly challenging. The final hurdle to obtaining employment in China was to apply for a work visa and residence permit, both of which are required to work legally in China. Even for twelve-month work visas, all foreigners must take a health exam including a blood test for HIV as part of a health certificate required by Chinese embassies.  After receiving my results, conversations with six visa consultancies confirmed the worst of my expectations – that it would not be possible to obtain a work visa as a foreign PLHIV. Additional research also confirmed that foreign PLHIV are unable to receive a clear health certificate and as result cannot obtain residence permit, according to China’s “Provisions Concerning the Health Certificate for Foreigners” (关于来华外国人提供健康证明问题的若干规定).  

 

This news shattered my dreams and disrupted my life. It not only had a devastating impact on my employment prospects and sense of self-worth, but also extended hurt and disrespect to all the colleagues, mentors, teachers, family, and friends who have helped me along the way.

 

Making the situation even curler is the amount of misinformation around China’s rules for foreign PLHIV. Many press releases and scholarly articles praise China for its announced removal of visa restrictions for PLHIV in 2010. Even today, UNAIDS continues to publish maps and memoranda classifying China as a country with “no laws or policies restricting entry, stay and residence of PLHIV” similar to the US and most EU countries.   It can be observed that scholarly research on HIV-related travel restrictions refer back to these data, drawing false conclusions about China’s role in eliminating residence restrictions for PLHIV.  This misinformation creates a sense of false hope for foreign PLHIV who apply for jobs in China. It also leads to the waste of resources for businesses extending offers to foreign PLHIV. Despite China’s progress on implementing anti-discrimination laws for PLHIV, foreign PLHIV who proceed with Chinese work visa applications will ultimately experience the humiliation of forced disclosure of HIV status to their employer combined with the devastation of having their work visa rejected and employment terminated.

 

Reflecting on China’s comparable lack of progress in removing restrictions for foreign PLHIV, the following table compares policies regarding the issuance of work visas to PLHIV:

Country  Source    Restrictions on      Restrictions on      Mandatory     Notes on

             Short-Term Travel Work Visas    Testing  

                            HIV Testing   Restrictions

Asia                           

–      Bangladesh    1     None      None      None     

–      China     1, 3, 4     None      Comprehensive Ban      For All Foreigners 5

–      Hong Kong    1     None      None      None     

–      India       1     None      None      None     

–      Indonesia       1     None      None      None     

–      Laos       1     None      None      None     

–      Malaysia 1     None      Limited Restrictions     Limited Scope       6

–      Myanmar       1     None      None      None     

–      Nepal     1     None      None      None     

–      Pakistan  1     None      None      None     

–      South Korea   1, 2 None      Limited Restrictions     Limited Scope       7

–      Thailand 1     None      None      None     

–      Vietnam  1     None      None      None     

Central Asia & Eastern Europe                        

–      Belarus   1     None      None      None     

–      Bulgaria         None      None      None     

–      Greece    1     None      None      None     

–      Kazakhstan    1     None      Comprehensive Ban      For All Foreigners 5

–      Mongolia       1     None      None      None     

–      Romania 1     None      None      None     

–      Russia    1     None      Comprehensive Ban      For All Foreigners 5

–      Serbia     1     None      None      None     

–      Tajikistan       1     None      None      None     

–      Ukraine  1     None      None      None     

–      Uzbekistan     1     None      None      None     

Western Countries                            

–      Australia 1     None      Limited Restrictions     For All Foreigners 8

–      Canada   1     None      Limited Restrictions     For All Foreigners 8

–      France    1     None      None      None     

–      Germany 1     None      None      None     

–      Israel      1     None      None      None     

–      Italy 1     None      None      None     

–      Norway  1     None      None      None     

–      Spain      1     None      None      None     

–      Sweden   1     None      None      None     

–      Switzerland    1     None      None      None     

–      United Kingdom    1     None      None      None     

–      United States  1     None      None      None     

Latin America                                  

–      Argentina       1     None      None      None     

–      Bolivia   1     None      None      None     

–      Brazil     1     None      None      None     

–      Chile      1     None      None      None     

–      Mexico   1     None      None      None     

–      Peru 1     None      None      None     

–      Venezuela      1     None      None      None     

 

 

1.    Deutsche AIDS-Hilfe e.V. “Quick Reference Guide, Entry and Residence Regulations for People Living with HIV”.  May, 2016.  

2.   

3.    Deutsche AIDS-Hilfe e.V. “The Global Database on HIV Related Travel Restrictions”.  Http://www.hivtravel.org. (Accessed: August 23, 2017)

4.   

5.    徐鹏, 刘康迈.  “我国取消外籍艾滋病病毒感染者和艾滋病病人入境限制的影响分析”. Chinese Journal of Health Policy. May, 2011. Vol 4, No. 5: 62. http://journal.healthpolicy.cn/ch/reader/create_pdf.aspx?file_no=20110512

6.   

7.    Private discussions with four major China-based visa consultancies. July, 2017.

8.   

9.    HIV positive foreigners are not granted work visas / residence permits. No waivers exist.

10. 

11.   Restrictions and testing is limited to only unskilled and partially skilled migrant workers.

12. 

13.  Restrictions and testing is limited and only applies to foreigners in the entertainment industry.

14. 

15.  As immigrants receive government health care, admission subject to assessment of cost burden. Various waivers to restrictions and rights to appeal exist.

      

 

 

As shown in the above table, China remains one of the most restrictive countries in the world with regard to issuing work visas for PLHIV, with policies that are most similar to those of Russia and Kazakhstan. In most other countries, restrictions on issuing work visas to PLHIV have been eliminated for nearly a decade.

 

Looking forward, I am hopeful that China can remove its ban on the employment of foreign PLHIV. The rationale for removing the ban on employment of foreign PLHIV is firstly justified by the dramatic advances in medicine to treat HIV and prevent transmission, compared to the primitive state of medicine in the 1980s when the ban was originally put in place. Secondly, bans on employing foreign PLHIV are highly stigmatizing, creating the impression to both Chinese citizens and the international community that PLHIV are unfit for work and unable to contribute to society. This stigma leads some PLHIV to work illegally or to falsify blood test results. Stigma also leads “at risk individuals” to avoid testing and treatment, thus contributing to the spread of the virus. Lastly, bans on issuing work visas to PLHIV are discriminatory, leading to unfair loss of employment and breach of privacy. The restrictions force businesses to terminate employment contracts on the basis of HIV status, which is contrary to anti-discrimination policies that most employers have in place. Overall, these restrictions are not aligned with the great advances that have occurred globally with respect to human rights and medicine, and the advances that have occurred in China with respect to its broad influence in culture, economics, trade, science, and technology. The ban does nothing to reinforce a positive international image for China, nor does it help China maintain international harmony with its foreign partners.

 

Of those countries that continue to ban employment of foreign PLHIV, some argue that restrictive policies towards PLHIV reduce transmission risks and costs on public healthcare. However, to put this into context for China, the total number of foreigners living in China totals around 600,000 (roughly 0.5% of China’s total population).  This figure contrasts with the growing number of Chinese citizens who travel abroad, totaling 122 million in 2016.  The difference between these two figures highlights the futility of banning employment of foreign PLHIV as a means of risk reduction – not to mention the fact that that transmission risks can be eliminated through medication and protection. With regard to costs imposed on public healthcare systems by foreign PLHIV, foreign residents are not entitled to public healthcare in China. Most employers of foreign professionals in China provide comprehensive private health insurance. With their condition managed, foreign PLHIV working in China would neither impose transmission risks nor would they impose costs on China’s health system. For these reasons, China’s ban on employment of foreign PLHIV serves no benefit.

 

I have noticed that the Chinese government has been a strong advocate for PLHIV, by expressing compassion and opposing discrimination towards PLHIV. This advocacy has been expressed directly from the top of China’s government, with President Xi Jinping publicly voicing his opposition to discrimination towards PLHIV.   According to President Xi Jinping, “HIV/AIDs is not terrible itself, but what is really dreadful is the ignorance on HIV/AIDS and the prejudice against HIV/AIDS patients”.  For more than a decade, Peng Liyuan, the First Lady of China, has been an advocate for equal rights of PLHIV, among other things, by participating in public service campaigns promoting compassion towards PLHIV.  In recognition of her contribution to the global response to HIV and her work to end stigma and discrimination for PLHIV, in January this year, UNAIDS and the World Health Organization granted Peng Liyuan the “UNAIDS Award for Outstanding Achievement”.  Overall, the incredible efforts made by the Chinese government to end discrimination for PLHIV should not be overshadowed by policies which characterize foreign PLHIV as unfit to work and unable to contribute to Chinese society.

 

With such a broadly defined ban on employment of foreign PLHIV, a large opportunity exists for China to update its policy. This could be achieved by either fully or partially removing the ban on issuing work visas and residence permits to foreign PLHIV, and by publicly announcing its removal to ensure its implementation. One approach could be removing the HIV test from the work visa health report for all foreign professionals. This would also remove the indignity of forced disclosure of HIV status to employers and characterization of foreign PLHIV as unfit for work. A second approach, following the practices of South Korea and Malaysia, would be to remove restrictions and mandatory testing for foreign working professionals while maintaining restrictions for sensitive industries, or unskilled workers who might lack access to private health insurance. A third approach, following the practice of Israel, would be removing restrictions and mandatory testing, but requiring all foreign professionals to have health insurance.

 

Looking forward to World AIDs Day on 1st December 2017, an amendment of China’s ban on issuing work visas to PLHIV would be a grand and compassionate gesture, reflecting strength and determination of the Chinese Government to end stigma and discrimination in China for PLHIV. PLHIV of all nationalities deserve a future where they can live normal lives, pursue grand ambitions, and contribute to global society – without discrimination caused by ignorance, prejudice, and complacency. Travel and residence restrictions are one of the leading causes of suffering and stigma for PLHIV – a collaborative and holistic international effort is needed to put an end to these unfair restrictions. Ending the ban would mean a great deal to PLHIV who dream of working in China and contributing to Chinese society. Ending the ban would reduce suffering caused by stigma and discrimination. Ending the ban will demonstrate to the world that China is a force for progress. Please take action and help make difference.

 

 

 

Yours faithfully,

 

 

 

Daniel Williams

 

 徐鹏, 刘康迈.  “我国取消外籍艾滋病病毒感染者和艾滋病病人入境限制的影响分析”. Chinese Journal of Health Policy. May 2011. Vol 4, No. 5. 62.

 

http://journal.healthpolicy.cn/ch/reader/create_pdf.aspx?file_no=20110512

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https://www.uscis.gov/archive/archive-news/human-immunodeficiency-virus-hiv-infection-removed-cdc-list-communicable-diseases-public-health-significance. (Accessed: August 30, 2017)

 

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 关于来华外国人提供健康证明问题的若干规定, (87) 卫防检字第48号. 中华人民共和国卫生部　中华人民共和国公安部.http://www.ziq.gov.cn/portal/chnl18640/11270.htm

 

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  Chang, Felicia. Prytherch, Helen. Nesbitt, Robin C., Wildersmith, Annelies. “HIV-Related Travel Restrictions: Trends and Country Characteristics”. Global Health Action. June, 2016. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3672469/

 

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