I don’t have HIV. I’m clear, though: my taxes funding diagnostic tests and medication for foreigners with communicable diseases is in my interest. It helps prevent transmission, protecting me and those I care far more about than them.
Government serving up immigrant policy this month left me dizzier than watching Serena win Wimbledon. One week, standing with Caricom neighbours, we decried out of one side of our mouths Dominican Republic removal of citizenship from people of Haitian descent born there—increasing their vulnerability to violence, and pushing them out of the country.
The next, out of the other side, we announced a new national health card, cutting Caricom neighbours’ HIV-positive citizens off access to life saving treatment. “That is the whole idea behind this health card, you know,” Health Minister Fuad Khan said unmistakably.
“Our citizens and legal residents are entitled to free service, not the whole world.”
There’s hyperactive imagination in T&T’s private health system (which keeps the public second class, despite our GDP) that could make us a health tourism destination. But, who in the “whole world” is coming here for public care?
Questioned how much we’ll save, the best policy basis for the decision chief HIV technocrat, CMO Colin Furlonge, could muster was, “We do not have that number, but we do know it is significant.” So how did Dr Khan single out Jamaicans, but not Guyanese?
Blaming outsiders and finding scapegoats is always good politics. Especially for a sitting government in an election year. It’s usually bad policy. Compelling human rights, public health and economic reasons exist for our nation providing care to some Caribbean neighbours with HIV. Lack of political leadership in eliminating stigma or outlawing discrimination that HIV attracts means those elements continue to fuel our Caribbean epidemic—keeping people away from testing and treatment. That’s what drives neighbours to seek both here. Not because it’s cheap or easy.
When people with HIV receive humane treatment, get medication and diagnostic tests regularly, they won’t infect others. Providing these for some Caricom nationals who fear seeking care at home, we help fight the regional epidemic and stop its spread across borders. That makes a lot of economic sense. Government decision makers long understood this. Khan was junior health minister when Basdeo Panday joined Caricom heads in 2001, declaring the region’s health its wealth.
For years, I’ve helped Caricom nationals take advantage of what everyone in HIV knows: people had access to treatment here regardless of nationality. Ambassador Dennis Francis told the UN Human Rights Council Khan and his ministry were “working on the completion of a policy to afford easier access to HIV/Aids care and services for migrants entering T&T…an acknowledgment by the Government that, even though they’re migrants, their human rights remain fully intact, and that there ought not, therefore, to be any systemic discrimination against such persons, given the fact that, whether they are legal or illegal, they are members of the national community.”
Instant letter writers defending the election-year about-face four years later, mock the idea Trinbagonians could travel to America and access HIV care. That’s precisely what happened before anti-retrovirals became accessible here in 2002. Those who could get visitors’ visas stayed in New York homes like mine, got registered for the State’s HIV drug assistance, often with help of health centres where Caribbean doctors worked. Such policies are why several friends are alive today. Others died trying. A Diamond Vale media worker I grew up with didn’t make it from Kennedy airport to my apartment. I shipped his cremains back to his family.
Without public health or health finance grounding, Khan’s comments and “Don’t split the vote,” last election season’s tribal rally, sound eerily alike. Patrick Manning, I’m told, disallowed certain words in state-funded HIV materials; and honest programming that could change sexual behaviour never developed. But, his office hired competent technical managers like Amery Browne and Izola Garcia; What’s your position? became a national catchphrase, and HIV something everyone personalised.
This Government’s first HIV policy step was to dismantle OPM’s co-ordination and resource allocation mechanism (and the institutional memory for HIV planning), assigning management of HIV to Khan’s ministry. Their manifesto promise to create a statutory HIV authority won’t show up on any scorecards in your daily paper.
Many of my Guyanese friends helped drive a PPP government some compare to the UNC out of office this May, with more grounded hopes of building a new politics in Guyana than when we voted the Partnership in 2010. I paid little attention to PPP governance. Except for health minister Leslie Ramsammy. I often quote his address on the 10th anniversary of Pancap, a mechanism established in recognition that fighting HIV requires a regional response and, as its strategic framework says, creating “regional goods.”
Listing political hurdles to effective HIV response, Ramsammy concluded: “But…I am the Minister of Health and I must be driven by public health reality.”
Like attorneys general, health ministers must rise above politics. Chief Medical Officer Colin Furlonge, in contrast, is purely a public health official. In our one encounter, he was at pains to convince an international funder what Government couldn’t do for people most vulnerable to HIV—gay men, sex workers, drug users—because we were all criminal. Now I guess he’ll add illegal migrants.