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Howard calls for HIV migrant ban. 13 April 2007 BBC News Service
Australia should refuse to allow migrants or refugees with HIV to enter the country, Prime Minister John Howard has said. Mr Howard said there may be special cases when an exemption could be considered but as a rule HIV-positive people should be denied entry. Mr Howard was asked about the issue during a visit to Victoria state, which has seen a sharp rise in HIV cases.

Any ban for migrants with HIV/Aids would need a change in the federal law.

Mr Howard, on a visit to Melbourne, told a local radio station he wanted to seek more advice on the issue, but said his gut feeling was that HIV sufferers should not be allowed in to the country. "My initial reaction is no," he said. "There may be some humanitarian considerations that could temper that in certain cases, but, prime facie - no." Victoria's public health officials have blamed the rise in HIV cases partly on overseas immigrants, but also on Australian residents relocating from other parts of the country.

Mr Howard, who has been in power for 11 years, is known for his tough stance on immigration. He likened his proposed ban to the ban already imposed on people suffering from tuberculosis.

John Howard has a reputation for being tough on immigration. "I think we should have the most stringent possible conditions in relation to that nationwide, and I know the health minister is concerned about that and is examining ways of tightening things up," he said.

Solicitor David Puls of the New South Wales HIV/Aids Legal Centre said the law allowed immigrants to be denied access where there are public safety concerns. "The Medical Officer of the Commonwealth does not consider HIV to be a public safety concern," he was quoted by the Australian newspaper as saying. He added that HIV should not be compared with tuberculosis as the latter is airborne and contagious, while HIV is transmissible but not contagious.

Australia has been alarmed by the country's rise in HIV cases. Infection rates rose by 41% between 2000 and 2005. There is particular concern about the rapid spread of HIV and Aids in neighbouring Pacific countries, such as Papua New Guinea.

Australia warned of Aids spread 29 July 2006 BBC News
Australia is being urged to upgrade health services in the Torres Strait amid fears that HIV and Aids could spread from neighbouring Papua New Guinea. Community leaders have urged Canberra to introduce more stringent border controls. It is only a short boat ride between southern parts of Papua New Guinea and Australian territories in the Torres Strait. The Australian island of Saibai is just four kilometres from Papua New Guinea, which has the highest rates of HIV and Aids in the South Pacific.

Thousands of people make the short journey across that part of the Torres Strait every year. Community leaders on Saibai have been urging the Australian government to do more to make sure that HIV and Aids do not spread across the border.

Health Minister Tony Abbott has been supportive of plans to bring in tougher screening of visitors arriving from Papua New Guinea. Medical services on Saibai island are also likely to be upgraded.

The residents of this tiny Australian territory in the Torres Strait have good reason to be nervous. Just a short distance away their neighbours in Papua New Guinea are facing an epidemic. Official statistics have indicated that about 16,000 people are suffering from HIV and Aids. Relief agencies believe that the true figure could be 10 times higher.

Shame and disgrace are often heaped upon those caught up in this escalating emergency in Papua New Guinea. Some patients have reportedly been thrown into rivers to drown or dumped into graves to die.

In the capital, Port Moresby, Aids-related illnesses are the leading cause of death at the main hospital. On Saibai there have been no reported cases of HIV and Aids so far. Community leaders have warned that without greater protection, islanders remain vulnerable to the looming threat from across the water.

In 2005 there were about 950 diagnoses of HIV in Australia mostly among gay men, who account for around 80% of infections. The figure for heterosexuals is just over 18% while intravenous drug users who attend needle exchange programmes make up about 1% of the total. The increase in the infection rate in the gay community follows a decline in the late 1990s.

"What's changed is that HIV has moved from being a fatal condition to being a chronic, manageable disease," said Geoff Honnor from the Australian charity People Living With HIV and Aids. "Gay men have adjusted their risk assessment accordingly."

2007 APR 12 -- Interventions that target individuals with a high risk of contracting HIV have a negligible impact on HIV transmission in the general population, according to a new study of communities in Zimbabwe, published today. The three-year study shows that community-based peer education, free condom distribution, and clinic-based STI treatment and counselling services targeted at female sex workers and their male clients had no impact on HIV incidence in the wider community.

The study shows that it was possible to reduce the incidence of HIV in men - but not the women - who were reached by the programme. However, the reduction in HIV incidence amongst these men did not have the anticipated impact on HIV incidence in the larger community.

The researchers, writing in the journal PLoS Medicine, had hoped that levels of HIV in the community as a whole could be reduced through targeting men and women who were perceived to have the riskiest sexual behaviour and reducing the incidence of HIV amongst them. They believed that this would reduce HIV incidence in the wider sexual networks where these people were thought to be key.

The programme aimed to reduce transmission through sex workers and it provided women with small interest-free loans together with training in small business management, in order to reduce their economic dependence on sex work. Recent studies show that commercial sex work centred around bars and beer halls remains a major source of HIV transmission.

The male participants benefited from the programme with a decrease in incidence of HIV-1, a reduction in reporting of unprotected sex with casual partners, and a decrease in symptoms of sexually transmitted infections. However, the study found that these benefits were not shared by the sex workers reached by the programme and there was no resultant reduction in HIV incidence for the community as a whole.

The researchers believe that their efforts to reduce incidence in female sex workers were unsuccessful largely for economic reasons. Whilst some men may have given up visiting sex workers or started to use condoms consistently, the sex workers themselves were unable to acquire alternative sources of income and continued to have unprotected sex with some of their partners - on occasions, in exchange for a larger payment.

An outbreak of tuberculosis has been not been heard of in Australia for well over 40 years (approx) in fact I am sure that the last two generations do not even know what it is.

An outbreak of pulmonary tuberculosis in young Australians. MJA 2007; 186 (5): 240-242.

Objective: To characterise a pulmonary tuberculosis (TB) cluster in the Hunter Area of New South Wales using a combination of traditional epidemiological methods and molecular typing. Design, setting and participants: Review of all notifications of TB in the Hunter Area between January 1994 and June 2005, with a detailed analysis of cases among people born in Australia or New Zealand. Main outcome measures: Comparison of genotypes of Mycobacterium tuberculosis isolates; extent of TB cluster.

Results:
Over the period studied, there were 72 TB notifications among people born in Australia or New Zealand. Genotypic testing was available for 20 of these cases, of which nine were confirmed to be part of a cluster. Two further cases for which genotyping was not available were epidemiologically linked to the cluster and regarded as probable cluster cases. Members of the cluster were relatively young (median age at diagnosis, 35 years; range, 21–57 years), and eight were women. Over the same period, there were 83 TB notifications among people born overseas, the majority being from Asia (47%) or central and eastern Europe (24%) (median age, 54 years; range, 9–63 years).

Conclusion:
Clinicians should maintain a high index of suspicion for pulmonary TB in a person presenting with a productive cough lasting more than 3 weeks, weight loss, haemoptysis, night sweats and chest pain, even if the person is not overseas-born or elderly. A comprehensive tuberculosis genotyping network at regional and national level in Australia could help identify clusters resulting from recent transmission.

[bT]he Hunter Area of New South Wales has had a low and stable number of Mycobacterium tuberculosis (MTB) notifications. Between 1994 and 2005 there were an average of 12 MTB notifications a year (range, 8–16), a rate of less than 5 per 100 000. The median age of infected patients was 55 years, with the majority (54%) born overseas in countries with high rates of endemic tuberculosis (TB). Infections in patients born in such countries are presumed to result from reactivation of infection acquired in their country of origin.

^^ Many European countries have raised this same issue - the Netherlands and Italy among them.

Incidence rates of pulmonary tuberculosis among immigrants from high incidence countries remain high for at least a decade after immigration into the Netherlands. Possible explanations are reactivation of old infections and infection transmitted after immigration. Control policies should be determined on the basis of the as-yet unknown main causes of the persistent high incidence.

Our study shows that, in spite of a gradual decrease, the incidence rates of pulmonary tuberculosis in immigrants remain high even a decade after immigration. The persistent high incidence rates are consistent with results of previous studies (2-5). Our study [combines data on all immigrant patients in whom tuberculosis was detected and all legal immigrants present in a 5-year period in a low incidence country, enabling detailed analysis with a long follow-up period.

We did not find a steep decline in incidence rates after immigration. One might anticipate such a decline, since the proportion of recently infected or reinfected persons will be higher sooner after immigration than later due to relatively low levels of transmission in the Netherlands. Recent infection is a known risk factor for developing active tuberculosis (6,7). Several explanations may account for the absence of an initial steep decline in incidence rates. First, the proportion of immigrants who were recently infected or reinfected may already have been low at the time of immigration. Next, the risk of reactivation of latent tuberculosis infection in these immigrants may have been higher than previously modeled in white nonimmigrant populations (8,9). Finally, immigrants residing in the Netherlands may have acquired new infections or reinfections, either through transmission within the Netherlands or through frequent visits to their country of origin. DNA fingerprinting data suggest that transmission within the Netherlands may indeed have occurred, although it is not the key factor; in a recent study, infections in 30% to 40% of Turkish, Moroccan, and Somali patients could be attributed to recent transmission, but 58% of all immigrant patients were not part of a cluster (10).

The Dutch screening policy consists of mandatory screening of immigrants at entry and voluntary screening in the next 2 years. Less than 50% of immigrants undergo voluntary screening in the second year. Screening identified 41% of the patients with a case diagnosed from 0.5 to 2.4 years after immigration. Screening may have influenced the observed incidence pattern slightly by diagnosing cases earlier than in the absence of screening. However, the average delay in detecting tuberculosis in immigrant patients who seek medical care themselves (passive detection) in the Netherlands is 50% of the incidence in the Netherlands . Control policies with regard to immigrant tuberculosis usually rely on chest x-ray screening and treatment of active tuberculosis. A supplemental approach, recommended by the Institute of Medicine, is to conduct tuberculin skin testing and to apply preventive treatment of latent infections. Whether all tuberculin skin test-positive immigrants should be treated, or only selected high-risk groups such as immigrants with radiographic evidence of inactive disease, is under debate. Adherence to preventive treatment is also a point to consider. To answer the question of why the incidence rates remain high, the relative importance of three factors needs to be established: reactivation of old infections, transmission in the host country, and infections acquired during visits to the countries of origin. These answers are essential to evaluate the cost-effectiveness of the Dutch screening policy and of alternative options, including other screening policies and use of preventive treatment.