For many expatriates, myself included, renewing a resident visa comes with a familiar routine: undergoing a mandatory medical test. On the surface, this requirement appears to be just another bureaucratic step in maintaining legal status. Yet, when revealed, the test is often focused almost exclusively on HIV. This focus raises serious ethical, human rights, and public health questions.
Global HIV Situation: Progress & Context
To understand why HIV testing is still so prominent—and why policies that use it to restrict rights feel discriminatory—it’s useful to review where the global epidemic stands today, according to the most recent WHO / UNAIDS reports:
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At the end of 2024, an estimated 40.8 million people globally were living with HIV (with confidence intervals around 37.0–45.6 million). (World Health Organization)
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In 2024 there were around 1.3 million new infections (range ≈1.0–1.7 million) globally. (UNAIDS)
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Approximately 630,000 people died from AIDS-related illnesses in that year. (UNAIDS)
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Treatment access has expanded: about 31.6 million people (∼77% of all people living with HIV) were receiving antiretroviral therapy (ART) by end-2024. (UNAIDS)
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However, treatment coverage for children is lagging. Only about 55% of children aged 0-14 living with HIV had access to ART. (UNAIDS)
These numbers show both the substantial strides made in detection and therapy, and the remaining gaps—among children, in less accessible populations, and in meeting the global targets. The epidemic is still very much alive, but it is also changing: more people are surviving, and more are aware of their status.
The Discrimination of HIV-Related Immigration/Residency Requirements
Given the context above—that most people with HIV are being treated, many know their status, and HIV is no longer the immediate death sentence it once was—the policy of linking visa or residency rights to HIV status seems increasingly out of step with modern public health knowledge and human rights norms. Here are some key points:
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Stigma & Discrimination Persist
Even as detection, treatment, and viral suppression improve, stigma remains strong. One of the most direct forms of this is restrictions on entry, stay and residence for people living with HIV. UNAIDS has documented that such restrictions are among the “long-standing and disturbing indicators of discrimination.” (UNAIDS) -
The Public Health Logic Is Weak
The public health justification for requiring HIV testing for visa or residency renewal is generally built on the idea of preventing spread. But modern treatment (ART) can reduce viral load to undetectable levels, at which point a person cannot sexually transmit HIV. Many people on ART are living normal lives without endangering others. The policy, therefore, punishes people not for risk but for diagnosis. -
Global and Donor Funding Trends Threaten Progress
There are worrisome signs that gains can be undone if support weakens. Recent studies warn that cuts in international HIV aid (including for treatment, prevention, and testing) could lead to millions more infections and deaths by 2030. For example, one Lancet HIV study projects that aid cuts could cause up to 2.9 million more HIV-related deaths by 2030. (The Guardian) -
New Prevention Tools Make the “Testing-only” Approach Obsolete
The WHO has recently recommended a new HIV prevention tool: lenacapavir, a twice-yearly injectable drug, as an alternative to daily oral medication. This offers people more options, especially those who have issues with daily adherence, stigma, or access. The roll-out of such tools makes policies that punish people based solely on serostatus feel even more outdated. (Reuters)
Ethical, Human Rights & Policy Critique
Given the data and the modern context of HIV, the visa/renewal requirement centered on HIV becomes problematic on multiple levels:
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Violation of Human Rights / Equality: When HIV status becomes a barrier to residency, work, or movement, it infringes on rights recognized in international human rights instruments—equal treatment before the law, freedom from discrimination, right to work, etc. Forcing a medical test that can strip someone of their livelihood or legal status skews the balance heavily in favor of control over care.
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Disproportionate Impact: Those most affected tend to be those with fewer resources: people from poorer countries, people of certain demographics, or marginalized populations who may already face discrimination. Mandatory HIV testing tied to residency can deepen inequalities.
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Counterproductive for Public Health: Fear of discrimination or expulsion may lead people to avoid getting tested, or to lie or hide their status, undermining the public health goals of early detection and treatment. HIV prevention works best in a regime of trust, confidentiality, and support, not of punishment.
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Missed Opportunities: If policies instead focused on universal access to prevention tools, testing (voluntary, confidential), treatment, education, and reducing stigma, the outcomes would likely be better. The recent roll-out of long-acting prevention (e.g. injectable forms) and better global rates of treatment show that the epidemic is manageable, in large part, through medical advances and safer policy frameworks.
Mandatory HIV testing for visa or residency renewal, when that test is used as a weapon to deny rights, no longer fits the current reality.
We know:
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tens of millions of people living with HIV are on treatment;
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many don’t transmit the virus when treated properly;
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discrimination in policy undermines both health and dignity;
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the epidemic’s burden is still major, but its shape is changing;
So to force a person to prove their HIV-status under threat of losing the right to live / work / stay borders on injustice. HIV is serious—and testing is vital—but it must be applied with compassion, proportionality, and respect. Rights should not be forfeited due to a diagnosis.
