Screening for HIV to End at Posts Abroad

The United States will soon introduce a policy to end all HIV screening of foreign personnel hired at its more than 250 diplomatic posts around the world, according to State Department officials. U.S. missions also will not be allowed to turn down applicants because they are known to be infected with the virus that causes AIDS or dismiss personnel who later acquire it.

The policy is designed in part to serve as a human rights model that will encourage other governments to end the stigmatization of HIV and AIDS patients, a major problem particularly in Africa, where Secretary of State Colin L. Powell on Monday ended a four-nation swing.

In Mali, South Africa, Kenya and Uganda, Powell repeatedly emphasized that people with AIDS and HIV should not be isolated by their societies.

“Because someone has HIV does not make them any less valuable as a human being, does not make them any less valuable in our eyes or in the eyes of God,” he said Sunday at a Ugandan AIDS clinic.

The shift is to demonstrate that the United States practices what it preaches, U.S. officials said Monday.

But the new policy is also expected to cost the United States millions of dollars in added insurance premiums and medical expenses. American diplomatic posts will now have to renegotiate insurance plans for employees to cover HIV-related medical services, such as medication to control opportunistic infections.

As a result, the yearly premiums just for U.S. posts in South Africa, which has the largest HIV-positive population in the world, and Kenya are likely to increase by at least $1 million each, U.S. officials say.

Premiums are expected to be based on national prevalence of HIV rather than individual health reports. In South Africa, almost 25% of the sexually active population is HIV-positive.

The policy may also lead to personnel shortages because of absenteeism among infected employees.

The new policy reflects the way in which HIV and AIDS have produced a plethora of side issues forcing governments to make difficult choices about their operations. It also underscores the commitment by Powell to deal with the full impact of the disease.

“AIDS is so much more than a health crisis,” Powell told reporters Monday en route from Uganda to Budapest, the Hungarian capital, for a meeting of the North Atlantic Treaty Organization.

The policy will ban the practice of testing local U.S. government employees both before hiring them and during regular medical checkups, a practice permitted when AIDS became a global issue in the 1980s, U.S. officials said.

“It’s the right thing to do,” Dr. Cedric Dumont, the State Department medical director, said of the new policy.

U.S. Foreign Service officers and their families will continue to be tested, both before being hired and at regular, two-to-three-year intervals. If they acquire the disease, American diplomats are restricted in where they can be sent, officials say. An unspecified number of HIV-infected U.S. diplomats are now serving abroad.

Local hires, by contrast, are usually not deployed outside the country in which they are citizens.

The State Department is responsible for diplomats’ medical care once overseas, often in places with inadequate medical support or tropical climates. For unknown reasons, HIV accelerates faster in tropical climates, according to U.S. officials.

Despite the short-term costs, the State Department calculates that the new policy may be a solid investment in the long term. The United States intends to use the shift to expand its role in dealing with HIV and AIDS around the world by formally incorporating the “best practices” on prevention into embassy programs.

U.S. diplomatic posts will “invest” in local staff by making them trainers and peer educators on AIDS prevention in the broader community, officials say. Because of the sweeping impact of the deadly virus, the United States is now seeking to be more proactive on the issue.

The disease has spread so fast that the U.S. has increased its funding of international AIDS programs 100% over the past three years, to more than $700 million, Powell said during his five-day African tour. About 70% of the funds go toward prevention and education efforts.

Some U.S. embassies, including the American missions in South Africa and Kenya, have already stopped screening for HIV prior to employment. In Kenya, at least one person known to be HIV-positive has been hired, according to a U.S. diplomat in Nairobi, the capital.

One African post has lost 10 employees over the past year to AIDS, officials said. The rate of HIV infection among employees at some African missions has already exceeded 25%, according to U.S. officials.

Powell said he knew the HIV pandemic was a catastrophe but hadn’t realized the full scope of its impact until his African tour. He cited the story of a Ugandan grandmother who had lost 12 children to AIDS, leaving her to support and care for 34 grandchildren.

“Until you see the kind of trouble that people have to go through every day to make ends meet, to still make the family work, to still find the daily bread to survive, you don’t have a true appreciation of it,” he said.

During his visit to sub-Saharan Africa, which accounts for 70% of all HIV/AIDS cases worldwide, Powell called on the presidents of the four countries on his itinerary, as well as other heads of state in vulnerable societies, to take the lead in ending discrimination against the infected.

“We need not just presidents but leaders at every level pulling together to deal with this crisis,” he told HIV patients in Uganda.