Dissertation Abstracts

Cordon Sanitaire or Healthy Policy? How Prospective Immigrants with HIV are Organized by Canada’s Mandatory HIV Screening Policy

Author: Bisaillon, Laura M, lbisaillon@utsc.utoronto.ca
Department: Population Health
University: University of Ottawa, Canada
Supervisor: Ronald Labonte and Dave Holmes
Year of completion: 2012
Language of dissertation: English

Keywords: HIV/AIDS , Immigration , Policy and law , Social organization
Areas of Research: Health , Migration , Institutional Ethnography


Since 2002, the Canadian state has required that applicants for permanent residence be screened for HIV. The policy and practices associated with this screening have never been systematically or critically scrutinized. Authoritative claims about what happens in the conduct of the immigration medical examination are at odds with the experience of immigrant applicants, including refugees, living with HIV. This is the analytic entry point into this social inquiry, which is organized within the theoretical and methodological frame offered by institutional ethnography and political activist ethnography. This frame carefully connects micro-level empirical research with broader research literatures and the historical record.

The social and reflexive production of knowledge in people’s day-to-day lives through which connections between local and extra-local settings are empirically investigable. The goal of this study is to produce detailed, contextualized understandings of the social and ruling relations that organize the lives of immigrants to Canada living with HIV. I investigate and critique the organization of the Canadian immigration process. How is this institutional complex ordered and governed? How is mandatory HIV screening organized, and with what consequences to HIV-positive applicants to Canada? Results show that this is a textually mediated organization in which the sites are connected by people’s discursively organized work practices and the texts they circulate. The positive result of an immigration HIV test catalyzes the state’s collection of medical data about an applicant. These are entered into state decision-making about the person’s in/admissibility to Canada.

I focus on a key component of the immigration process, which is medical examination and HIV screening, along with the HIV test counselling practices that happen (or do not happen) in this process. The reported absence of the latter form of care causes problems and contradictions for prospective immigrants. This investigation proceeds from the standpoint of people living with HIV and the problems the experience with mandatory immigration HIV screening. The main empirically supported argument I make is that the Canadian state’s ideological work related to the HIV policy and mandatory screening ushers in a set of institutional practices that are highly problematic for immigrants with HIV. This argument relies on data collected during 18 months of fieldwork in interviews, focus groups, observations, and analysis of texts organized under Canada’s Immigration and Refugee Protection Act (S.C., 2001, c. 27). Canadian immigration medical policy makers can use of these findings, as can civil society activists acting on behalf of immigrants and refugees to Canada living with HIV. I make nine specific recommendations for action on HIV and immigration policy and law in Canada that would reduce inequities within the immigration system.

Reference: Bisaillon, L. (2012). Cordon sanitaire or healthy policy? How prospective immigrants with HIV are organized by Canada’s mandatory HIV screening policy. Doctoral Dissertation, University of Ottawa. http://www.ruor.uottawa.ca/en/handle/10393/20643