Protecting the health of children moving to Canada

Abstract

The Public Health Agency of Canada prides itself on being a global leader of child and maternal health. Since January, 2002, while a policy at Citizenship and Immigration Canada requires mandatory HIV testing as part of the Immigration Medical Examination (IME) for children older than 15 years, for children younger than 15 years, HIV testing is mainly required when they have an HIV-positive parent, have received blood or blood products, or are going to be adopted in Canada.1Li A Immigrants, refugees and non-status people with HIV.https://www.catie.ca/en/practical-guides/managing-your-health/17Date: 2009Date accessed: August 6, 2019Google Scholar, 2Immigration, Refugees and Citizenship CanadaOperation Directorate, Health Branch, Immigration Medical Examination instructions. HIV screening.https://www.canada.ca/content/dam/ircc/migration/ircc/english/department/partner/pp/pdf/imei_hiv.pdfDate: Nov 11, 2013Date accessed: August 9, 2019Google Scholar, 3Haddad N Li JS Totten S McGuire M HIV in Canada—surveillance report, 2017.Can Commun Dis Rep. 2018; 44: 348-356Crossref PubMed Google Scholar Furthermore, children born abroad but whose fathers have become naturalised Canadian citizens have automatic citizenship and do not undergo health risk assessments or an immigration medical screening upon moving to Canada. These old policies do not mandate any HIV care within Canada and might—in the era of offering immediate treatment to all people with HIV—leave some children with either delayed or no HIV care. System failure to counsel migrants on HIV pathogenesis, inadequate connection to HIV care upon arrival in Canada, and absent recognition of denial, stigma, religious beliefs, and distrust of systems can all restrict engagement with HIV care.4Giacomazzo A Think link: programmatic approaches for successful linkage to HIV care.https://www.catie.ca/en/pif/spring-2019/think-link-programmatic-approaches-successful-linkage-hiv-careDate: 2019Date accessed: August 9, 2019Google Scholar, 5Kimani S My mother died without telling me I had HIV.https://www.bbc.co.uk/news/world-africa-48799980Date: July 3, 2019Date accessed: August 9, 2019Google Scholar Children younger than 15 years who are moving to Canada are even more vulnerable to this policy and its system linkage issues because of their reliance on parents and the absence of mandatory HIV testing. In our regional HIV care centre, we have encountered six situations in which the absence of HIV testing of children younger than 15 years who were born abroad, coupled with a mixture of the aforementioned factors (including inability to link records and maternal denial), led to very late HIV diagnoses and untreated congenitally acquired HIV infection. These presentations have been profoundly negative for children because of the irreversible damage of untreated HIV infection, for their families who provide ongoing care needs, for the provincial health system because of care costs, and for Canada because of the lost productivity of a young adult. The current policies leave children at high risk of HIV because of missed screening opportunities. If child welfare is indeed a political priority, the health of children moving to Canada must be protected by mandatory HIV testing at immigration and subsequent facilitated engagement to HIV care immediately upon arrival. Age, sex, and culturally sensitive counselling is necessary for both children and their families. They also need education on HIV and HIV care programmes—as outlined by the Operations Directorate on the IME.1Li A Immigrants, refugees and non-status people with HIV.https://www.catie.ca/en/practical-guides/managing-your-health/17Date: 2009Date accessed: August 6, 2019Google Scholar We therefore advocate for a change in policy so that all children moving to Canada, irrespective of age and citizenship, be screened for HIV during the Canadian IME. We declare no competing interests.