Need Urgent Help!!!Can HIV positive person get PR ?

[computergeek]

Just to emphasize something that was said up above -- if you have not done this, your wife needs to be retested. The usefulness of the test is not its sensitivity, which is very high, but the combination of its sensitivity and the prevalence of HIV. False positives are known. You should also be retested, although your negative test is more likely to be correct.

True. I don't usually point out that the Positive Predictive Value (PPV) of the test is actually low in a low prevalence population, but that is in fact the case. Ideally, you would be best served by having a co-culture test done for confirmation, but I only know one lab that performs the test (in New York). Repeating the same test can eliminate laboratory error, but does not actually improve the PPV of the test (because the tests are self-referenced. Namely, they prove the sensitivity of new tests by validating against the results of older tests). That's a rather technical argument and one I certainly wouldn't try to present to CIC, as I suspect it would go over their heads.

Other than that, keep going as you are -- I work in public health and HIV prevention , and would like to emphasize that the public perception of HIV has not changed in the last 20 years, even though the medical state of knowledge has. HIV today is a chronic, manageable infection, and if your wife is treated, complies with her doctor and testing regime, and takes care of herself, she can expect to lose about 5 years of life (on average). By comparison, if you smoke, you will lose 13 life years (on average). The fear and stigma associated with HIV are out of proportion for disease that is quite comparable to Hepatitis B.

This is ingrained in the CIC system as well. These days a finding HIV positivity is very difficult to overcome precisely because they assume that a patient will be compliant - and thus the rejection is on the grounds of excessive demand. The prices of medication are propped up in Canada and further reinforced by the Schedule F prohibition against importation of generic equivalents (so an individual cannot import low cost equivalents from other jurisdictions where medications have lost patent status). Even the US no longer tests for HIV as part of immigration screening - but CIC does. Last I looked, less than 1/3 of non-EDE applicants who tested HIV positive were granted permanent residency on the basis of excessive demand.

If you qualify, there is one treatment regimen that does not exceed the excessive demand threshold when purchased in Canada because the cost is below the cut-off amount. That is 3TC, ZDV and NVP (Lamivudine, Zidovudine, and Nevirapine). They are all off-patent in Canada (but Combivir, which combines 3TC and ZDV is not off patent yet, so the cost is proportionately higher. This is an alternative first line treatment, but most patients generally don't qualify for this treatment based upon current treatment guidelines (specifically, the requirements for a low CD4 count prior to starting NVP). Over the next several years additional drugs will come off-patent and become viable alternatives. They trade cost against convenience, since single pill treatments tend to be covered by patents on the combinations, even when the underlying drugs are off patent.

The best thing to do with CIC is convince them that she does not require treatment in the 5-10 year time frame under consideration.

 

[itiswell]

computergeek,
please I just sent you a pm...can you reply please? Thanks

 

[citizenhopeful]

Anyone know if CIC or DMP would inform you if you were tested positive ? I read the most recent CIC guide which states that you would be require to sign the acknowledgement; however, this info is last updated in 2012. I'm wondering what about test done in September 2008 in Vancouver?

 

[computergeek]

Anyone know if CIC or DMP would inform you if you were tested positive ? I read the most recent CIC guide which states that you would be require to sign the acknowledgement; however, this info is last updated in 2012. I'm wondering what about test done in September 2008 in Vancouver?

Yes. The rules for DMPs in 2008 with respect to disclosure to the applicant and signing of the acknowledgement of post test counseling have not changed since before 2008.

 

[citizenhopeful]

Yes. The rules for DMPs in 2008 with respect to disclosure to the applicant and signing of the acknowledgement of post test counseling have not changed since before 2008.

Thank you so much for your quick response !

 

[canadacalling2012]

latest update on my case is that . my medical was done on oct 2012 . passport sent to consulate in india in nov 2012. My wife tested hiv positive during medical. As per medical advise we stated ART treatment of my wife with the same doc. who send the report to canada consulate.
dec 2012:
CD4 -185
Viral load: 39000

After 6 months of ART we went for test again as prescribed by doc.

June :2013
CD4 : 250
Viral load: 80

Doctor is very happy with the prognosis . But no reply received from the consulate. Its more than 8 months we have submitted our passport . I have email them regarding the status of the file in
jan 2013
march 2013
may 2013
june 2013

But no reply from consulate. Need to know how much we need to wait ? Waht are the option with us ?
As our passport are with consulate we cant travel abroad for visitor visa also ... Need expert opinion on this.
Currently my wife is on medication ART . which cost is almost 40 $ /month. and testing as recomended by physician is 180 $/6 months in our country . Need to know can we show this as a arguement for cost ?

 

[computergeek]

You should review the new page here: http://www.cic.gc.ca/english/resources/tools/medic/admiss/excessive.asp

It is unlikely that a medical officer will approve an HIV positive patient on drug treatment because the cost in Canada for most courses of treatment exceed the excessive demand threshold. Given your wife's medical information, I know of at least one course of treatment that does not exceed the threshold (and more will be emerging as more patents expire over the next few years) but that is probably not her course of treatment.

It is unlawful for anyone other than a doctor, pharmacist, or hospital to import HIV medications into Canada (they are all Schedule F drugs). Thus, even though the drugs are quite inexpensive in India, they cannot be legally brought into Canada.

First thing is you must determine what the cost of her treatment would be in Canada. When you are sent a fairness letter it should include that information (see the above link - that's now supposed to be included in a fairness letter). You would need to examine the coverage provided by the province where you intend to land, so you can determine what the actual cost would be and how much of that would be born by the government. The current cost threshold is $6235 per year and the normal time horizon for evaluation is 10 years.

I have only seen people in situations like this successful if they had an external source providing the medications (e.g., non-governmental organizations). Promises to pay for the medications yourself and offers to import the drugs are likely to not be persuasive to CIC, unfortunately, though you can propose them. For example, one way around Schedule F (which works quite effectively at keeping anyone requiring high cost medications) is to have them sent to a location in the US (which does permit importation of HIV medications for personal use) and then to bring them across the border personally (which is permitted, again limited to a personal use supply which is defined as being 90 days worth).

In my rejection, I provided evidence that I was beneficiary of two insurance contracts and one health savings account that provided 100% coverage for up to $68k in prescription medication (far in excess of the anticipated cost of any course of treatment) and I was still refused, simply on the basis of provincial policy (which might have covered the medication costs.)

If you are heading to Toronto, you should consider contacting HALCO (http://www.halco.org) as they have been very active in this area as well and have been successful in court in the past.

 

[on-hold]

latest update on my case is that . my medical was done on oct 2012 . passport sent to consulate in india in nov 2012. My wife tested hiv positive during medical. As per medical advise we stated ART treatment of my wife with the same doc. who send the report to canada consulate.
dec 2012:
CD4 -185
Viral load: 39000

After 6 months of ART we went for test again as prescribed by doc.

June :2013
CD4 : 250
Viral load: 80

Doctor is very happy with the prognosis . But no reply received from the consulate. Its more than 8 months we have submitted our passport . I have email them regarding the status of the file in
jan 2013
march 2013
may 2013
june 2013

But no reply from consulate. Need to know how much we need to wait ? Waht are the option with us ?
As our passport are with consulate we cant travel abroad for visitor visa also ... Need expert opinion on this.
Currently my wife is on medication ART . which cost is almost 40 $ /month. and testing as recomended by physician is 180 $/6 months in our country . Need to know can we show this as a arguement for cost ?

And just a quick note, since I know that this is all new to you -- ART is permanent, you can't say that your wife is 'currently' on ART. She might stop, yes, but that would be a dangerous failure, not a possibility that should be entertained. It's important to remember that HIV drugs have severe side effects (though they are continually getting better), and that people usually start out on the best ones. Stopping increases the chances of drug resistance greatly, and can force a change to worse formulations.

Recent advances in treatment have actually made immigration by HIV+ people more difficult. In the past, you would be treatment free for years until your immune system reached a low point -- you could immigrate now, since your use of expensive drugs was some distance in the future. Now, they've found real benefits to starting treatment almost immediately -- your health is safer now, but you can't immigrate, because you'll be using too many resources too soon.

 

[computergeek]

And just a quick note, since I know that this is all new to you -- ART is permanent, you can't say that your wife is 'currently' on ART. She might stop, yes, but that would be a dangerous failure, not a possibility that should be entertained.

I caution the OP not to accept anything that one finds in an internet forum on this topic especially with respect to medical advice. Subjects such as treatment strategies - including treatment interruption - are something that is the patient's decision and should be done in consultation with the patient's medical providers after being suitably advised about the advantages and disadvantages of different treatment options.

It's important to remember that HIV drugs have severe side effects (though they are continually getting better), and that people usually start out on the best ones. Stopping increases the chances of drug resistance greatly, and can force a change to worse formulations.

Recent advances in treatment have actually made immigration by HIV+ people more difficult. In the past, you would be treatment free for years until your immune system reached a low point -- you could immigrate now, since your use of expensive drugs was some distance in the future. Now, they've found real benefits to starting treatment almost immediately -- your health is safer now, but you can't immigrate, because you'll be using too many resources too soon.

The core drug treatment paradigms have not changed substantially. What has mostly changed is the convenience factor for patients. Thus, rather than taking three different generic drugs, one can take a single patent covered formulation that involves time release. For someone coming at this from an immigration perspective it is important to understand this because it is possible to come up with treatment combinations that might be "less convenient" but do not contravene the excessive demand threshold.

India has much lower cost drugs because Indian recognition of patent extension techniques routinely used in the US and Canada have not been so successful in India.

Indeed, when doing cost calculations of drug costs it is actually important to point to patent expiration dates because costs will be expected to drop substantially at that point. Thus, from an immigration cost perspective it may be better to choose a less convenient formulation at lower cost, than a more convenient formulation at higher cost.

In attempting to determine costs it is quite challenging to find valid governmental data on the costs of medications. Quebec publishes a list of the prices that it will pay and that can be useful. For example, a combination of nevirapine, lamivudine, and zidovudine (as separate pills) does come in considerably below the excessive demand cost threshold. That is because all three are now available as generics in Canada. Not all patients can use this combination (it is an "alternative first line treatment") but it is worth pointing out as a potentially low cost alternative.

Depending upon the province where the applicant will land, there may be other options as well. For example, in British Columbia there is actually an option to opt out of public funded health care entirely, in which case one cannot create an excessive demand. But that option is not available in most provinces. Some provinces provide "means testing" for availability of medications. In such a case, one might be able to replace zidovudine with tenofovir or darunavir/r without exceeding the excessive demand cost threshold.

Tenofovir is an excellent example of one of the "new" drugs. It was first patented in 1986, but via reformulation and recombination it's patent status has been stretched considerably. It is probably the most commonly used core HIV medication (in India it is used in Cipla's Viraday and in Canada in Atripla, currently the preferred first line treatment medication.)

The OP needs to do his homework in this area. CIC has published a wealth of new information about medical inadmissibility and it is valuable to understand that when preparing for the process. I suspect the OP will be receiving a fairness letter at some point in the near future (9-12 months seems to be the norm from medicals to receiving a fairness letter).

 

[on-hold]

I caution the OP not to accept anything that one finds in an internet forum on this topic especially with respect to medical advice. Subjects such as treatment strategies - including treatment interruption - are something that is the patient's decision and should be done in consultation with the patient's medical providers after being suitably advised about the advantages and disadvantages of different treatment options.

Though I agree wholeheartedly with the sentiment expressed here about taking medical advice, I still want to point out that what I said is an accepted fact, and not one that will vary depending upon doctor or country -- there is no standard treatment regimen that involves beginning ART and then quitting, and suggesting this as a possibility would be ridiculous (I know the poster did not). The only times ART is begun temporarily are (I believe) for preventing infection after accidental exposure, for HIV+ women giving birth, and for HIV- partners of HIV+ individuals (who would presumably stop if they broke up). A regular patient outside of these situations begins ART for life, and quitting may result in the virus developing resistance and necessitating a treatment change. Nor is it really true that all ART drugs are the same; the earliest ones have fallen into relative disuse because of their side effects, and are no longer considered ideal. Since everyone experiences different side effects, a treatment change can cause significant discomfort, and it's best to stay with the original formulation that can be tolerated as long as possible.

 

[Worried2008]

Guys
Ca any one suggest me how to opt out for intended resident.I mean from where I can start this procedure? Whom I should meet?which department?
How to overcome the point in order to opt out you need to be opt in and to opt in you need to be PR and to be a PR you need to be opted out.
any one working in health department can show us a way.please

Hi computer geek.

 

[scylla]

Guys
Ca any one suggest me how to opt out for intended resident.

What do you mean by "opt out for intended resident"? Can you explain in more detail?

 

[Worried2008]

Hi Scylla

As computergeek already mentioned that Alberta and BC has an option for their residents to opt out of the Provincial health care plans.Once you opt out for certain period ,you have to pay upfront for all the medical services and prescription drugs .
You can opt out if you are registered with it.

Now if a intended resident { like my Mom who is sponsored by me in family class ,she will reside in Alberta with me, All the procedure is done and now caught by IRPA 38(c) } of Alberta or BC falls in excess demand ,I was thinking to opt out is best option for them.

 

[computergeek]

Here is the link for the BC opt-out description: http://www.health.gov.bc.ca/msp/infoben/electoptout.pdf

I would suggest that if you wish to pursue this, that you submit this information and the executed "opt out" form to the CIC officer to demonstrate that you are serious about your intent. I should caution you that it is likely that the officer will discount your decision to opt out because there is no enforcement mechanism - they cannot make you send in the form or renew your "opt out" status. But it is another potential argument that you can present (and note that only the affected person needs to opt-out as part of mitigation, not everyone in the family.)

 

[on-hold]

Here is the link for the BC opt-out description: http://www.health.gov.bc.ca/msp/infoben/electoptout.pdf

I would suggest that if you wish to pursue this, that you submit this information and the executed "opt out" form to the CIC officer to demonstrate that you are serious about your intent. I should caution you that it is likely that the officer will discount your decision to opt out because there is no enforcement mechanism - they cannot make you send in the form or renew your "opt out" status. But it is another potential argument that you can present (and note that only the affected person needs to opt-out as part of mitigation, not everyone in the family.)

This is bizarre -- I lived in BC for a year and didn't know this was possible; and I always thought that participating in the various provincial health care systems was universally mandatory. I'm kind of shocked that this option is available. If anyone knows how many people choose this option, I'd like to know.