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

computergeek

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Dula said:
I need some information about the doctors who can help me about the cost estimate and attorney that you recommend. I am working on my fairness letter and your point is helping me. In my case my wife is HIV positive and we are like living hell hear in Canada like a dog because we don't have any paper even though I work here and contribute to Canada. Canada is doom to fail if it runs its public health policy based on popular mob not scientific ideas. HIV is used as scape goat of keeping Canadian health cost down by keeping "sick immigrants out". They are totally wrong. HIV is less than diabetes, heart disease and other disease people they let in both for cost and health quality. Thanks to advanced drugs.
The best source of drug costs is the Quebec formulary published by the Regie. It's the only public guide of which I'm aware, but it is comparable to what other provinces pay.

Note that ALL medical conditions are subject to this costs scrutiny, not just HIV. While CIC has been sloppy when it comes to estimating costs, when presented with evidence that the costs do not exceed the excessive demand threshold, the medical officer will withdraw an adverse opinion.

I will send you PM with the names of prospective attorneys.
 

juhanjuhanjuhan

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Feb 1, 2015
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computergeek said:
I just responded. I have been out of the country for work for the month and am only just now responding.
Hi Computergeek,

I hope you'll be able to enlighten me about our situation. My mom applied for PR as live in caregiver when I was still a minor and she is including us on her application. We are now on the final stage of the application, unfortunately I tested positive. From what I read, I will be declared medical inadmissible if we don't do something about this and everyone will be denied. I am now 22 years old and an adult. I would prefer being dropped from the application if that is possible so that it won't affect my family. Is it too late for me to be dropped from the application?
 

computergeek

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juhanjuhanjuhan said:
Hi Computergeek,

I hope you'll be able to enlighten me about our situation. My mom applied for PR as live in caregiver when I was still a minor and she is including us on her application. We are now on the final stage of the application, unfortunately I tested positive. From what I read, I will be declared medical inadmissible if we don't do something about this and everyone will be denied. I am now 22 years old and an adult. I would prefer being dropped from the application if that is possible so that it won't affect my family. Is it too late for me to be dropped from the application?
Actually, if you are on the application and are found to be inadmissible, you and your entire family will be deemed "medically inadmissible".

But note that the first step is in determining if you are medically inadmissible at all. This is done based upon your CD4 and HIV-1 RNA levels ("viral load") as measured by blood tests the panel physician orders. A high CD4 and low viral load are consistent with a lack of need for immediate treatment and may mean you are not inadmissible. If the doctors are of the opinion you need treatment, then the determination will be based upon the actual cost of the medications. Some therapeutic combinations are currently not excessive demand, and a number of drugs are now losing patent status in Canada, which means the cost of those additional treatments will be going down as well. For example, the combination of nevirapine, lamivudine and zidovudine is about $3500 per year in Canada and that is far below the excessive demand threshold (~$6385/yr last I checked).

My advice would be to work with one of the handful of attorneys experienced in excessive demand medical inadmissibility. It's a highly specialized field, but one in which the practitioners have been rather successful, both directly with CIC and then when the issue goes to court.
 

juhanjuhanjuhan

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computergeek said:
Actually, if you are on the application and are found to be inadmissible, you and your entire family will be deemed "medically inadmissible".

But note that the first step is in determining if you are medically inadmissible at all. This is done based upon your CD4 and HIV-1 RNA levels ("viral load") as measured by blood tests the panel physician orders. A high CD4 and low viral load are consistent with a lack of need for immediate treatment and may mean you are not inadmissible. If the doctors are of the opinion you need treatment, then the determination will be based upon the actual cost of the medications. Some therapeutic combinations are currently not excessive demand, and a number of drugs are now losing patent status in Canada, which means the cost of those additional treatments will be going down as well. For example, the combination of nevirapine, lamivudine and zidovudine is about $3500 per year in Canada and that is far below the excessive demand threshold (~$6385/yr last I checked).

My advice would be to work with one of the handful of attorneys experienced in excessive demand medical inadmissibility. It's a highly specialized field, but one in which the practitioners have been rather successful, both directly with CIC and then when the issue goes to court.
Thanks Computergeek.

Is it an option for me to be dropped from the application instead? I am an adult and could take care of myself. I also would like to know if CIC will still deny the application if I dropped from it.
 

computergeek

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juhanjuhanjuhan said:
Is it an option for me to be dropped from the application instead? I am an adult and could take care of myself. I also would like to know if CIC will still deny the application if I dropped from it.
It may be possible. You would have to request that from the visa office, however, and acknowledge that you understand it means you cannot be sponsored in the future as a member of the family class by your parent (though you can get credit for family ties and could be sponsored by a partner/spouse in Canada). I wouldn't recommend applying for an economic class application - CIC routinely turns them down for cases like yours.
 

juhanjuhanjuhan

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Thanks computegeel. i would like to be dropped from the application rather than everyone be denied because of my situation. I could live on my own now and I'm sure my mom will help me living here in the Philippines.
 

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Plus 1. . nice informative post.


computergeek said:
I know quite a lot about this area and have advised others in the past.

An HIV positive person can obtain a PR visa, but it can be challenging and it will increase the amount of time to process your application.

Your Panel Physician (formerly "Designated Medical Practitioner") should have drawn blood for an HIV-1 RNA test ("viral load") and a CD-4 test (a specific type of white blood cell used for cell mediated pathogenic response). Those results will then be forwarded to Immigration Medical Service. Their decision may be predicated, at least in part, on the province in which you will be landing. For example, if you plan on landing in BC, while they will go through all the process in the end because BC provides 100% coverage for the drugs unless your wife is not expected to require them for most of the next 10 years she will likely be declared inadmissible, though I can provide you with some information that you can use to argue against this decision.

Drug coverage varies by province, though, so a complete analysis cannot be done without that information.

Normally, what IMS will do next is send a sealed letter to you to take to the Panel Physicial (DMP). Normally this will ask for additional information and whether or not you will require treatment in the next 5-10 years. What this means is that you need to be looking for a sympathetic doctor now. Ideally, you want one that can either say definitively or probably that she will not require treatment within that time period. Not every doctor will say that, so you may wish to consult with more than one.

If after reviewing the additional medical information they determine she will require medication in the 10 year time period, they will advise you that she is "probably" medically inadmissible. This is done by way of a fairness letter. You will have 60 days to respond to the fairness letter.

You may challenge the finding of the medical condition, e.g., she had a "false positive". This is actually quite likely. The doctor may tell you the test is 99.6% accurate, but will not advise you that the positive predictive value (PPV) is much lower than that, because the prevalence of the condition is very low in the general population.

You may challenge the medical officer's estimate of costs. This is an area in which I can provide you with guidance, particularly if you can present a particular treatment regimen to her doctor and have the doctor agree that it is a viable treatment model - this is because one approved treatment is now made up of generic medications that have much lower cost and thus do not exceed the excessive demand cost threshold.

You may provide a plan to mitigate costs. This can include insurance plans, NGOs that will pay for treatment, and health savings plans.

If you do receive or expect to receive a fairness letter, I would strongly suggest you engage an attorney to assist you. I can recommend someone who specializes in HIV medical inadmissibility cases and can point out a handful of other attorneys specializing in medical inadmissibility. A well formulated response to the fairness letter potentially will overcome the initial inadmissibility conclusion and ultimately lead to a successful conclusion. In addition, it will set the stage for a successful challenge to a negative decision.

If you are refused, you may challenge the refusal in Federal Court. That will require you have an attorney. CIC's track record in medical admissibility cases for FSW applications is not good - they lose about 75% of such cases according to my own review of case law. If you are interested, look up the following four decisions: Sapru, Rashid, Companioni and Ortiz at canlii.org. These are all on-point cases with respect to medical inadmissibility and the last two are specific to HIV (CIC lost both of those cases).

If you need more information, feel free to ask (I won't hand out attorney names in public, but will send them privately.) You don't have 10 posts yet, so you won't be able to send PMs.
 

dkk985

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Mar 21, 2015
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I have read most posts here.. and i might be repeating some of the issues im about to bring up but here it goes:

I have just started ART and and looking to apply for migration/PR.
On paper as per my education and all other factors.. on the points system i have a very strong case for migrating to canada and securing PR. The only hiccup is I just know that i will receive a letter of fairness coz of my status.

I'm 26. My question is about my chances of making it through as I come under the category of "non-ede". I'm taking viraday (Atripla in Canada), costs of which have been totaled to roughly $800/ month or $6300 a year. I'm looking at Toronto, Ontario as my destination.

How long till Atripla is off patents? or can i still make my case against excessive demand based on the alternative first line of treatment with generic constituting drugs individually?

Is there a chance of HALCO providing a letter of support for a person like me who inst even in Canada yet?

Or can I depend on showing my own economic/ financial standing to take care of my own expenses? (Eg. Sourcing medication by mail at a relatives US address and securing personable amounts for every 90 days by physically going the distance myself)

Are these arguments valid or will they hold weight in court to fight the excessive demand argument by the state of Ontario?

I apologize if i have repeated already discussed points
 

computergeek

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dkk985 said:
I have read most posts here.. and i might be repeating some of the issues im about to bring up but here it goes:

I have just started ART and and looking to apply for migration/PR.
On paper as per my education and all other factors.. on the points system i have a very strong case for migrating to canada and securing PR. The only hiccup is I just know that i will receive a letter of fairness coz of my status.

I'm 26. My question is about my chances of making it through as I come under the category of "non-ede". I'm taking viraday (Atripla in Canada), costs of which have been totaled to roughly $800/ month or $6300 a year. I'm looking at Toronto, Ontario as my destination.

How long till Atripla is off patents? or can i still make my case against excessive demand based on the alternative first line of treatment with generic constituting drugs individually?
It's been a while since I researched that, but as I recall, it is within the next 3 years.

dkk985 said:
Is there a chance of HALCO providing a letter of support for a person like me who inst even in Canada yet?
HALCO's lawyer is very active in this area. It's certainly worth contacting them.

dkk985 said:
Or can I depend on showing my own economic/ financial standing to take care of my own expenses? (Eg. Sourcing medication by mail at a relatives US address and securing personable amounts for every 90 days by physically going the distance myself)
Won't work, as they have no means of enforcing a promise not to use public services. What does work is to demonstrate that the public expense portion is below the excessive demand threshold. I've seen several people do this with the one generic combination (Lamivudine, Zidovudine, Nevirapine) available. It's also possible if you can demonstrate that your income will require that you pay sufficient portion (but this is specific to the provincial rules).

dkk985 said:
Are these arguments valid or will they hold weight in court to fight the excessive demand argument by the state of Ontario?
Arguing costs works, provided you can present a reasonable argument. Legal arguments revolve around several possible areas, including charter guarantees, treaties that Canada has signed regarding the rights of people with disabilities, the fact that CIC has no legal basis for making decisions about health care (because it is reserved exclusively to the provinces), etc. But legal arguments only work when you can't make the cost arguments work and have to go to court.

The Federal Court is not obligated to accept your case for legal review - only about 20% of cases are actually granted leave. Of those cases, only about 20% are granted Judicial Review (which means they overturn the CIC decision). Having said that, the last time I looked, excessive demand medical inadmissibility cases were much more likely to go against CIC - like 3:1 against.

But if you want to be successful, you really need to be working with one of the two attorneys that specialize in this area.
 

Arvind Sharda

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Dear Sir,Need ur expert Guidance..

one of my friend whose wife is primary applicant has been a carrier to Hep B. does it block their road to PR. MR is awaited. should they reveal it to concerned doc.
 

veggievan

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Hi computergeek,

I have read almost all of your posts here, and thanks again your posts are very helpful!!!

Here is my situation:

I am currently holding student visa and studying in the university in Vancouver, and I have been to Canada since 2009. I was diagnosed HIV+ in 2013 and I am taking atripla now (ST. Paul hospital IDC CILNIC).

I will be graduating by the end of the next year (2016) hopefully, and I am planning to apply for PR. I know that my HIV status would be a barrier for me because of the medical inadmissibility. I have asked the social worker at ST. Paul HOSPITAL. She has told me the same thing but she has also told me that recently there was a patient in the IDC clinic got approved PR as a single person (there was also one patient in Toronto got approved) which leave some possibility for me. She also suggest me find an attorney to assist my application.

My question is: as you have mentioned many times, we can argue with the visa officer about the costs of the medications, will this argument work? In another word, is there still a chance for me apply PR as a single person if I am hiv+ who is taking atripla now? ( I was deciding to give up my PR application, was planning going back to my country after graduation since it seems that it was impossible for a hiv+ person who is on medication like me to apply for PR as a single person). Also, as you have said that the atripla will be off patent within next three years, so the application would be increasingly easy for those of us who are taking medications! :) A good news!

By the way, may I ask you for a favor, Could you please PM the attorneys who are specialized in such case. I would greatly appreciate it! Thank you!
 

Arvind Sharda

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Hi Computergreek need ur advice..

Arvind Sharda said:
one of my friend whose wife is primary applicant has been a carrier to Hep B. does it block their road to PR. MR is awaited. should they reveal it to concerned doc.
 

computergeek

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veggievan said:
I am currently holding student visa and studying in the university in Vancouver, and I have been to Canada since 2009. I was diagnosed HIV+ in 2013 and I am taking atripla now (ST. Paul hospital IDC CILNIC).

I will be graduating by the end of the next year (2016) hopefully, and I am planning to apply for PR. I know that my HIV status would be a barrier for me because of the medical inadmissibility. I have asked the social worker at ST. Paul HOSPITAL. She has told me the same thing but she has also told me that recently there was a patient in the IDC clinic got approved PR as a single person (there was also one patient in Toronto got approved) which leave some possibility for me. She also suggest me find an attorney to assist my application.

My question is: as you have mentioned many times, we can argue with the visa officer about the costs of the medications, will this argument work? In another word, is there still a chance for me apply PR as a single person if I am hiv+ who is taking atripla now? ( I was deciding to give up my PR application, was planning going back to my country after graduation since it seems that it was impossible for a hiv+ person who is on medication like me to apply for PR as a single person). Also, as you have said that the atripla will be off patent within next three years, so the application would be increasingly easy for those of us who are taking medications! :) A good news!
There is always a chance. But it is a difficult task and you should be geared for a fight. You are, however, an excellent candidate for exactly that type of fight: you're young and just entering the workforce. You became ill in Canada and there is an H&C argument that kicking someone out of the country after 7 years is unfair as your life is now centered around Canada and not your home country. Assuming you qualify for a 3 year PGWP, that length of time only helps strengthen potential H&C arguments.

Atripla will lose its patent status over the next few years (http://www.nature.com/news/generic-hiv-drugs-will-widen-us-treatment-net-1.11173 - though this is US patent expiration and Canadian expiration can vary a bit from this, but is harder to research). That will dramatically change the cost of treatment analysis.

You may also speak to your doctor about other therapy combinations. For example, darunavir/ritonavir as the backbone is also a popular combination and can be combined with truvada. This will be a generic combination sooner. Or darunavir/ritonavir with lamivudine and abacavir, all of which will be generic by the time you are applying. By 2017, tenofovir (which was invented in 1986 but has had an exceptionally long patent life) will be off patent, and then generic atripla (Viraday from Cipla, for example) will be available. The cost outside Canada for this is as low as $60 per month, though the Canadian price is still likely to be closer to $300 per month - but that's far below the excessive demand threshold.

I always recommend looking at the Quebec formulary for pricing - it will tell you when generics become available in Canada (because the price will drop and generic options will show up).

http://www.ramq.gouv.qc.ca/en/publications/citizens/legal-publications/Pages/list-medications.aspx
 

computergeek

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The patent expiration date for Darunavir is 2023 in Canada (it expires this year in the US), so that's probably not as good an option. Efavirenz (one of the component of Atripla) doesn't go off patent in Canada until 2017 (it's off patent in the US already).

Here is the database for drugs and it lists the patents that cover the drugs: http://pr-rdb.hc-sc.gc.ca/pr-rdb/search-recherche.do?lang=eng