About NAFSA
NAFSA's Statement on AIDS and International Education Issues
ACHA/NAFSA Joint Committee on International Student Health Care
This statement was developed in January 1989 as a compilation of the general issues addressed in the ACHA General Statement on Institutional Response to AIDS and the ACHA special report, AIDS on the College Campus.
AIDS requires a global cooperative effort of research and education to prevent new infections of Human Immunodeficiency Virus (HIV) and provide treatment for those infected with HIV. AIDS cases have already been reported in over 150 nations. Insufficient surveillance and health care provisions in many countries and political sensitivities in others have led to extensive underreporting of cases of AIDS and HIV infection. The World Health Organization estimates that between five and ten million people were infected in the late 1980s and that by the early 1990s, 50 to 100 million may be infected. By all estimates, AIDS and HIV infection will have a devastating social and economic impact, particularly on developing and underdeveloped nations.
AIDS challenges higher education, as it does humankind, to maintain a perspective of compassion in a time of great fear. It also calls for the initiation of appropriate action. HIV and its associated illnesses are not limited by geographic boundaries. The urgency and fear surrounding AIDS may lead to insularity among nations as they attempt to secure their borders against persons infected with HIV. Similarly, foreign study and the rich diversity of culture and learning brought to the United States by international students may suffer from fears and prejudices. We encourage institutions of higher learning to work toward solutions to the global problem of HIV infection and to promote international cooperation and understanding rather than protectionism and suspicion.
The global nature of AIDS and HIV infection raises critical issues for colleges and universities. With significant numbers of students from other countries studying in the United States and U.S. students studying abroad, institutions of higher education face the increasingly complex task of providing AIDS-related information and services to international students.
For the purposes of this statement, "international students" refers to both foreign students in the United States and U.S. students abroad.
NAFSA's Statement on AIDS and International Education Issues: Index
Similarly, U.S. students studying abroad face potential separation from regular institutional and social support mechanisms.
The chief academic officer at an institution may also be involved with implementing these recommendations. Many foreign students in the United States are in graduate studies, and their primary connection to college or university services is through their academic departments.
AIDS education programs for international students should serve two primary purposes: to prevent unwarranted fear of infection, and to provide accurate information about prevention.
Students may have fears about studying or traveling in a country with a real or perceived high prevalence of HIV infection. These fears may be based on misconceptions about transmission (i.e., casual contact) or on valid concerns about exposure through sexual contact or contaminated blood.
Student concerns based on misinformation about the routes of transmission may deter them from studying in countries with a high prevalence of reported HIV infection. Institutions in the United States should be aware that the United States is considered a country of high prevalence. Foreign student admissions offices should be prepared to address prospective foreign student concerns about enrolling in institutions in the United States. Similarly, students who are enrolled may have concerns about living and studying in the United States.
Misinformation may also contribute to institutional and individual reprisals against persons (whether infected or not) from high-prevalence countries. The institution should make every attempt in all of its AIDS education programs to allay fears and prevent discriminatory actions based on misinformation. Institutions should respond decisively and thoroughly to harassment or other abuse toward any student. Students who have lived or studied abroad may express concerns about infection from sexual contact or exposure to blood. The institution should address these concerns according to the recommendations contained herein and in the chapter on psychosocial issues in AIDS on the College Campus, second edition (ACHA, 1989).
The variety of developmental, cultural, and religious attitudes among international students toward sexual behavior, sexual negotiation and decision-making, condom and contraceptive use, and intravenous drug use will determine the methods that will effectively provide students with preventive education.
The responsible office should attempt to identify developmental and cultural attitudes toward sexual and drug use behaviors. Program development should take into consideration these diverse attitudes and values and should respect differing cultural perspectives. The range of specific program activities and formats should offer many different means of obtaining information appropriate to varying levels of student comfort with discussing these behaviors.
At a minimum, the education program should:
Information regarding AIDS and travel abroad may be difficult to obtain or confusing. Some of the information may change frequently or differ according to source. Maintaining current information will depend upon the close cooperation of the student health service, the foreign student affairs office, the study abroad office, and the individual student. Those institutions that sponsor students abroad have a heightened responsibility to obtain such information. Information for students preparing to study abroad should address the following issues:
"You might want to be tested if ... you will be required to undergo mandatory testing (e.g. for military, Foreign Service, or Job Corps application). Since mandatory test results will become part of a permanent record, you might want to receive anonymous testing and counseling first, and perhaps withdraw your application if the result is positive."
In keeping with the recommendations of the ACHA and NAFSA Joint Committee on Foreign Student Health Care, institutions of higher education should provide adequate health care and services to all international students and facilitate health care for their dependents, including those infected with HIV, whether or not they are symptomatic.
All institutions with international students will benefit from the collection and sharing of successful AIDS-related program models, educational materials, and information sources. A combined effort among many colleges and universities will promote better services for all international students.
This statement was developed in January 1989 as a compilation of the general issues addressed in the ACHA General Statement on Institutional Response to AIDS and the ACHA special report, AIDS on the College Campus.
AIDS requires a global cooperative effort of research and education to prevent new infections of Human Immunodeficiency Virus (HIV) and provide treatment for those infected with HIV. AIDS cases have already been reported in over 150 nations. Insufficient surveillance and health care provisions in many countries and political sensitivities in others have led to extensive underreporting of cases of AIDS and HIV infection. The World Health Organization estimates that between five and ten million people were infected in the late 1980s and that by the early 1990s, 50 to 100 million may be infected. By all estimates, AIDS and HIV infection will have a devastating social and economic impact, particularly on developing and underdeveloped nations.
AIDS challenges higher education, as it does humankind, to maintain a perspective of compassion in a time of great fear. It also calls for the initiation of appropriate action. HIV and its associated illnesses are not limited by geographic boundaries. The urgency and fear surrounding AIDS may lead to insularity among nations as they attempt to secure their borders against persons infected with HIV. Similarly, foreign study and the rich diversity of culture and learning brought to the United States by international students may suffer from fears and prejudices. We encourage institutions of higher learning to work toward solutions to the global problem of HIV infection and to promote international cooperation and understanding rather than protectionism and suspicion.
The global nature of AIDS and HIV infection raises critical issues for colleges and universities. With significant numbers of students from other countries studying in the United States and U.S. students studying abroad, institutions of higher education face the increasingly complex task of providing AIDS-related information and services to international students.
For the purposes of this statement, "international students" refers to both foreign students in the United States and U.S. students abroad.
NAFSA's Statement on AIDS and International Education Issues: Index
- Foreign Student Education
- U.S. Student Education
- HIV Antibody Testing
- Foreign Service
- Permanent Resident Status
- Blood Supplies
- Needles
- Insurance
- Condoms
- Staff
- Referrals
International Student Issues
Foreign students in the United States are often unfamiliar with the major support services of an institution, including its health care system. Many foreign students are separated from their families, established social support systems, and sources of information. Students from countries where academic institutions provide limited health services may be unaware of the range of services available at U.S. institutions. Cultural differences and language barriers may significantly inhibit access to campus AIDS education and service programs or inhibit foreign students from seeking out or participating in such programs.Similarly, U.S. students studying abroad face potential separation from regular institutional and social support mechanisms.
Responsibilities of the College or University
Responsibility for implementing these recommend-ations rests with a variety of institutional offices. Each institution should designate an office to be primarily responsible for coordinating institutional policy. Implementation of these recommendations will require the close cooperation of the chief student affairs officer, student health service, foreign student affairs office, and education abroad office in providing AIDS-related information, referrals, and medical services. Other members of the institution's AIDS task force or advisory committee should be involved where appropriate, including counseling staff and professionals in student activities, residential life, and disabled students programs.The chief academic officer at an institution may also be involved with implementing these recommendations. Many foreign students in the United States are in graduate studies, and their primary connection to college or university services is through their academic departments.
Education
The office or offices with primary access to international students must be integrally involved in coordinating appropriate AIDS education programs. In some cases, this office may not necessarily be responsible for coordinating AIDS education for domestic students (e.g., foreign student affairs instead of student health).AIDS education programs for international students should serve two primary purposes: to prevent unwarranted fear of infection, and to provide accurate information about prevention.
Students may have fears about studying or traveling in a country with a real or perceived high prevalence of HIV infection. These fears may be based on misconceptions about transmission (i.e., casual contact) or on valid concerns about exposure through sexual contact or contaminated blood.
Student concerns based on misinformation about the routes of transmission may deter them from studying in countries with a high prevalence of reported HIV infection. Institutions in the United States should be aware that the United States is considered a country of high prevalence. Foreign student admissions offices should be prepared to address prospective foreign student concerns about enrolling in institutions in the United States. Similarly, students who are enrolled may have concerns about living and studying in the United States.
Misinformation may also contribute to institutional and individual reprisals against persons (whether infected or not) from high-prevalence countries. The institution should make every attempt in all of its AIDS education programs to allay fears and prevent discriminatory actions based on misinformation. Institutions should respond decisively and thoroughly to harassment or other abuse toward any student. Students who have lived or studied abroad may express concerns about infection from sexual contact or exposure to blood. The institution should address these concerns according to the recommendations contained herein and in the chapter on psychosocial issues in AIDS on the College Campus, second edition (ACHA, 1989).
Foreign Student Education
An effective AIDS prevention program must recognize those attitudes and values that will affect a student's ability or willingness to receive and act upon AIDS information. Programs should offer education and counseling in a flexible, culturally sensitive, non-threatening manner.The variety of developmental, cultural, and religious attitudes among international students toward sexual behavior, sexual negotiation and decision-making, condom and contraceptive use, and intravenous drug use will determine the methods that will effectively provide students with preventive education.
The responsible office should attempt to identify developmental and cultural attitudes toward sexual and drug use behaviors. Program development should take into consideration these diverse attitudes and values and should respect differing cultural perspectives. The range of specific program activities and formats should offer many different means of obtaining information appropriate to varying levels of student comfort with discussing these behaviors.
At a minimum, the education program should:
- actively involve foreign students in developing and delivering peer education programs. Foreign student participation in AIDS education is essential to identifying the target audience's cultural norms, issues of greatest concern, and most effective channels of information. Foreign student involvement will demonstrate institutional cross-cultural sensitivity and will provide greater access to information and peer support.
- provide AIDS training sessions to staff of foreign student offices, education abroad, and other departments that provide services to international students.
- include AIDS information in any new student orientation program.
U.S. Student Education
Institutions of higher education should develop and implement AIDS education and prevention programs for U.S. students according to the recommendations contained in the General Statement on Institutional Response to AIDS and AIDS on the College Campus. The institution should make additional efforts to provide preventive education for U.S. students preparing to study abroad.Information regarding AIDS and travel abroad may be difficult to obtain or confusing. Some of the information may change frequently or differ according to source. Maintaining current information will depend upon the close cooperation of the student health service, the foreign student affairs office, the study abroad office, and the individual student. Those institutions that sponsor students abroad have a heightened responsibility to obtain such information. Information for students preparing to study abroad should address the following issues:
HIV Antibody Testing
Individual national requirements for HIV antibody testing for purposes of entry or residence vary widely and change frequently. In some countries, testing is required for any visa or for an extended visa. In some countries, actual testing requirements may differ from the official stated policy of the country.Foreign Service
Students applying for foreign service positions should be aware that there is currently mandatory HIV antibody testing of applicants for positions in various U.S. agencies. Testing issues are addressed in the ACHA brochure, "The HIV Antibody Test," which states:"You might want to be tested if ... you will be required to undergo mandatory testing (e.g. for military, Foreign Service, or Job Corps application). Since mandatory test results will become part of a permanent record, you might want to receive anonymous testing and counseling first, and perhaps withdraw your application if the result is positive."
Permanent Resident Status
Foreign students seeking permanent resident status in the United States should be aware that the United States requires HIV antibody testing of all applicants for permanent residency. Those applicants testing positive are denied status.Blood Supplies
A higher risk of transmission of HIV through contaminated blood or blood products used for transfusion therapy exists in some countries with inadequate or inconsistent screening of the blood supply.Needles
If a student anticipates the need for hypodermic needles during study abroad (e.g. for insulin injection), the student health service should carefully consider recommending that the student obtain U.S. hypodermic equipment and needles to take abroad. The responsible office should obtain information on a given nation's laws regulating the import and possession of hypodermic needles.Insurance
The institution should provide information on adequate insurance coverage for students going abroad.Condoms
Some Islamic countries regulate the import or possession of condoms and other contraceptive devices. Students traveling overseas should be aware that the reliability and quality of condoms vary according to different national standards. Some condoms manufactured in countries outside the United States have a demonstrated lower rate of effectiveness.Staff
All institutional staff who have regular contact with international students should be prepared to address AIDS-related issues. In addition to training on the medical, legal, and psychological aspects of AIDS, staff in student health, counseling, and residential life should receive training in cross-cultural sensitivity.Referrals
The responsible office and all other staff who have contact with international students should know how to refer students to health educators, clinicians, or counselors, either on or off campus, who are especially sensitive to and experienced with the needs of people of other countries and cultures.Treatment and Care for HIV-Infected Individuals
The institution should serve as an advocate and referral source for health care and social services for HIV-infected students. HIV-related illness may lead to a foreign student's withdrawal from the institution, loss of visa status, or possible deportation. In some cases, individuals have successfully avoided deportation where it could be proved that deportation would result in a loss of adequate medical treatment. This argument may have increasing importance as new treatments become available in the United States for HIV-infected persons.In keeping with the recommendations of the ACHA and NAFSA Joint Committee on Foreign Student Health Care, institutions of higher education should provide adequate health care and services to all international students and facilitate health care for their dependents, including those infected with HIV, whether or not they are symptomatic.
Insurance
AIDS and HIV infection have increased the complexity of numerous issues about insurance coverage and benefits. Most health insurance policies, including those sold as group policies for students in colleges and universities, exclude pre-existing conditions from coverage. Exact definitions of pre-existing conditions vary; in some policies, pre-existing conditions are excluded only if they were diagnosed prior to the effective date of the policy, but in others, pre-existing conditions are excluded even if they were not diagnosed. Students with known positive HIV antibody tests prior to insurance enrollment might well be excluded from benefits should an illness related to HIV infection develop. The responsible office should obtain and make available information about insurance procedures and benefits regarding coverage of HIV-infected individuals.Confidentiality
The potentially devastating consequences of the unauthorized disclosure of an international student's HIV infection emphasize the absolute necessity that such information be kept strictly confidential. All staff who have access to information on the HIV antibody status of an international student should be reminded of the necessity of confidentiality prior to their involvement with international students. Confidentiality issues are further discussed in the General Statement on Institutional Response to AIDS and in AIDS on the College Campus.Travel Abroad by Individuals with HIV Infection
Immunizations
The institution should advise students or provide referral concerning required immunizations for travel. In doing so, the institution should follow the recommendations of the U.S. Public Health Service and the ACHA Immunization Update regarding the effects of vaccines on seropositive individuals.Medical Care
The student health service and other officers should coordinate information on the availability of medical care and treatment for individuals with HIV infection in other countries.Risks of Travel
The responsible office should provide HIV-infected individuals with information on the health risks (e.g. parasitic infections, disease outbreaks, etc.) of travel to certain geographic regions.Conclusion
General institutional issues regarding educational, clinical, and administrative policies concerning persons with HIV infection and AIDS are addressed in the ACHA General Statement on Institutional Response to AIDS and in the ACHA special report, AIDS on the College Campus. This statement incorporates the recommendations contained therein. This statement is also consistent with the recommendations of the ACHA-NAFSA Joint Committee on Foreign Student Health Care concerning basic health care services and insurance coverage for international students.All institutions with international students will benefit from the collection and sharing of successful AIDS-related program models, educational materials, and information sources. A combined effort among many colleges and universities will promote better services for all international students.
