The news came suddenly, and it tore through a life already in motion. A man in his twenties, who had left Egypt to build a future in Dubai, learned that the routine blood test tied to his residency visa had returned a different result: he was HIV-positive. Within days, he was told, he would have to leave the country. The diagnosis itself was devastating, but what he remembered most clearly was the sentence that followed: the order to pack up his life and disappear. Later he told me, with a voice heavy from the weight of it: “the deportation was worse news than HIV itself.”
His story is not exceptional, but we rarely hear it told. Across the Arab states, mobility is conditioned on a blood test. Workers, students, and long-term residents are required to prove they are “free of communicable disease.” A diagnosis of HIV is not met with treatment or care, but with expulsion. Lives are derailed in a matter of days; jobs lost, homes abandoned, families forced into sudden disclosures, health put at risk.
This essay traces the system that makes such ruptures possible. It centers on the United Arab Emirates, where mandatory testing and deportations remain official policy, and on Egypt, where people living with HIV must navigate a medical system riddled with neglect and stigma. For those who are sent back, as well as for anyone forced to live under these conditions, these practices are not “health” measures in any meaningful sense. They are migration controls, mechanisms of policing who belongs and who does not, clothed in the language of public safety. Through historical investigation, policy analysis, and life testimony, I map how these restrictions reproduce stigma while undermining public health. And I ask: what happens when a virus becomes a border, when a diagnosis decides who may stay and who must go?
Historical & Political Backdrop
The modern policing of HIV and mobility did not emerge in a vacuum; it grew out of much older colonial regimes of managing populations, disease, and borders. As I explored elsewhere, the 1884 Berlin Conference set in motion a profound reorganization of African landscapes and populations, laying the structural groundwork for HIV to emerge as an epidemic (Awadalla 2022). Epidemics, then and now, were never only biological events. They were political. They justified expansion, displacement, and new forms of surveillance. To call HIV a public health issue without naming this legacy is to misrecognize its life as a tool of governance. Seen in this light, contemporary restrictions on people living with HIV are not aberrations but continuations of an older logic.
While the binding of mobility to blood tests is often cast as an Arab peculiarity—a marker of the region’s supposed backwardness—the history tells us otherwise. The first modern blueprint for HIV-based exclusion did not come from the Middle East but from the United States. Travel restrictions for people living with HIV crystallized not in Cairo or Dubai, but in Washington, D.C. In 1987, the United States formally added HIV to its list of “communicable diseases of public health significance,” thereby barred non–citizens with HIV from entry or immigration. For more than two decades, the United States remained one of the few countries in the world with an explicit travel ban on people living with HIV, a policy not lifted until 2010. However, what was stipulated as U.S. policy soon radiated outward, taken up and adapted by states across different political contexts, including the Arab world.
As Karma Chávez documents, this policy was never based on medical evidence (Chávez 2021). HIV was not transmissible through casual contact, nor did borders serve as barriers to epidemics. Instead, “when it came to non-citizens, HIV/AIDS once again became an opportunity to enact alienizing logic,” as politicians and public health officials recycled “long-standing racialized, xenophobic, and nativist fears about migrant health and sexuality.” In this framing, HIV was imagined as a foreign threat carried by outsiders, intensified by its association with “deviant” sex and the specter of death. The U.S. ban thus reassured the public not by containing the virus, but by designating who could be treated as danger.
Today, restrictions on people living with HIV take many forms. UNAIDS estimates that more than forty countries still impose HIV-specific travel bans, and NAM AIDSmap shows just how widely these rules are scattered, across North America; Central and South America; the Caribbean; Sub-Saharan Africa; North Africa and the Middle East; Western, Northern and Southern Europe; Central and Eastern Europe; Central Asia; East Asia; South and South-East Asia; and Oceania. Some states bar entry altogether; others demand disclosure of HIV status in visa or residency applications, or automatically deny permits after a positive result. A smaller number (including several Gulf countries) go further, deporting migrants who test positive. Even states that pride themselves on progressiveness are not exempt: Canada and Australia maintain forms of HIV-related entry barriers, and in Germany, some federal states still subject asylum seekers to mandatory HIV testing, violating the principle that such testing must be voluntary and confidential. The picture is uneven, but the underlying logic repeats: borders are drawn not only on maps but also in blood.
The Arab States region1 has one of the highest concentrations of such restrictions globally. In the United Arab Emirates, Kuwait, Oman, Qatar, Saudi Arabia, Egypt, Syria, Iraq, Sudan, Yemen, Bahrain, Jordan, and Tunisia, foreign residents must prove they are “free of communicable disease” to obtain or renew visas. Testing positive for HIV often leads to deportation within days, or at minimum the cancellation of permits and denial of residence. While the precise consequences differ; some states deny entry, others cancel work permits, others deport outright, yet the pattern is clear: the virus is treated as grounds for exclusion, and the people who carry it are denied the right to belong. Even tourists are not fully exempt: cases have been reported of travelers being denied entry after HIV medication was found in their luggage, underscoring how border regimes extend stigma beyond the workplace and into the most basic right of movement.
Unlike in the U.S., where activists and scholars such as Chávez have traced a clear genealogy of HIV-related border controls, the legal and bureaucratic history of these policies in Arab states remains largely unmapped. The scarcity of sustained historical or archival work in the region is striking, and it underscores an urgent need for research that can document how these regulations emerged, circulated, and hardened into state practice. Deportations are rarely recorded, data on testing regimes are scattered, and migrant voices are often silenced. The lack of documentation is itself a form of control: without records, there is no accountability, and without testimony, there is no politics. It is only through community networks, whispered accounts, and rare interviews that we can glimpse the violence of these regimes.
To situate HIV restrictions in the Arab region within this broader history is not to excuse them. It is to recognize that they are part of a global architecture of control, one that marries public health optics to migration management. Just as colonial powers once reframed epidemics to justify conquest, today’s states use HIV to redraw borders of belonging. The challenge is not simply to criticize “bad policy” in this or that country, but to confront the wider system that makes some lives disposable in the name of protecting others.
Epidemics of Signification and the Logic of Foreignness
From the very beginning, HIV was framed through the language of foreignness. Early American media and public-health discourse organized the epidemic around the notorious “4H Club”—homosexuals, heroin users, hemophiliacs, and Haitians—casting the virus as deviant, dangerous, and above all imported. Paula Treichler reminds us that AIDS quickly became an “epidemic of signification,” a site where origin myths, racial fantasies, and anxieties about national purity flourished. These narratives surfaced in varied forms around the world, from claims that AIDS was a CIA bioweapon to local conspiracies tailored to regional politics. In Egypt, for example, similar conspiratorial explanations emerged: early press coverage in the late 1980s warned of an Israeli plot to deliberately spread HIV, fueling public hysteria and reproducing the same impulse to imagine AIDS as a threat engineered elsewhere.
This same logic underpins the persistence of HIV travel bans. By making HIV synonymous with otherness, states justified measures that excluded people with the virus from entering, working, or settling. Deportations, like the case we later explore from the United Arab Emirates, are the most violent end of this spectrum. But even in their milder forms—visa restrictions, mandatory testing of migrants, requirements for disclosure at borders—travel bans repeat the same symbolic gesture: HIV is always something that comes from elsewhere, never something “of us.”
Across the world, punitive HIV policies extend far beyond borders. Criminalisation of HIV non-disclosure, exposure, and transmission now exists in 91 countries with HIV-specific statutes, while another 41 countries use general criminal law to prosecute people living with HIV, according to HIV Justice Worldwide. Blood-donation bans for gay and bisexual men persist in many Western countries, a reminder of how HIV continues to be governed through moral panic rather than scientific evidence. In the Arab region, this global logic takes on its own forms. Egypt, for instance, has used morality laws to police people living with HIV: in 2007–2008, police arrested twelve men on suspicion of being HIV-positive, chained those who tested positive to hospital beds, and prosecuted them for “habitual debauchery,” treating HIV status itself as incriminating evidence. Together, these examples show how HIV becomes a proxy for policing sexuality, morality, and social belonging—an “epidemic of exclusion” in which stigma is enforced not only culturally, but through the law.
The lesson here is clear: when HIV is framed through foreignness, responses tend to be rooted in punishment, control, and exclusion. What gets lost is the recognition of HIV as a manageable condition, and of people living with HIV as human beings entitled to movement, intimacy, and dignity.
Deportation Worse Than Diagnosis
Migration choices under HIV surveillance split lives open: between the possibility of exile, asylum, or return. Between those forced back, those who manage to leave, and those still waiting. As I reflected in Those Who Left and Those Who Stayed, these fractures shape how illness, mobility, and belonging intersect in ways rarely captured by policy or research (Awadalla 2021). But it is important to note: HIV does not universally determine migration in this way. In most of the world, a diagnosis does not automatically trigger deportation or forced return.
It is in places where laws bind residency and employment to blood tests that HIV becomes a border, a decision point that tears lives apart. And elsewhere, where treatment remains patchy and stigma suffocates, people may find themselves compelled to migrate in search of care and the possibility of living openly. The account at hand sits precisely in that fracture. These stories remain rare in published accounts from the Arab region, which is why further documentation is vital.
One such case is that of Salem2, a young gay Egyptian man who, like many of his peers, sought a life beyond the constraints of home. After finishing his studies, he traveled to the United Arab Emirates on a tourist visa, hoping to secure work and carve out stability. He succeeded: a job, a rhythm, the beginnings of a life. What he did not know was that every step of that life as a migrant worker would be tethered to a system of medical surveillance.
In the UAE, employment is inseparable from medical surveillance. From the first day of hiring, a blood test is required—presented as a matter of public safety, but in practice serving as a tool of gatekeeping. When his blood was first drawn, the young man had no idea that an HIV test was included. Later, when he changed jobs, the ritual repeated itself: a medical screening as routine as signing a contract. Thereafter, every two years, another test determined not only his health but his right to remain employed. Medical data, visa status, and work authorization were bound together in a single file, fusing the intimate matter of blood with the bureaucratic machinery of migration control.
The third time, something shifted. By then, he had learned from friends that the routine employment check included an HIV test. When his company’s human resources office (not a doctor) told him he needed a “confirmation test” at another center, he immediately understood what it meant. A confirmation test was not routine; it pointed toward HIV. The news hit him like a physical blow. At the gym, he collapsed, his body buckling under the weight of what was now almost certain. For years, like many gay men in Egypt and abroad, he had lived with the fear that HIV was the worst fate imaginable: not only death, but disgrace.
The confirmation test was carried out at Al Muhaisnah Center, a facility designated to determine “medical fitness.” His suspicion that he had already been marked was confirmed the moment he arrived. “The maltreatment already started at the door,” he recalled. Staff looked at him as if he carried a verdict, not a virus. At the entrance, he was ordered to surrender his passport, treated more like a suspect under investigation than a patient seeking care. When the result came back positive, it was not a doctor who informed him but, once again, his company’s human resources officer. The message was blunt and final: he had five days to leave the country.
“The deportation was worse news than the HIV itself,” he later said. He had started to settle in Dubai, to believe that his life could take root. Now, everything collapsed. He had promised his family he would not return to Egypt for at least five years, hoping to escape the compulsory military service and to send money home instead. Suddenly, he had to reappear before them, with both a failed migration project and a diagnosis that carried unbearable stigma. To his mother, he explained it as the outcome of a heterosexual relationship, unable to reveal the truth of his sexuality.
Back in Egypt, the ordeal continued. It took months before he was able to access HIV medication, during which time he lived with uncertainty about his health. The delays were not incidental: structural shortages, bureaucratic bottlenecks, and the near-total centralisation of antiretroviral treatment in a handful of government clinics meant that timely access was never guaranteed. When he needed surgery for appendicitis, every hospital he approached rejected him after disclosure of his status. Eventually, he learned to lie in order to secure treatment, a deception necessary for survival.
There was, ironically, one small silver lining: his HIV status exempted him from the military service he had long dreaded. There was, ironically, one small silver lining: his HIV status exempted him from the military service he had long dreaded. And while this exemption is technically a form of discrimination, among queer Egyptians it is rarely experienced that way. Conscription is widely feared, a site of violence, humiliation, and hyper-masculine discipline. So being spared it feels less like exclusion and more like a welcome release.
Beyond that, the diagnosis brought something else—a reckoning. Amid the upheaval, he found himself rethinking the course of his life. “Despite everything, HIV made me think about the future, about solutions rather than problems,” he reflected. This shift did not lessen the violence of deportation, but it shows how a diagnosis can redirect a life. For many people living with HIV, the virus becomes a kind of wake-up call; not a gift, not a blessing, but a confrontation with mortality and vulnerability that forces new priorities, reshapes futures, and sometimes sparks the will to survive differently.
Yet the injustice remained sharp. He saw himself, and others like him, as laborers who built the wealth of the Gulf but were discarded like waste the moment they no longer fit the mold of the “healthy migrant.” He noted the hypocrisy: Emirati citizens living with HIV could access treatment and continue their lives, while migrants were swiftly deported. The double standard was clear; locals were patients, migrants were threats.
His life since has been marked by instability. Egypt had never felt safe: the weight of stigma, the absence of confidentiality, and the daily precarity of trying to access treatment as a gay man with HIV left little room to breathe. Twice he tried to leave for Europe, but failed—blocked by the fortified migration regime of the EU. Eventually, he made his way to Lebanon, the nearest place where UNHCR offered a legal path toward resettlement, and there he sought asylum, his future still uncertain. What he knows for certain is this: the system is profoundly unfair. It does not protect health; it enforces hierarchy. And its consequences—the collapse of lives, the rupture of families, the scattering of futures—are far more devastating than the virus itself.
Beyond Borders, Beyond Stigma
The Gulf presents a particular case. In the United Arab Emirates, migrants outnumber citizens by a wide margin, and the kafala (sponsporship) system keeps workers tethered to employers with little protection or recourse. In this context, health testing becomes another instrument of control. A medical check is not simply about well-being; it is a checkpoint inside the body. A virus becomes reason enough to sever contracts, cancel permits, and erase futures.
Yet the UAE is not alone. Across the region—including Kuwait, Oman, Qatar, Saudi Arabia, Egypt, Syria, Iraq, and Sudan—residency and employment continue to hinge on HIV testing. A positive result may be recorded through different bureaucratic steps—denial of entry, cancellation of permits, or termination of contracts—but in nearly all cases the end point is the same: deportation. The story traced here is not only about one man’s deportation, but about how entire systems decide whose lives can take root and whose must be uprooted.
Undoing these harms means looking in several directions at once. Governments in the region must stop confusing stigma for strategy. Ending deportations, breaking the link between residency files and HIV status, and guaranteeing treatment for all (citizens and migrants alike) are not radical demands but the minimal conditions of public health. Global health institutions already call for the removal of restrictions, but their words will ring hollow unless they name and pressure the states that persist in these practices, and unless they offer genuine alternatives rooted in care rather than punishment.
International funders and INGOs must invest in listening, in testimony, in the slow and unglamorous work of documentation. We need more research in the Arab region, where silence has been the rule, and where stories like this one rarely make it into the record. Promising models already exist: projects like Positive Destinations are gathering the voices of people who live the violence of borders in their bodies. Such archives are not only evidence but a form of resistance, an insistence that lives cannot be erased so easily.
Civil society, too, has a role to play. HIV restrictions are part of a larger lattice of control that includes the kafala system and other regimes of migrant precarity. They intersect with barriers to organizing, restrictions on speech, and the constant threat of surveillance. Grassroots groups—whether focused on migrant rights, queer rights, labor rights, or health equity—rarely have the luxury of working in isolation. Linking these struggles—against stigma, against labor exploitation, against borders—can build solidarities stronger than any single campaign. This means insisting that access to treatment cannot be separated from the right to organize at work, that the fight against HIV stigma cannot be detached from the struggle against deportation, and that migrant justice is inseparable from health justice.
For years the global HIV movement has insisted that the virus is no longer a death sentence. Yet in contexts like these, it often becomes something else: a life sentence. Not one of dying, but of being forced to live differently—rerouted by bureaucracy, estranged from family, cut off from the right to settle and belong. A single diagnosis can redraw the map of a life.
To speak of ending AIDS is not only to promise new medicines or fewer infections. It is to demand an end to the logic that treats people with HIV as outsiders, as temporary, as unworthy of staying. It is to recognize that freedom of movement, the possibility of love, and the right to make a home cannot be contingent on the results of a blood test. What is needed, then, is not an appeal to morality but a shift of logic: from control to care, from suspicion to solidarity, from exclusion to freedom. Only by undoing the borders inscribed in our bodies can we imagine futures where people are not sorted into those who may stay and those who must leave, but where everyone has the chance to root themselves, to move, and to live fully.
- This encompassing 22 member states of the Arab League: Algeria, Bahrain, Comoros, Djibouti, Egypt, Iraq, Jordan, Kuwait, Lebanon, Libya, Mauritania, Morocco, Oman, Palestine, Qatar, Saudi Arabia, Somalia, Sudan, Syria, Tunisia, the United Arab Emirates, and Yemen. ↩︎
- Pseudonym for the protection of the interlocutor. ↩︎
References
Awadalla, Ahmed. 2021. Between Certain Death and a Possible Future: Queer Writing on Growing up with the AIDS Crisis. Edited by Mattilda Bernstein Sycamore. Arsenal Pulp Press.
Awadalla, Ahmed. 2022. ‘“Where Does AIDS Come from?”: The Untold Story of the AIDS Epidemic’. JEEM, February 28. https://jeem.me/de/node/1121.
Chávez, Karma R. 2021. The Borders of AIDS: Race, Quarantine, and Resistance. Decolonizing Feminisms. University of Washington press.Treichler, Paula A. 1987. ‘AIDS, Homophobia and Biomedical Discourse: An Epidemic of Signification’. Cultural Studies 1 (3): 263–305.
