By Ray Mwareya
August 26, 2020
In 2018 I arrived in Montreal, Canada as a refugee seeking protection from harm. Soon after I arrived a longstanding fear of mine exploded: I was asked to take my first ever HIV, tuberculosis and syphilis blood test. Enormous personal fear of what the test might reveal almost drove me to take an under-the-table car wash job and abandon the legal immigration process.
In Canada, a blood test screening for HIV is mandatory for asylum seekers before they can obtain a work permit and a Social Insurance Number. When I found out I had to take the test, my heart sank. My biggest fear was that my partner would be furious and leave me if I was found to be infected with HIV. I read immigration booklets explaining that by law, I would have to inform my fiancée within 60 days if I was found to be infected with the virus; I could be prosecuted if I infected someone without disclosing my status upfront. If that happened, my refugee claim could be rejected and deportation could ensue.
I was further unsettled about how the test results could impact my ability to work. What if my work permit was delayed because immigration doctors found syphilis or HIV in my blood tests? Being a refugee, if I had an infection, would I be seen as a burden to the healthcare system? Being unable to buy medication could have a dire outcome.
As the test date approached, a dubious entrepreneur who owned a car wash a few blocks down the street asked me to sidestep the immigration blood test and take a cash job at his car-washing garage. “Work under the table,” “Get paid off the books”, he said. Out of fear, I was tempted, but I rejected his illegal offer.
On the day of the test at a private clinic in Montreal, I arrived late to the 11:30 am appointment time, utterly unmotivated. An eager nurse stood in the reception corridor.
“R-A-Y, French or English?” the nurse asked, my name booming across the clinic’s packed reception area. It was time for me to meet the immigration panel doctor. I met his eyes through the crowd, feeling nervous but proud: I was being responsible by partaking in the HIV test and helping to protect Canada’s public health.
“Here’s a jar for your urine sample!” the nurse shouted across the eerily-silent room. I took it to the bathroom.
Two minutes later I limped back into the physician’s room, feeling very shy from the very publicly-announced urine test. The panel doctor approached me.
“For the HIV test you’ll wear only your underwear and socks,” he said, handing me a gown.
I took off my jacket. The doctor told me to take off my watch. I sat down on the exam table. He tapped my femur bones with his reflex hammer and I recoiled. “Open your mouth wide, breathe hard, in-out,” the doctor said.
I was desperate to hide my bloody gums and the gaping holes in my mouth where my upper front-teeth had been, fearing that I could be found to be infected with HIV during the dental exam. Or that the doctor would see my dental problems and think they were an obstacle to me being certified as a healthy person.
“Any syphilis diagnosis in the last 12 months? Hepatitis?” the doctor asked.
He noticed my cold sweats and released me into the care of the nurse who had announced my urine sample. The nurse smiled and measured my blood pressure.
I smiled back, trying to hide my missing teeth. After a few minutes she removed the blood pressure cuff and it was time for the HIV/tuberculosis test at last.
“Sign here,” said the nurse as she un-bundled her test kit.
“I fear vein needles,” I moaned.
“You fear needles?”
“Staring at needles. I look aside,” I said.
“You can look out the window. It’s a lovely Montreal day, very dark and dreary,” she joked. “I wonder if the sun will ever show up.”
She rubbed wet cotton onto my veins. “Left or right arm?” she asked.
She pushed the needle into my vein. It was painless for me but she panicked anyway. “Are you okay? Tell me, Ray, if you feel dizzy.” She noticed she had failed to puncture my vein properly. “Oh, this is bad. I´ll try on the other arm. You’ve got the best veins in Montreal,” she said.
I shut my eyes when she pierced my other arm. “Oh, I missed. It is not your fault. It’s me that’s bad,” the nurse said as she patched cotton swabs over the wounds. She got up. “I’ll call my colleague,” she said, leaving the room.
A senior nurse arrived and introduced herself. “It’s a tense day for all of us,” she smiled, coldly I thought, and probed at my veins with her un-gloved fingers. “Have you drank water lately?” she asked.
“Oh yeah, warm water today, at dawn,” I said.
“Have you eaten?”
“Light breakfast,” I replied, scared.
The skillful second nurse did her work and I was finally released. I loitered around the clinic’s reception desk.
“Your results will be emailed to you in seven to ten days. We are pretty fast now,” the cashier said bluntly. “If we find HIV in your blood, sir, you’ll have to pay $250 for further testing, out of pocket.”
I had wished to avoid the HIV test due to my sexual past. A positive diagnosis would have left me crushed with denial and depression. In the end, I was comforted to find out that in Canada, medicine to treat HIV is available for people living with the virus. I learned from Health Canada brochures that knowing one’s HIV status early is crucial to avoid preventable and premature death. Despite my fear of the test, ultimately I was more worried about the shame I would feel from falling severely ill in a developed country from a perfectly treatable infection.
My contrasting fears ultimately made me decide to get tested, and I’m glad I did.
Ray Mwareya is an independent writer in Ottawa. Follow him on Twitter.
Photo by Martha Dominguez de Gouveia.