Moving to Sweden with hiv – what you need to know

Moving to a new country can be taxing, moving countries with hiv can be even more difficult and require additional planning and knowledge. In this article we will present a broad overview of what you need to know when moving to Sweden with hiv. The article starts with a general background of hiv and healthcare in Sweden, laws related to hiv in Sweden and finally immigration to Sweden with hiv, including work and studies.

The information in this article is accurate as of 30th of April, 2020. If in doubt, always consult a legal party to gain up to date information or contact us. (Article updated july 2019 in wake of the new announcement from Folkhälsomyndigheten/Swedish public health authority)

The Swedish healthcare system and hiv

Sweden offers universal healthcare. In practice this means healthcare is available as a right to all citizens, and in many instances also for people permanently or temporary residing in Sweden (more on this later). Hiv testing, treatment and care is generally incorporated in the division of infectious diseases at hospitals and Hiv care is offered at most major hospitals in Sweden’s 21 counties.

For persons living with hiv in Sweden, check ups on eg. viral load and cd4 is usually done every 6 months for stable patients, and in some cases even less frequently. The infectious disease doctors, who normally treats persons living with hiv, can together with the patient decide the frequency of checkups. Normally lab work is done a couple weeks ahead of the appointment with the infectious disease doctor, thus every checkup round requires two visits to the hospital. Both visits are by appointment only.

All hiv medicine are prescription only in Sweden, and persons living with hiv usually receives a one year prescription and are able to refill once every 3 months. Medicines needs to be pre-ordered as they are rarely kept in stock in smaller local pharmacies, and can be either sent to a nearby postal service or to the nearest state run pharmacy (Apoteket).

Healthcare in Sweden is governed through a separate legislative county level body called ”Landsting”. In Sweden there are 20 of these and all run their own budgets. Local management, governance, doctors mandate and differences in county interpretation of laws might cause some differences in how patients experience hiv care.

Laws regarding hiv in Sweden

According to the Swedish Communicable Diseases Act, individuals who might suspect they contracted hiv are obliged to consult a doctor and test for hiv. Sweden also requires all persons living with hiv to adhere to a set of rules which in practice means that when there is a situation, even theoretically posing a risk for transmission, persons living with hiv needs to disclose they are living with a “blood borne infection”. These situations includes dental work, drawing blood, getting a tattoo, using syringes and all forms of sex, even while using a condom. (New rules as of July 2019, see further down)  The rules should be thought of in conjunction with the level of prosecution for hiv-related offences in Sweden, which historically is and has been very high compared to other western countries.

Although these laws still are in effect, increased understanding of transmission while on treatment and the concept of TasP (Treatment as Prevention) has incurred changes. Since 2013 infectious disease doctors has the mandate to void the need to disclose when engaging in sex. This applies for individuals following treatment guidelines, meaning taking their medicines as prescribed, showing an undetectable viral load for at least six months and being free of other sexually transmitted diseases. Condom use is still required, and only the need to disclose is voided.

Moreover, a ruling by the Supreme Court in 2018, acquitting a person living with hiv on the count of “creating a danger to another”, despite having unprotected sex, in effect established that the risk of transmitting hiv while on treatment is too low to be considered a risk judicially.

As of 2019 new rules are under revision and is expected to decrease the legal burden on persons living with hiv and generate greater freedom.

Update July 2019:

Folkhälsomyndigheten (Swedish public health authority) announces  that there is no risk of transmitting hiv, when people living with hiv are undetectable and on a stable treatment regimen, when engaging in unprotected sex. The infectious disease guidelines that are given to people with hiv whom are undetectable and on a stable treatment regimen has been revised. The new guidelines does not include an obligation to disclose status, even when having unprotected sex. Hence, the use of a condom is no longer required.

For more information:

Announcement from Folkhälsomyndigheten:

https://www.folkhalsomyndigheten.se/nyheter-och-press/nyhetsarkiv/2019/juni/ingen-risk-for-hiv-via-samlag-om-behandlingen-ar-valinstalld/

Infectious disease guidelines for hiv:

https://slf.se/smittskyddslakarforeningen/app/uploads/2019/07/hiv-pat-med-valinstalld-behandling-190703-korrekt-titel.pdf

Children with hiv

Childcare is a right for all children in Sweden and they can start pre-school from the age of one. For children living with hiv, the status does not affect this right whether it is preschool or higher education. Regarding possible disclosure of hiv status eg. “blood borne infection”, it is not required by law to disclose this information prior to entering preschool. When entering preschool, healthcare journal requisition is optional and the guardians can opt out of having it transferred when entering preschool. However, it is the responsibilities of the guardians to see that your child adheres to the guidelines set by the Swedish Communicable Diseases Act, thus to prevent transmission.

Nonetheless, for children entering  preschool it is a common recommendation for guardians to inform the preschool manager about the status. If further personnel is to be informed it is in consultation with guardians and  your doctor. When starting school it is the school health team, thus the school doctor and nurse who should be informed. Regarding disclosure of status it is always you as guardian who decide who, or if to inform.

For children living with hiv there are a number of hiv related educational activities and social gatherings such as ”Barnhiv Centrum”. With the aim of providing an inclusive environment for children living with hiv where knowledge, social development and friendships can be gained. 

Immigration to Sweden and hiv

Sweden does not ban entry or stay based on hiv status, and your hiv-status will not influence your immigration process, whether you are visiting for a few weeks, moving for work, or immigrating to stay with a Swedish spouse.

For individuals seeking asylum in Sweden, a basic healthcare check will be offered, inclusive of hiv testing. The outcome of the test does not influence the immigration process or the decision by the Swedish Migration Board, irrespective of granting asylum or not.

Access to treatment and costs

For eu-citizens moving to Sweden

Hiv treatment for eu-citizens residing in Sweden is regulated by the European Union and is generally free of charge. If you misplace or lose your medication you are entitled to substitution medicine. However, all hospitals might not stock all brands of hiv medicine,so getting ahold of your hiv medicine on the spot might become an issue.

For non-related hiv issues that are deemed ”non-essential”, care might not be offered for free. If visiting a health care facility, the practitioner will assess how essential the need for care is and depending on the circumstances care might be offered free of charge. The objective with the guidelines of providing essential care is to make visitors feel safe and medically taken care of while they are staying in Sweden. Essential care should ensure that a planned stay in Sweden is not cut short because of a medical need.

As a eu-citizen you should carry and be able to present your European healthcare insurance card at health care facilities and hospitals. This is to avoid having to pay any medical fees upfront. In the case you are not carrying the card you might have to pay a fee, although these fees would be reimbursed by your EU-country, nontheless you would still need to claim the cost back by yourself. A check will also be performed to make sure that the care given in Sweden is covered by your healthcare plan policy in your home country.

For non-eu-citizens moving to Sweden

In general, if you have received a permission to stay that is less than 1 year, you won’t be able to obtain a personal identification number and receive healthcare as citizens or people insured in the Swedish social security scheme. However, hiv-treatment due to its importance for sustaining life and lowering transmission will be offered once in country, there might be shorter prescriptions than 1 year, and refills might be only monthly due to the temporary nature of the stay. For non-eu citizens that has received a permission to stay longer than 1 year, a personal identification number can be obtained and healthcare is offered on the same level as citizens.

For asylum seekers and non-documented immigrants

Non-documented and non-eu immigrants with a permission to stay is entitled to hiv treatment free of charge according to the law. Some differences, such as shorter refills and pickup at hospital might occur.

It should be noted that the county level management of hospitals and interpretation of the law does influence the level of care and procedures surrounding hiv-care for immigrations, especially asylum seekers, non-documented immigrants and non-eu citizens.

Moving to Sweden for work

There is no mandatory hiv testing in Sweden to obtain a work permit but for certain professions persons living with hiv are barred from taking up employment, this relates mainly to work in the military branches. Other professions such as flight attendants, surgeons and police officers, although not explicitly excluding persons living with hiv has at least anecdotally direct or indirect discriminated against people living with hiv.

As a rule of thumb, even if employers are asking for health information, it does not relate to ones legal right to work in Sweden. Discriminating people living with hiv based on hiv-status alone is illegal.

Moving to Sweden for studies

Hiv does not pose a barrier to study or obtain a visa to stay based on studies.

In summary: Hiv does not pose a barrier moving to Sweden and hiv treatment will be offered, if its needed, to anyone, regardless of immigration status. However, obtaining a personal identification number can make the experience living with hiv in Sweden better and easier. Whether this is done through a longer permission to stay, work or other arrangements, the personal identification number grants clarity for both the health care staff in how to service you as the healthcare offered would be on par with what a Swedish citizen receive. The laws concerning hiv and people living with hiv, can be tricky, there are several rules to adhere to, and although there are signs of change, Sweden still has a history of prosecuting and criminalizing hiv. Thus, living well with hiv in Sweden requires one to stay on top of both rules, and one’s own health.