Screening out: HIV testing and the Canadian immigration experience. By L.Bisaillon, Vancouver: UBC Press. 2022. pp. 304. CAD $89.95 (cloth). ISBN: 9780774867474; CAD $32.95 (pbk). ISBN: 9780774867481; CAD $32.95 (ebk). ISBN: 9780774867504

Screening Out: HIV Testing and the Canadian Immigration Experience is an excellent ethnographic account of how mandatory HIV testing has become an ominous tool for rendering permanent resident applications ‘medically inadmissible’ in the Canadian federal immigration system, leaving some people in even more precarious circumstances than where they began. The book speaks to a wide audience of readers: sociologists in particular and social scientists more generally; ethnographers in particular and qualitative researchers more generally; scholars of immigration and migration, HIV/AIDS, gender, race and health and architects of public policy. The book also makes a brilliant contribution to Institutional Ethnography. It should come as no surprise that Bisaillon has received numerous accolades including book awards from the Canadian Sociological Association (2023) and the Canadian Studies Network (2023). The book is organised around two compelling arguments: (1) significant changes are needed to the current Canadian immigration medical policy and (2) those changes must be predicated on the actual professional practices of those conducting medical exams, as well as a more compassionate view of the value of human beings and a broader recognition of the richness they offer to contribute to Canada. To convince us of these arguments, the book is divided into five chapters. To begin with, the introduction locates current federal immigration HIV screening practices in a 2002 policy change, the first change in over five decades. To explore the implications this policy has for current applicants and for the nation, the author describes a comprehensive bilingual research design spanning several years that includes in-depth interviews and focus groups with key informants within and outside the immigration system, analyses of central policy documents and medical screening forms and numerous site visits across Ontario and Quebec. The role of Institutional Ethnography as the central analytic perspective is also brought to bear. The middle three chapters of the book are told in narrative structure from the perspectives of Martha, a woman living with HIV who is applying for permanent residency in Canada, and Dr. Meron, an immigration doctor whose medical work has become more administrative than therapeutic as a result of the immigration policy requirements. The biographical accounts are poignant while informative and are interwoven with the author’s rich analysis. The conclusion not only reveals the fates of our protagonists after several years of navigating this system, but offers two concrete recommendations for structural change that would advance a more ethical and evidence-informed immigration policy in the 21st century. One of the major strengths of the book is its use of Institutional Ethnography. This approach anchors the analyses in the everyday embodied experiences of people who are actually living through and navigating an inflexible immigration system, bound by formulaic medical documents that largely deny the consideration of social context and individual experience. A common criticism I’ve heard levied at IE is that it relies too heavily on esoteric knowledge and insights in order to truly grasp the project at hand. Whatever one thinks of the merits of that criticism, I can assure lay readers (like myself) that this book is relatable and compelling to a broad audience of academics, public intellectuals and policymakers. Bisaillon has a flare for writing about the everyday and a command of language that brings the reader into the nitty gritty of her project from start to finish. The ethnographic analysis is brought to life via the standpoints of the author and the central characters as well as by the integration of documents and texts that undergird the immigration process. As Bisaillon points out early on, the federal immigration system is a major social institution in Canada, yet it often escapes our notice. We know it’s there, but not how it works. Most of us have relatively little understanding of how this system operates on a daily basis, at least compared to other major social institutions like health care, education and the legal system. The institutional analysis at the heart of this book brings to light the legacy of a macro policy change that now impacts the lives and livelihoods of some of the most marginalised and vulnerable people applying to become Canadians. Relatedly, a second strength of the book is the narrative structure that brings to life the immigration system as a social institution through the experiences of Marta and Dr. Meron. Showing the many entanglements and frustrations of the central social actors and their everyday experiences in the immigration system—both navigating and reifying it—is where this ethnographic study is at its strongest. The book is so wonderfully written here, that it is almost as though one is reading a novel at times. Marta is particularly compelling as her voice and her accounts represent the experiences of countless others and cannot simply be dismissed as an outlier. Dr. Meron is more of a foil, though also a sympathetic character to the extent that his everyday medical practices have been appropriated and distorted to facilitate detached macro decision-making processes for which he is at times ambivalent. As a gay man who not so long ago navigated the very system that is on display in this book, I was struck by how Marta’s experiences brought back the vivid memories, concerns and anxieties about health and HIV that I too experienced on my journey to Canada. This book is ideal for upper division undergraduate and graduate courses in sociology, health and health care, migration and immigration politics, HIV/AIDS studies and public health to name a few. This review would be remiss if it didn’t mention that this book pulls at the heartstrings and will definitely stir up emotions. Don’t be surprised if at a couple points Martha’s recollections of the injustices and indignities that she has experienced bring you to tears—as they should. I can see why Bisaillon’s work is winning so many awards.

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