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The Real Costs of the HIV Ban [18 May, 2009]

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Originally posted on Queercents.com.  Read comments here.

This is Part 2 of a series on immigration.  It looks at the real costs of the HIV ban, in place since 1987, and provides a brief look at the history and implications of this policy.

Readers of Queercents might remember that my last post here engendered some intense, ah, discussion and led to several charges of censorship.  I’ve posted a piece about what happened on Bilerico, and you can find that here, in a piece entitled “”Yasmin Nair: Eat This!” Or, How to Leave Comments Without Going up In Flames.” Those interested in UAFA should know that I’ll also be resurrecting that piece on Bilerico in the next couple of days.

Since 1987, the United States has banned HIV-positive immigrants (non-citizens already in the country, who might be seeking permanent residency) and travelers from the country.  The reasons for the ban are rooted in a potent combination of homophobia and xenophobia, and it places the United States in a list of only 14 countries, including China, Saudi Arabia, Moldova, and Russia that have a similar bar in place.  The bar may be lifted for individuals but only in very narrow cases, and may require the support of an employer or family member, both of which can be difficult to get.

The 1952 Immigration and Nationality Act (INA) stated 31 grounds for exclusion, including a bar against the admission of aliens infected with “any dangerous contagious disease.” In 1987, the CDC added HIV to that list.  The implementation of the bar was based on two rationales that have both proven baseless.  One is the public health rationale, and the other is that allowing HIV-positive immigrants into the country increases the burden on public health resources.

The public health rationale, that allowing HIV-positive immigrants to enter the country will result in untold and hapless numbers of citizens being infected, is based on ignorance and hysteria.  As any schoolchild will (hopefully) be able to tell you, AIDS is not like tuberculosis, which can be transmitted through the air.  It requires sexual contact.  So the supposition that AIDS will infect U.S citizens is based on the idea that hordes of HIV-positive immigrants are entering the country with the explicit agenda of having unprotected sex with our citizenry.  This ignores several realities, not the least of which is the aforementioned issue of the exact workings of the virus.  The other reality is that, in fact, several HIV-positive immigrants are infected once they enter the United States.  Pretending that AIDS can only enter from the outside through the bodies of dangerous immigrants feeds into the mythology of AIDS as an omniscient and deadly disease when it is, in fact, both manageable and treatable.  It also allows the state to absolve itself of its duty towards those who live here – which is to educate, through sensible AIDS prevention strategies in places like high schools, and to provide health care with the necessary medication and treatment options for those already infected.

The second rationale is the idea that HIV-positive immigrants will become a drain on health resources.  But we don’t have the best health care resources even for citizens in the first place.  And not allowing HIV-positive immigrants to live openly with a condition that’s otherwise manageable and treatable only compounds health issues for them and, potentially, for the larger public.

Here’s why: with the bar in place, HIV-positive immigrants are faced with the possibility of returning to their country of origin, where they might not have access to the kinds of treatments available in the United States (and that’s if they have decent health care to begin with).  It’s also likely that their countries of origin are particularly hostile to people with HIV and where they might be greeted with violence or worse on account of their condition.  The third possibility is simply that an immigrant might have formed attachments and bonds in the United States such that he or she now claims this as the home country.  In which case, faced with the possibility of being denied permanent residency/citizenship, the immigrant might be compelled to simply go underground and live as an undocumented person.  Such is the case of Paolo (not his real name), who came here as a student, found himself HIV-positive after a few years, and eventually disappeared to live an undocumented life.

The GMHC report Undermining Public Health and Human Rights: The United States HIV travel and immigration ban states that, in New York, “foreign-born individuals from nearly every region of the globe are more likely (32%) to be diagnosed with both HIV and AIDS than their native born counterparts (24%).” But the report cautions that this is not a case of foreign citizens being inherently more apt to bring AIDS to the country or willfully infecting citizens, but, rather, “a marker of both late testing and diagnosis.”

The problem for people like Paolo is that they’re least likely to have access to health care that can provide them with the treatment options they need.  Illinois is one of the states that does provide care to undocumented people without probing into their status, but that’s an exception.  And even in Illinois, a lot of people aren’t aware that they can access such care.  This means that we, in essence, compel undocumented and HIV-positive people to live in conditions where they either can not or will not seek treatment and counseling.  And they’re also most likely to engage in risky sexual behavior as they attempt to eke out their livings in, for instance, underground street economies.

So, far from reducing the burden on a public health care system, the HIV bar actually increases that burden and creates an entirely new group of undocumented people.  There’s another economic cost that comes with the creation of this group: people in such vulnerable situations, who are afraid of being outed as HIV-positive, as undocumented and, possibly, as gay/lesbian, are also among the most vulnerable workers in the sprawling informal/shadow economy.  They are most likely to end up with highly exploitative bosses.  Even if not faced with unscrupulous employers, they’re not able to overtly resist exploitative labor conditions and unfair wages.  None of this is good for labor organizing, for undocumented immigrants, or for our cities and towns in general.

As for the actual cost involved in keeping out HIV-positive immigrants? According to a Gay Men’s Health Crisis report, “Studies of the WHO (1987) estimate that costs of setting up screening and testing procedures for all ports of entry (air, sea and land)—including the costs of testing, the cost of personnel and resources required to establish, maintain and monitor the screening activity, and the cost of the necessary infrastructure—amounts to about $20 per traveler screened.  In the United States, we are spending about $10 million a year to exclude approximately 500 aliens.”

All of which is to say: the real cost of the HIV ban lies in its very existence.  It’s a shameful reminder of our homophobia and xenophobia, and it’s time that we moved forward into the 21st century and took it off the books.

The statutory HIV ban was lifted by Congress and George Bush in July 2008.  But HHS still needs to lift HIV from a list of communicable diseases.  Until that happens, travelers to the United States and immigrants within the country face being barred outright or being denied access to the treatment and care that could help keep them alive.

*Added May 22: Serena asked, in the comments section, why HHS has still not lifted HIV from the list.  That’s a great question; I’ve always assumed it was typical bureaucratic slowness combined with xenophobia and an utterly irrational and unfounded fear of HIV.  But, I wondered, might there be some kind of rationale offered by HHS? I put that question to a couple of experts.  I’m waiting to hear from one, but in the meantime here’s what Jim Pickett, of the AIDS Foundation of Chicago, has to say: “There is no good reason, absolutely no science.” I think that sums it up.



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