August 10, 2008

U.S. acts to open borders to foreigners with HIV

Hernán Rozemberg - Express-News

After more than two decades on the books, a little-known yet strictly enforced federal law barring foreigners with HIV or AIDS from entering the country is on its way out.

Tucked in a bill pledging $48 billion to combat the disease, signed into law by President Bush last week, was language stripping the provision from federal immigration law.

But that change didn't fully lift the entry ban on visitors with HIV or AIDS, which applies whether they're on tourist jaunts or seeking longer stays. The secretary of the Department of Health and Human Services still needs to delete HIV from the agency's list of “communicable diseases of public health significance,” which includes tuberculosis, gonorrhea and leprosy.

An HHS spokeswoman declined to comment, noting administrators are still reviewing the new law. An April report from the Congressional Budget Office said that, based on information from HHS' Centers for Disease Control and Prevention, HIV will be dropped from the list and new regulations will be in place in two years.

Both immigrant and HIV awareness advocates, however, say the toughest hurdle has been cleared, that the lifting of the immigration provision has been a long time coming — politics finally catching up with medical knowledge.

“Today everyone knows that you can't get AIDS from sitting next to someone on an airplane or sharing a bathroom — American policy should reflect this,” said Victoria Neilson, legal director of Immigration Equality, a New York-based advocacy group that has led a years-long campaign against the ban.

In San Antonio, people in the HIV/AIDS community welcomed the new law, but noted that plenty of people here had already circumvented the travel ban, since the area has been a long-standing destination for unauthorized immigrants.

Jan Patterson, an infectious disease specialist in San Antonio, agreed that the ban has no scientific underpinning.

When HIV first surfaced, researchers didn't know how it was transmitted, but it has long been widely known that HIV is not easily contracted and that even people with full-blown AIDS can live for a long time, said Patterson, who has taught for 15 years at the University of Texas Health Science Center.

In a speech before signing the law, President Bush emphasized that “HIV's deadly stigma” is still a societal obstacle because patients still don't receive mainstream acceptance.

Congressional support for lifting the travel ban was bipartisan and strong, but not unanimous. Leading the opposition was U.S. Rep. Lamar Smith of San Antonio, the top Republican in the House Judiciary Committee. He sent a missive to his colleagues titled “The bill threatens the health and lives of Americans.”

The e-mail cited the CBO's April report predicting that revoking the travel ban would allow an estimated 4,300 immigrants with HIV to enter the country in 2013, increasing to 5,600 by 2018. Smith's message left out the report's estimate of the public cost of treating these immigrants and their children between 2010 and 2018: $83 million.

Smith warned the disease has killed more than 500,000 Americans despite improved treatment and that allowing infected foreigners in would increase public risk.

The Family Focused AIDS Clinical Treatment and Services, a 2,000-patient clinic in San Antonio, offers services to anyone diagnosed with HIV whether they're in the country legally or not, said its director, Tracy Talley.

So immigrants, particularly from Mexico, have made their way across the border for years just to get treatment unavailable back home, Talley said.

Many of them are referred to the clinic through a nonprofit aid group in San Antonio, Mujeres Unidas Contra el SIDA or United Women Against AIDS. The group's director, Yolanda Rodríguez-Escobar, concurred with Talley that most HIV immigrants here are border-crossers who might never have heard of the travel exclusion.

They'd prefer to enter the country legally for treatment if given the option, said one of them. But in Mexico, the stigma of the disease is so great, those infected have always simply assumed their only immigration option is to go underground, he said.

“Everybody in Mexico knows that if you've got HIV, you might as well forget trying to get papers,” said Antonio, 41, an unauthorized immigrant with HIV in San Antoni.

Howard Wallen of New York tried to get papers to bring his wife into the country from Ethiopia, where he met her in 2002, later marrying her and having a daughter. They soon found out Abeba's HIV status prevented her from coming to the United States with him.

She eventually died from AIDS — an outcome that might have been different had she received therapy in the United States, Wallen said.

“She deserved the dignity of that chance,” he said.

The HIV prohibition issue stretches beyond U.S. borders. The 11,000-member International AIDS Society counts 67 countries restricting the entry or stay of HIV patients.

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Should the Texas State Legislature pass immigration enforcement laws in 2009?