Obama Lifts HIV Immigration Ban

By Jon Feere, November 1, 2009

President Obama has announced the elimination of immigration provisions which ban entry of immigrants with HIV in a move that will undoubtedly increase HIV infection cases in the United States. The background to this change and the Bush Administration’s role was discussed in an earlier Center for Immigration Studies blog.

The Obama Administration's new rule will eliminate a clause in the Immigration & Nationality Act (INA) that denies admission to those with HIV. In 1993, a clause specifically designed to reduce the spread HIV/AIDS into the United States was added to the INA; it was passed by the Senate with a vote of 76 to 23. It reads:

"Any alien who is determined (in accordance with regulations prescribed by the Secretary of Health and Human Services) to have a communicable disease of public health significance, which shall include infection with the etiologic agent for acquired immune deficiency syndrome…is inadmissible." (8 USCS § 1182)

It is the responsibility of the Department of Health and Human Services (HHS) to determine whether a disease qualifies as a "communicable disease of public health significance." By making this change, President Obama has declared that HIV is no longer a communicable disease of public health significance. Politics, it seems, has triumphed over public health.

Currently, HHS lists the following eight diseases as "communicable diseases of public health significance": Tuberculosis, Leprosy, Human Immunodeficiency Virus (HIV), Syphilis, Chancroid, Gonorrhea, Granuloma Inguinale, and Lymphogranuloma Venereum. After the first two on the list, the remainder are all sexually transmitted diseases. Of those, HIV/AIDS is the most deadly; about 16,000 people die of AIDS in the U.S. every year while approximately 56,000 people become newly infected with HIV every year. At the end of 2003, an estimated 1,039,000 to 1,185,000 persons in the United States were living with HIV, with 24 to 27 percent undiagnosed and unaware of their infection. The epidemic is growing most rapidly among minority populations and is a leading killer of African-American males ages 25 to 44. In 2006, the overall rate of HIV diagnosis was at least 18.5 per 100,000. It is likely that this rate will increase as a result of the Obama Administration’s new rule.

But the president did not address this possible fallout. Instead, he trivialized this concern and supplanted science with politics, saying:

"Twenty-two years ago, in a decision rooted in fear rather than fact, the United States instituted a travel ban on entry into the country for people living with HIV/AIDS. Now, we talk about reducing the stigma of this disease -- yet we've treated a visitor living with it as a threat. We lead the world when it comes to helping stem the AIDS pandemic -- yet we are one of only a dozen countries that still bar people from HIV from entering our own country.

"If we want to be the global leader in combating HIV/AIDS, we need to act like it. And that's why, on Monday my administration will publish a final rule that eliminates the travel ban effective just after the New Year. Congress and President Bush began this process last year, and they ought to be commended for it. We are finishing the job. It's a step that will encourage people to get tested and get treatment, it's a step that will keep families together, and it's a step that will save lives."

A number of questions should be asked. How many immigrants with HIV will enter the United States as a result of this policy change? How many new HIV infections will result? What will this cost U.S. taxpayers in medical care? Why is the United States maintaining the travel ban on curable, less-deadly diseases, but opening the door to HIV, if not for political reasons? Will syphilis, gonorrhea, and the other STDs be dropped from the travel ban, and if so, what will this do for infection rates and health care costs?

As I noted in the earlier blog, the United States reportedly has the highest prevalence of HIV infection of any developed country. The Obama Administration's policy change may ensure that the United States keeps that title. In the least, it will reduce the ability of our immigration system to protect Americans from communicable disease.

UPDATE: The Department of Health and Human Services has released its final rule on this matter. In it, HHS explains:

"While HIV infection is a serious health condition, it is not a communicable disease that is a significant public health risk for introduction, transmission, and spread to the U.S. population through casual contact. As a result of this final rule, aliens will no longer be inadmissible into the United States based solely on the ground they are infected with HIV, and they will not be required to undergo HIV testing as part of the required medical examination for U.S. immigration."

HHS also explains that increasing the HIV population through immigration is not a threat because so many people in the United States are already infected:

"An individual infected with HIV will not pose a significant risk to the general U.S. population since HIV infection already exists as an endemic disease...[so] maintaining HIV infection on the list of inadmissible conditions for entry into the U.S. would not result in significant public health benefits. Further, this approach is not in line with current international public health practice."

In response to public concerns that allowing HIV-infected individuals to immigrate might result in costs to our health care system, HHS explains that:

"...these reasons are not part of the scientific criteria used in determining whether HIV infection should be included as a defined communicable disease of public health significance and as a basis for admission to the United States."

Still, HHS did provide some numbers. Based on their estimates, every year anywhere from 1,073 to 6,409 HIV-infected immigrants would be granted legal permanent residency.

Anywhere from 170 to 1,014 people in the United States will become infected as a result of the policy change, costing anywhere from $4 million to $22 million in health care expenditures for this "onward transmission."

Overall, the estimated health care cost of removing HIV from the list of "communicable diseases of public health significance" may range from $19 million to $173 million in the first year alone. HHS explains that this will obviously double the second year as a new wave of immigrants arrives, triple the third year, and so on.

The entire rule and additional HHS analysis is available online.