Under the direction of President Bush, Congress is on the verge of authorizing $48 billion for an AIDS/malaria/tuberculosis program dubbed by the Associated Press as the “most ambitious foreign public health program ever launched by the United States.” Originally launched in 2003, the President’s Emergency Plan for AIDS Relief (PEPFAR) is designed to reduce the spread of infectious diseases throughout the world. It has bipartisan support: Senator Richard Lugar (R-Ind.) said the program “has helped to prevent instability and societal collapse in a number of at-risk countries.” Senator Joe Biden (D-Del.) said the program will “literally save and extend the lives of tens of millions of people.”
It will also increase HIV cases in the United States.
A small provision in the bill 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)
The proposal currently before Congress would eliminate the HIV-specific clause. Elimination of this clause, in turn, would allow the political appointees in Health and Human Services (HHS) to determine whether HIV qualifies as a “communicable disease of public health significance.” This determination would have the potential to change with White House administrations, making HIV immigration issues a political football.
Preventing the entry of aliens with infectious diseases is nothing new. One of the purposes behind an immigration system is to limit the spread of communicable disease. 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 undeniable that this rate will increase if Congress’ proposal is approved and HHS drops HIV from the list.
None of these facts seem to be on the radar of the bill’s supporters. Senator John Kerry (D-Mass.) said he was “proud to have been part of eliminating this draconian ban.” He claimed that passage of the Senate version of the bill puts the U.S. “one step closer to ending a discriminatory practice that stigmatizes all those living with HIV, squanders our moral authority, and sets us back in the fight against AIDS.” The senator didn’t explain how welcoming more HIV to our shores helps the fight against AIDS.
In the early 1990s, many members in Congress supported adding HIV as a grounds for admissibility out of concern for the potential costs to the health care system, a concern that arguably hasn’t abated since the ban’s original inception.
Rep. Gerald Solomon (R-N.Y.) said then, “We have to point out that it costs over $100,000 per year per AIDS patient. I have hospitals in upstate New York, small hospitals that are presently taking care of as many as 300 AIDS patients. Three hundred times $100,000 is backbreaking on that hospital.”
Rep. Marge Roukema (R-N.J.), noting that the U.S. spent more than $2 billion in 1992 on AIDS research and treatment, asked: “How can we add to the burden of health care the expense of treating these HIV-infected immigrants?”
Sen. Ted Kennedy called the concerns about costs to the taxpayer, “hogwash.” He claimed that preventing the spread of HIV into the United States was an example of “gay bashing.”
With rising costs of health care being a heated political issue this year, one wonders how increasing the burden on our health care system is justifiable.
The United States reportedly has the highest prevalence of HIV infection of any developed country. The current proposal will 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.
The bill numbers are S.2731 and H.R.5501.
UPDATE: President Bush signed the bill into law on July 30th. It now falls on HHS to determine whether HIV is a "communicable disease of public health significance."