Comment on Proposed Rule: “Medical Examination of Aliens – Removal of Human Immunodeficiency Virus (HIV) infection from List of Communicable Diseases of Public Health Significance.”

Prepared for the Federal Register

By Jon Feere on July 21, 2009

Comment on Proposed Rule: “Medical Examination of Aliens – Removal of Human Immunodeficiency Virus (HIV) infection from List of Communicable Diseases of Public Health Significance.”
Docket ID: CDC-2008-0001
Document ID: CDC-2008-0001-0001

Removal of Human Immunodeficiency Virus (HIV) infection from the list of communicable diseases of public health significance will increase HIV cases in the United States. Proposed Rule 42 CFR 34 is a step backward on national security and health security.

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 (HHS)) 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).

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.1 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.2,3 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.4 The epidemic is growing most rapidly among minority populations and is a leading killer of African-American males ages 25 to 44.5 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 HHS drops HIV from the list. 6

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?”

With rising costs of health care being a heated political issue this year, a discussion of how this policy change may increase the burden on our health care system seems necessary.

None of these concerns have been addressed by supporters of the Proposed Rule. The United States reportedly has the highest prevalence of HIV infection of any developed country.7 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.