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After the Entry Ban, Why Danger Persists for Immigrants Living With HIV in the U.S.

Veteran Advocates Agree, HIV May Not Be an Immigrant's Biggest Problem Anymore

December 18, 2013

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Before and After the Entry Ban

Olivia Ford: When people think of immigration, HIV and the U.S., oftentimes the most present image in their mind is the decades-old "travel ban" barring people living with HIV from entering the country, which was lifted in 2009. Could you paint a picture for readers of the life of a person living with HIV and desiring to enter the U.S., whether to visit or to live, both before and after the travel ban was lifted? What changes did the lifting of the ban bring about?

N. Ordover: The first thing that I'd like to do is to replace travel ban with different verbiage. This is something that the Coalition to Lift the Bar actually worked very hard to do on a national level. The problem with using the term "travel ban" is that it actually erased the policy's most vulnerable victims, which were immigrants and other mobile populations. It kind of made it sound like, Oh, people can't come for a vacation to the United States. And what it meant in reality was that people with HIV weren't permitted to enter the United States. If they did manage to enter the United States, or were here and then seroconverted, they had difficulty entering the workforce, accessing the health care system -- all these barriers that arose because they were not able to adjust their immigration status, and then, obviously, could not fully access any sort of housing or welfare benefits that they needed, and just couldn't participate fully in civic life.

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Even for travelers, calling it a "travel ban" minimized the impact. There were some folks who were able to visit the United States on short-term visas under the ban. They could be in the U.S., usually for 30 days or less, if they were able to get a special waiver, which was not that easy to get. But what happened then was that their passports were stamped. This was a mark of inadmissibility that was visible at every port of entry they subsequently went through anywhere in the world.

It was never a matter of vacation plans thrown off course, but something that was an invasion of privacy and placed people, even travelers, in very serious jeopardy. We actually fought very hard to get the words entry ban used instead.

Again, if a person was afraid they weren't going to be able to get into the country, they might choose to travel without their HIV meds so as not to be stopped with them at customs and potentially get turned around. And then folks who were living here, because they couldn't get public benefits, often wouldn't seek out any type of medical care and oftentimes ended up in emergency rooms with AIDS diagnoses when their HIV did not necessarily need to progress to that point.

We saw all different kinds of folks encountering this, in all different kinds of ways, from folks having difficulty with adoption proceedings to people not being able to get asylum claims through. We did a story-collecting project, and one of the stories that I used to tell was of a young man named Victor (not his real name). He left his home in Guyana; he was being physically abused there. When he was a teenager, his mother helped him get to the United States. When he got to Miami, he was held at the Krome detention center [Krome Service Processing Center] for months and months and months, which was a standard practice for people coming from Guyana without paperwork.

He was granted a credible fear interview. The immigration officer did believe that he would be killed if he returned home. He was released into the custody of relatives; he moved in with his aunt and uncle in the Bronx. He became extremely ill. He went to the ER. He was hospitalized for weeks. He was tested for HIV; the test came back positive. But he had waited so long that he had progressed to an AIDS diagnosis.

When his aunt and uncle heard his diagnosis, they threw him out. He couldn't get stable housing or care, because he did not have a recognizable legal status. He couldn't access Medicaid. He couldn't get food assistance. He couldn't go back to Guyana, because he would be killed -- either by his father or by AIDS complications, because the HIV treatment regimen available there was not quite adequate at the time. Ultimately, his housing situation exacerbated his health crisis and he died in 2003, at St. Vincent's Hospital. He was 23 years old.

This is not an atypical story.

Since the ban has been lifted, we're seeing immigrants with HIV, and HIV is maybe not their biggest problem anymore. The repeal of the entry bar was an island of redress in this sea of brutality and human rights violations against immigrants in the U.S. As long as we have a climate that's dangerous for immigrants, it's going to be dangerous for immigrants with HIV.

"We see so many people living with HIV, or people who are at risk of becoming HIV positive, also overlap with other very vulnerable populations that are often targeted by the immigration enforcement system." -- Cristina Velez

Cristina Velez: I really want to emphasize that point that you just made, Dr. Ordover, about HIV not necessarily being the biggest barrier to full social integration for immigrants living with HIV at this point in time. We see so many people living with HIV, or people who are at risk of becoming HIV positive, also overlap with other very vulnerable populations that are often targeted by the immigration enforcement system, or find themselves caught up in it in some way and are seriously disadvantaged by some of the policies that have been adopted to deal with undocumented people in the United States. That, of course, exacerbates their vulnerabilities and causes problems with treatments. That's definitely what I'm seeing.

Victoria Ojeda: I wanted to reaffirm what you've both said. One of the issues that we're seeing in Mexico with some folks that have gotten deported is that they've had social situations in the U.S. that they've been unable to address. For example, onset of drug abuse that progresses to drug addiction and leads to unraveling of people's lives. And then, the lack of access to care and drug treatment services has further exacerbated their situation to the point where people are then getting involved in the criminal justice system, and then being deported.

One thing we're not sure of with the male deportees that we're seeing in Tijuana, in Mexico, is whether they're becoming HIV positive in Mexico, or finally being tested in Mexico after becoming HIV positive while in the U.S. But certainly, circumstances for immigrants in the U.S. haven't helped their situation, in terms of lack of access to timely and affordable health services and interventions that would potentially offset some of the health risks following their deportation.

Cristina Velez: And I think that, for some long-term undocumented residents of the United States, the over-20-year existence of the HIV entry ban had a very negative effect in that it really pushed people underground, especially members of the LGBT population. For that period, those residents weren't able to get relief from whatever vulnerabilities they were experiencing otherwise, due to not having access to immigration benefits because of their HIV status. We know that, for many people who are here without solid immigration status, that in and of itself will open so many doors and allow them to develop the kind of stability that they simply cannot [achieve] without it.

N. Ordover: I don't want to at all understate what the repeal of that ban has meant, but the follow-up has not been what I think a lot of us would have liked to have seen.

It was so critical to overturn that policy; and it took a couple of steps, because it was legislative and it was administrative, and we had to deal with both components. But the infrastructure remains in place: The Patriot Act, the Homeland Security Act, the Illegal Immigration Reform and Immigrant Responsibility Act, welfare reform -- all those things still present a serious barrier. And the onus has fallen, as it always does, on marginalized and vulnerable people to know their own rights. Because I am convinced that there are still people out there who are underground, because they don't understand that the ban has been lifted, or they may be too afraid to sort of poke their head out.

"Why would you ever think that something that could get you killed in your country of origin would be something that you would want to proclaim, that could give you haven somewhere else?" -- N. Ordover

One thing we saw even when the ban was in place was that fears around encountering violence -- either state-sponsored or not being able to be protected by the state from violence, based on your HIV status or, in some cases, your sexual orientation -- were grounds for asylum. But because the asylum laws put up such a small window of when one can apply for asylum, a lot of LGBT folks and folks living with HIV didn't try to apply for that. Because why would you ever think that something that could get you killed in your country of origin would be something that you would want to proclaim, that could give you haven somewhere else?

Cristina Velez: When talking about the effect of the entry ban on long-term residency, we also should consider the fact that this ban overlapped with the Defense of Marriage Act (DOMA), which has been ruled unconstitutional, and the institution of the one-year asylum deadline, which is still with us. All these measures acted directly upon members of the LGBT population, in particular those immigrants who were not clued into the asylum process. Unfortunately, ignorance of the law -- not knowing before the deadline that you could have filed an application for asylum -- is no excuse in asylum proceedings. So that, along with having tremendous fear of the immigration authorities to begin with because of the HIV ban -- and not being able to regularize your immigration status by marrying a U.S. citizen, which so many heterosexual or opposite-sex couples could do who were in the same situation -- all of these things combine to further marginalize the people that we're talking about.

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