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
"Some immigrants that have come of age in the U.S. but have been working have probably missed some of these prevention education campaigns because of language and educational issues."
Olivia Ford: The condoms as evidence discussion definitely has bearing on prevention efforts in impacted communities, including immigrant communities, but we haven't talked much about prevention programs in this conversation. Dr. Ojeda, have you witnessed any effective programs around prevention services in immigrant communities in your area?
Victoria Ojeda: One thing that we're seeing, and that has been documented in the literature as well, is just the acceptability of doing HIV testing door-to-door in immigrant communities in order to increase access to this particular service. That has been shown to be acceptable in many communities throughout the U.S. So I think that's certainly something that could be explored a little bit more broadly, so that you could link folks to care in a more timely fashion, and also conduct more intervention and prevention services for partners. I think that's one aspect.
Making greater access to needle exchange programs for injection drug using persons would certainly be another mechanism to reduce infection. To the extent that people feel comfortable and know where those programs are, and that language barriers aren't an issue, I think it would be important for immigrant communities.
One of the things that we've seen in the population that we work with in Mexico is relatively low levels of literacy and educational attainment. And that's certainly correlative with poor or lower knowledge about HIV transmission mechanisms. One of the conclusions that we've come to in our studies is that some immigrants that have come of age in the U.S. but have been working have probably missed some of these prevention education campaigns because of language and educational issues. Facilitating access to HIV prevention information for some groups of immigrants would, I think, certainly be important. Because they probably didn't get it when they left their home country; and they're probably not going to get it in the U.S. unless more concerted efforts are made.
Olivia Ford: A number of statements have come up throughout this conversation about the importance of knowing one's rights as an immigrant to the U.S. If you had just a moment to share with a wide range of people a couple of general things that someone ought to know as a person living with HIV and desiring to enter the U.S., what would you suggest that they know?
N. Ordover: Well, I might want them to know Cristina's number.
Victoria Ojeda: I was going to refer them all to you!
Cristina Velez: HIV continues to play a different role in adjudications from outside the United States. And although it may not come up in every case, it is possible that it may come up. The medical exam that's required for immigrant visas no longer includes an HIV test. So that's very important for people to know -- is that they will not be tested for HIV. If they haven't been already, they won't be tested at the point at which they are applying for an immigrant visa to the United States.
If they are aware that they are HIV positive and they report that as part of their medical history, then it may be in the notes attached to the medical exam that are forwarded to the consulate, where the visa is adjudicated. And at the visa interview they may be asked more questions than other people who are not HIV positive about their ability to afford medical care in the United States. Where a person's HIV-positive status is known by the consulate, there is guidance that is still instructing them to inquire into the person's financial ability to pay for care for themselves. That's a problem that I think we're going to start seeing movement around in the immigration advocacy community; now that DOMA is a thing of the past, I think this is going to come up more and more.
N. Ordover: I'd just like to say, in terms of DOMA being a thing of the past: When we started the Coalition to Lift the Bar, there was a member organization that wanted us to focus on what was then the United American Families Act -- so that if you had a lover who was a U.S. citizen, they could sponsor you. But the Coalition actually took the position that rights and access shouldn't be based on relationship status, for a whole number of reasons.
One of those reasons was that we thought that was a little tenuous to base rights on, as we probably all know from our relationship histories; but another was that about 80 percent of the folks who came through the doors of the member organizations of the Coalition were single, whether they were gay or straight -- so, no spouse, no boyfriend, no girlfriend, no lover. So I think it will be interesting to see what happens now that DOMA's gone, if it's really making a dent in our communities -- because that's certainly not what we saw before.
Cristina Velez: That's interesting. I was thinking more from an advocacy perspective, that there's room for that to come up again now that DOMA is out. And I think people are interested in addressing it. I put a question out on my gay and lesbian immigration listserv, and got some responses. People are interested in addressing this. So, hopefully, we'll see that happen. Hopefully, we'll make it happen.
Victoria Ojeda: I'm thinking about, if a person's coming here, and let's just say that they're not HIV positive, but they have an experience that maybe elevates their risk for HIV, I would think that having access to HIV testing would be something that we would want people to know about. I don't know the ins and outs of access to HIV testing in, let's say, community clinics or for low-resource persons, or people that are not permanent U.S. residents. But I'm wondering if making that knowledge available, about resources and how to access those resources, is something that also could be contemplated.
"If folks are really serious about, not just defending, but expanding the rights of people living with HIV and AIDS, we're going to have to get actively, aggressively on board with some pretty serious immigrant justice work."
Cristina Velez: Yeah. There's a group of individuals that I've worked with who are now at Housing Works, who entered the U.S. for the International AIDS Conference in Washington, D.C., in 2012. They have since become asylees. And some other people, who are also asylees, have become interested in developing a resource network for new arrivals, to maybe help connect people with care and connect people with resources. That's been a nice thing to see: people who have made it through the process, helping those who come next.
But I think you're right. They've identified that there is a gap that needs filling.
N. Ordover: This has been great for me, to be part of this conversation with all of you. But I just want to say -- and this is going out particularly to the readership of TheBody.com: If folks are really serious about, not just defending, but expanding the rights of people living with HIV and AIDS, we're going to have to get actively, aggressively on board with some serious immigrant justice work. And we're going to have to get on board with fighting for some very deep structural change. None of this is going to go where we want it to go while the infrastructure that promotes such a dangerous environment for immigrants is in place.
This transcript has been edited for clarity.
Olivia Ford is the executive editor for TheBody.com and TheBodyPRO.com.
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