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

Contributing Editor
Cristina Velez
Victoria Ojeda Cristina Velez

As we move into the fifth year without the decades-old U.S. ban on entry and immigration for people living with HIV -- and enact visions of a country free of the Defense of Marriage Act -- what has changed for HIV-positive immigrants living with HIV, or vulnerable to becoming HIV positive, in the U.S.? "As long as we have a climate that's dangerous for immigrants," remarks longtime immigration justice advocate Dr. N. Ordover, "it's going to be dangerous for immigrants with HIV." caught up with three experts working in different areas of immigration and HIV, to map from multiple angles the current HIV landscape for immigrants in the U.S. Victoria Ojeda, Ph.D., of the University of California - San Diego School of Medicine, has researched immigrant health issues in the U.S. for 15 years, the last eight in Mexico working on issues of deportee health and HIV vulnerability; N. Ordover, Ph.D., was a founder and leader of the Coalition to Lift the Bar -- an alliance of HIV, immigrant, human rights, and LGBTQ service and advocacy organizations and individuals living with HIV, which successfully campaigned to overturn the HIV entry ban -- and a member of UNAIDS' international team convened to address the issue of bans on entry and residence among people with HIV worldwide; and Cristina Velez is the supervising attorney in the immigration practice at HIV Law Project in New York City, which recently merged with Housing Works to become the largest legal service provider for people living with HIV in the New York area.

Table of Contents

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.

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.

Immigration Status and Access to Care

Olivia Ford: Can you all elaborate a bit on some ways that not having a solid immigration status affects access to HIV care and services? I know that access tends to vary depending on what area of the country a person is in.

Cristina Velez: From my experience in New York City, I do find that it's somewhat of a safe haven for undocumented people living with HIV in that, for the most part, they can at least obtain access to antiretroviral medication and primary care related to their HIV. With the public hospitals that provide HIV clinical care in the New York area, I see a lot of undocumented immigrants who are able to at least have their basic medical needs met, in that regard.

The problem arises when they have medical needs that are considered to be unrelated to their HIV, although that may be debatable in some circles. If the AIDS Drug Assistance Program considers them to be unrelated medical problems, then they will not cover care for those conditions, and that can put some immigrants in a very precarious position, as far as their health.

Many undocumented people are also in need of emergency housing assistance and, especially with the economy the way it's been the last few years, have also required cash assistance and food assistance just to get by. It's much more difficult for undocumented people to access those kinds of services. And so, we're seeing the gap grow larger between immigrants who can qualify for those additional services and those who cannot.

I can't speak to all the policy issues that have created this gap in services and care, but I can say that it's very difficult to see, from my vantage point, being involved in direct services and feeling like there is really a limited amount that I can do to help them bridge this gap.

N. Ordover: I just want to echo that, and underline how critical stable housing is to maintaining your health -- anyone's health, but especially folks who have ongoing issues like HIV. And New York is not a very hospitable place to try and find housing if you don't have some pretty serious means.

For folks outside of New York, you may know that we are about to get a new mayor. And in our outgoing mayor's term, he managed to rezone about 37 percent of the city. We're at this place where the power of real estate is hampering what were already some meager housing options for low- and no-income folks. Add to that an immigration status that is not recognized, and it's very difficult to get yourself in a situation where you can stay healthy.

Victoria Ojeda: From the perspective of the border region, there are community health clinics that are providing HIV care to the undocumented community, certainly. But one of the issues that we're facing here on the border is that, as folks get repatriated to Mexico, there's a disconnect in their treatment. Sometimes people are sent to immigration facilities while they're waiting to be repatriated, and they don't have access to their medications. And sometimes they're returned to Mexico without any medications, or without any documentation indicating that they're HIV positive, which also makes it difficult for them to get linked to HIV care.

"One of the concerns from a binational perspective is that the fact that folks are having a hard time accessing care, both in the U.S. and then subsequently in Mexico, means their health is deteriorating." \-- Victoria Ojeda

One of the concerns from a binational perspective is that the fact that folks are having a hard time accessing care, both in the U.S. and then subsequently in Mexico, means their health is deteriorating. But a lot of these folks have, certainly, an intention of returning to the U.S. -- whether it's for economic reasons or because they're separated from their families. So, ideally, what we would like to see is some mechanism to facilitate linkages to HIV care, once folks are repatriated -- so that their health does not deteriorate, but also to prevent ongoing transmission and just protect their health and that of their intimate partners and other contacts. And that has not been very easy to do.

One of the things that we're trying to do through the University of California - San Diego, in partnership with the Autonomous University of Baja California, is through a student-run free clinic. We have over 1,200 patients that have been attending this free clinic in the last two years. And we have an HIV telemedicine service, so that we are linked with the state of Baja California's HIV/AIDS program. About half of our patient population is made up of deportees from the U.S., so for those that are HIV positive, what we're trying to do is promote exactly this linkage to HIV care and whatever other services. Because not only are they coming back to a city, and maybe a country, that they don't recognize, but housing and financial instability are huge issues, as has been mentioned previously. Those are, all three, major concerns for deportees. So, on both sides, we see that it's a worthwhile investment for both countries to make, to promote access to HIV care for this population.

Olivia Ford: Can you talk about what repatriation processes can look like, what they may entail, from the perspectives of your respective work?

N. Ordover: I do want to say that we're in a situation now where there are institutions, like hospitals, who are taking some extralegal initiative, we could say, to "repatriate" immigrants who are uninsured, whether they're documented or not.

I don't think there's a formal process, just because it is extralegal. And I certainly don't want to make it sound like this is happening in enormous numbers. But I will say that every once in awhile an email report comes through my inbox of a hospital that has transported one of their patients from the U.S. out of the U.S. -- usually at the Mexican border. And when we're talking about folks who don't have a lot of means and maybe already don't feel so entitled, their legal rights may not matter in the eyes of the institution, right, if they don't have the means and the power to exercise them? So this is a problem.

There are also some real language issues that are hampering folks' ability to exercise their rights. There is a belief that there are always translation services and interpretation services. That's not true. We've all heard stories of folks where there was nobody who spoke their language: They may be from Mexico, but their first language was not Spanish and they are in places in the U.S. where there aren't other folks who can help them understand.

Be they by-the-book or extrajuridical procedures and processes, nobody is really falling over themselves to make sure that folks know their rights and can access them. That's, I think, a lot of what we're seeing, and what we're going to continue to see.

Cristina Velez: From what I understand about the medical repatriation problem, it is quite varied across different jurisdictions. I've heard a lot of different horror stories about people -- not necessarily people who are HIV positive, but people who are incapacitated in some way, either through a workplace accident or some other kind of sudden event that may leave them unconscious for a long period of time, or unable to express themselves. These are people who may be eligible for relief from removal, but who don't know that -- or their families are unable to get them legal assistance in time.

The hospitals have been moving pretty quickly to send people back, once it's determined that there's no financial coverage for their care -- rather than wait for them to have their rights evaluated by a competent person, and the steps to be taken to get them immigration status that would make them eligible for coverage, and also allow them to continue living in the United States.

Even if it's an extrajudicial removal, once they are removed from the United States, there are immigration penalties that they incur that make it very difficult for them to come back to the United States, even if they are eligible for relief.

When we see people who are marginalized in such a way, as a legal services office, one of the things that we do is we conduct a really thorough immigration intake for them. And sometimes we discover that they're eligible for a form of relief that they are unaware of, such as the U Visa, for example, that they would never have approached an attorney to ask for. It's so important that there is some kind of intervention for people who are in danger of being repatriated without consent.

Victoria Ojeda: There are a couple of different mechanisms for getting returned to your country of origin. And it's not entirely clear to all of the people that are undergoing the process. Sometimes, people are signing documents, legal documents that will bar them from reentry from the U.S. And sometimes they go before a judge. It's a convoluted procedure that is not necessarily transparent to the immigrants themselves. That has serious implications for their abilities to return and, again, to reestablish their lives here, if that were a possibility. Sometimes they are waiving that right. That certainly could have important health consequences for those that are living with HIV.

Immigration and HIV Criminalization

"In some circumstances, HIV can be an enormously sympathetic factor for someone's case. And in other circumstances ... it's the basis, essentially, for finding that someone should be removed to another country." \-- Cristina Velez

Olivia Ford: I wonder if we could talk about instances in which immigration status has interacted with other modes of criminalization of HIV status. This question comes directly out of reading about In the Matter of Ramirez, a case involving enhanced sentencing based on HIV status in which immigration status was also a factor. I know you were involved with that case, Cristina; would you like to start?

Cristina Velez: Sure. That was a case that HIV Law Project worked on with the Public Law Center, which provided the primary counsel for this individual. Scott Schoettes from Lambda Legal, and Alison Yager from my office, and I joined to draft an amicus brief that was actually on behalf of many AIDS service organizations, that addressed the specific science related to HIV transmission, and the particular circumstances of the case, which happened to be oral sex.

It's funny, because in some circumstances, HIV can be an enormously sympathetic factor for someone's case. And in other circumstances, such as those that came up in Ramirez, it's the basis, essentially, for finding that someone should be removed to another country.

So, In the Matter of Ramirez, the client was a gay man from Mexico who had already previously been granted withholding of removal, based on some horrific persecution that he had suffered there at the hands of authorities. He was called back into immigration court following his prosecution for prostitution, which included an enhancement under California's HIV criminalization law. Specifically, what happened was that this was a man who had struggled for many years with a mental illness, substance abuse and addiction, had fallen on some very hard times and relapsed into some of these behaviors, and had been picked up for prostitution by an undercover police officer who solicited him for oral sex and then discussed using condoms with him. And so the act was never completed.

Our client, who had apparently agreed to purchase condoms and use them, was arrested for prostitution and was given an enhancement for being HIV positive -- which is sort of a separate matter, in that it was unusual for the California HIV criminalization statute to be applied in a case like his, but nevertheless, it was. The Department of Homeland Security called him back into immigration court -- this is years after he had been granted relief. They sought to terminate his relief and forcibly remove him to Mexico. The argument was that this recent prostitution offense was a "particularly serious crime" -- which is a term of art that, in practice, means that the circumstances of the offense make a person a danger to the community.

And in finding that he was, in fact, a danger to the community, and had committed a particularly serious crime, the immigration judge revealed -- according to us -- a very stunning lack of knowledge regarding HIV transmission methods, and course treatments. Her decision really emphasized the chance for onward transmission to others, and held Mr. Ramirez responsible for that onward transmission.

So we found that this decision was a very dangerous decision, even though it didn't have precedential value. At the time that the decision came down, Mr. Ramirez also lacked legal counsel. Munmeeth Soni of the Public Law Center, who was representing him at the appeal stage, stepped in after this decision had been completed. It showed the confluence of factors that can really disadvantage immigrants with HIV from getting fair hearings in the immigration world. And he was in detention during all this time.

We submitted this amicus brief that addressed really specifically the science behind the judge's decision, and demonstrated that her decision was based on faulty assumptions and faulty information. I believe the Department of Homeland Security had submitted evidence that had been superseded, also. The amicus brief, which was lengthy and very detailed, also countered some of the assumptions that she used in making her decision, but was really mostly dispassionately based on science.

I'm glad to say we were very successful. After the submission of the amicus brief, the Department of Homeland Security followed up with a motion to remand the case back to the immigration court, so that the judge could reverse her decision. They decided to step down and essentially withdraw their argument that Mr. Ramirez had committed a "particularly serious crime."

N. Ordover: End-to-end, how many years was Mr. Ramirez tangled up in this convergence, would you say?

Cristina Velez: Mr. Ramirez was arrested in 2009 after becoming homeless following the loss of his job and the dissolution of his long-term relationship. He was sentenced to 16 months in prison, which is very long for this offense, but it's because of the enhancement, I believe. In May 2012, the Department of Homeland Security moved to reopen his removal proceedings before the immigration court, arguing that his most recent conviction was a "particularly serious crime" sufficient to terminate his grant of withholding of removal (a form of humanitarian relief -- like asylum, but with a higher burden of proof and fewer benefits). They detained him and it wasn't until sometime around June 2013 that the immigration court terminated the proceedings and restored his immigration status.

N. Ordover: Even though, as you say, it had a good outcome, it's still so, so brutal, in and of itself. I always think about all the things it hits up against: the whole tangle of our incredibly brutal immigration laws, and the treachery of them; but also the criminalization of transmission statutes, which are so hard to deal with in the U.S. In a place like Norway, for example, criminalization of HIV exposure is covered by one national law, and advocates are just trying to get that one law repealed. In the U.S., it may or may not exist, depending on where you are. It lives in a lot of different local statutes. It's so hard to get our arms around.

And the other thing, too, is the way that condoms are being used as evidence of prostitution. It's something that's come up a lot around the stop-and-frisk practice and conversation that's happened in New York. It's something that trans women of color in particular in the city have been harassed with -- the mere possession of condoms.

Here's a case where it's all coming together. It's this perfect storm, but also indicates all these directions that we need to focus on, discretely but also together, to really try to take them on at a structural level.

Cristina Velez: I remember talking to Ramirez's attorney when I was working on the amicus brief, and hearing how overwhelmed her office was with the number of transgender people in detention -- that they could not possibly represent them all. And they were placed in a detention center that was far away from other legal services. You talk about a perfect storm: Just simple access to counsel issues are a really key aspect of that, unfortunately.

N. Ordover: The Victoria Arellano case a few years ago [in which a young transgender Mexican woman living with HIV was detained and eventually died in an immigration detention center after being denied HIV care] was a really good -- and by good, I mean horrible -- illustration of all of this and where it ultimately leads, or can lead.

Olivia Ford: The Ramirez case, and the use of condoms as evidence of prostitution, are all compounded by -- or, really, derived from -- the criminalization of sex work itself.

N. Ordover: This criminalization impoverishes our movements, and our communities. In the LGBTQ community, although not only in the LGBT community, we have a lot of community members who are sex workers, or former sex workers, who maybe have some criminal convictions, who've used drugs, and all of these folks are currently barred from entering the U.S. or adjusting their immigration status once they're here. So there are more bans yet to be dismantled.

I'm sure I'm not the only one in this conversation who could think of many people who fit into those categories who have done an enormous amount of work, and have been leaders in immigrant justice movements and in the HIV/AIDS movement.

So, by either pushing them underground or detaining and deporting them, or not letting them into the U.S. in the first place, it's not only their human rights and their health that we're putting at risk, we're actually impoverishing our own communities.

In the heady days after the HIV entry ban was repealed, the International AIDS Society rushed to have the International AIDS Conference, which is held every two years, in the United States, where it hadn't been because of the ban for many, many years. There were many of us, including some of us who had worked very hard on lifting the HIV entry ban and were very happy that it got lifted, who really tried to make the case that it should not be in the U.S. while these other bans were intact. Obviously, we lost that one.

Access to Testing and Prevention Education

"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." \-- Victoria Ojeda

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.

Conclusions: Knowing Your Rights -- and Fighting for Rights

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." \-- N. Ordover

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 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 and