For Immigrants Living With HIV, an Impossible Choice Between Viral Suppression and Deportation
Somewhere, in the hostility of yet another hot and humid Alabama summer, a 50-year-old grandmother holds her infant grandson to her chest. As she holds him, she sings to him -- in part to suppress his cries for the mother who is not with them and in part to stifle the anxious hum in her head, because she has idea where her daughter is. Until recently, the young boy was being held at a detention facility run by the U.S. Immigration and Customs Enforcement (ICE) agency. In that ICE detention center -- that holding pen of federally sanctioned human suffering -- the boy celebrated his first birthday.
As the grandmother sits there, she prays that her daughter is still being detained in that ICE center. She prays not because anything is worthy of supplication at the center itself but because, if her daughter is still being held there, the hope remains of a reunion and the avoidance of the daughter's return to Honduras, which would amount to a death sentence. The grandmother sits and thinks these unenviable thoughts while she looks over at her dresser and the nearly empty pill bottles that sit there.
Within those translucent, orange-tinted cylinders is her antiretroviral medication. Without it, the grandmother's viral load would skyrocket, her CD4 count would drop, and the microscopic defenses within her body would slowly shut down, leaving her vulnerable to the sorts of opportunistic infections that often claim the lives of those living with HIV. She knows that she must go see her HIV clinician to have her prescriptions refilled and blood tests done, but she is afraid of what might happen. She is afraid that, if she goes, ICE might find out where she lives and takes her grandson away from her forever.
This story, as it was relayed to TheBody by Jean, a Latinx HIV engagement specialist at an AIDS service organization in Alabama, is not unusual in 2018 America. The themes of separation, trauma, and having to decide between one's own health and the safety of those one loves can be found all across the country in immigrant communities from Alabama and Ohio to Los Angeles and New York City. Many came to America as asylees, running from a homeland where their lives were endangered daily by gang violence, domestic abuse, or virulently anti-LGBTQ policies and attitudes. Others simply came to the U.S. in search of the better life that has historically been its promise.
Now, they find themselves stuck between the proverbial rock and a hard place. Do they venture out to their local clinic for the HIV medication they so desperately need -- knowing that doing so could lead ICE not just to their doorstep, but to those of their friends and family -- or do they remove themselves from care and stay in hiding, putting themselves in grave danger in an attempt to avoid deportation? It is an impossible question with no satisfactory answer, made all the worse by the level of engagement and personal pride that is often found among immigrants seeking HIV care in the U.S.
"The majority of our clients are [undetectable], and they are proud of that fact," Jean told TheBody. "They don't want to lose that, but they often feel as if they have no choice. For many of them, being sent home would be a death sentence."
Jesus, an HIV prevention outreach supervisor at an AIDS health care provider in the New York City area, expressed similar sentiments.
"The majority of immigrant patients we see want to be engaged in their health," Jesus said. "These are people who risk everything -- leaving their families and all social support networks and/or fleeing under dangerous physical conditions just to survive, to make a better life for themselves. Sometimes these are LGBTQ people seeking asylum from countries with dangerous anti-LGBTQ policies in place. That's why it's so important to build trust with these communities."
Unfortunately, the Trump administration has thus far done everything in its power to intimidate immigrants so they will ultimately shrink from care, making it impossible for HIV service organizations to build lasting, trusting relationships. To be sure, widespread fear of deportation existed amongst immigrants living with HIV during the Obama and Bush years, but what they are being forced to endure now is far more sinister, as evidenced by the Trump administration's on-again-off-again policy of family separation and the extension of its xenophobic attacks to lawfully residing immigrants.
In California, one survey found that 40% of the state's health care providers reported immigrant families canceling appointments or scheduling fewer visits, while a study of a health care provider network in Colorado showed a staggering 75% of providers reporting increases in appointment no-shows and cancellations by immigrant clients. National level inquiries have returned similar results, such a survey by the Migrant Clinicians Network showing roughly two-in-three heath care providers polled reporting that their clients attitudes and feelings around health care had changed primarily due to the shift in immigration policies and fear resulting from those policies.
And, while President Trump's draconian and unconscionable policy of separating immigrant parents from their children has rightfully received a great deal of press coverage, a more subtle, but in some ways equally insidious, proposed change to immigration law by the administration has received less attention. In March of this year, The Washington Post released the leaked draft of a proposed change to a Department of Homeland Security rule, known colloquially as the "public charge" rule, that would essentially penalize lawfully residing immigrants for receiving any sort of public assistance, such as Medicaid or food stamps, by making it more difficult for them to become U.S. citizens.
In her piece for TheBody on this proposed rule change, Amanda Lugg, director of advocacy for the African Services Committee, discussed how, if instituted, the public charge rule change would serve as a de facto ban on people living with HIV immigrating to the U.S. Among other things, the rule would require people living with HIV to show proof of unsubsidized health insurance, effectively eliminating anyone utilizing Medicaid, the AIDS Drug Assistance Program, or any Affordable Care Act cost-sharing subsidies from consideration for citizenship.
The bottom line is that all immigrants living with or affected by HIV, regardless of documentation or resident status, are under attack from the Trump administration, and it is up to all of us in the HIV advocacy community to support and protect them in whatever way we can. Whether it's showing up in massive numbers to publicly protest the barbaric policies of the Trump administration and their endorsement by members of Congress, or working with community health center and Ryan White clinic administrators and staff to ensure that our clinics are safe spaces for immigrants to be in, we must try to dismantle and thwart the mechanisms by which the U.S. government is trying to terrorize millions of our immigrant allies. No one should ever have to choose between viral suppression and deportation.