NATIONAL COMMISSION ON ACQUIRED IMMUNE DEFICIENCY SYNDROME
1730 K Sureet. N.W.. Suite 815
Washington. D.C. 20006
(202) 254-5125 [FAX] 254-3060

Statement on Immigration
July 1991

The exclusion of HIV-infected travelers and immigrants from the United States was initiated
in 1987. It has resulted in serious discriminatory effects against people with HIV and has
sent a misleading and distracting signal to the American people, since HIV-infected travelers
and immigrants pose no threat to an informed public.

Since the first statement by the National Commission on AIDS on this topic in November
1989, a number of events have occurred:

1) The U. S. Public Health Service undertook and conducted a thorough review of the
exclusionary list of "dangerous communicable diseases” and recommended formally

that, from a public health vantagepoint, only active tuberculosis should remain on it.
Secretary Sullivan has embraced and endorsed that recommendation.

 

 

 

_ The U. S. Congress reaffirmed the appropriateness of placing such judgment in the
hands of the Secretary of Health and Human Services. .

As the June 1, 1991, deadline neared for decision about what list of diseases
constituted -grounds for exclusion, a new debate apparently arose within the
mi ion around the proposition that travelers should be dealt with separately
from immigrants. One view in this discussion was that the costs of medical care for
people with HIV infection or AIDS made this disease a communicable disease of
public health significance that should result in exclusion of immigrants. The .-
mmission has reviewed that issue and found that present immigration law deals
extensively and in detail with such economic concerns in the exclusion of persons who
wish to immigrate if they are likely at any time to become a public charge. To single
out HIV disease in this economic context seems irrelevant and highly discriminatory.

The issuance on May 31, 1991. of an interim rule that extends the same travel and
immigration restrictions as “communicable diseases of public health significance” that
previously were classified as “dangerous contagious diseases” defies public health
knowledge. This action perpetuates the misleading and discriminatory effects of prior _
HIV inclusion on an outdated list of diseases. This has had the additional, serious
side-effect of jeopardizing further important scientific meetings which are crucial to

the efficient exchange of scientific information and progress in the midst of this
accelerating pandemic.

 

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Thus, we urge Secretary Sullivan to maintain his strong public health stance regarding this
issue. We further urge Attorney General Thornburgh to accept the public health
recommendation that concludes that HIV does not warrant exceptional treatment in travel
and immigration policy. We further urge him to ensure that any revision of “public charge"

oe in such policy be made in an even-handed way that does not single out persons
wit . |

 
BACKGROUND INFORMATION

HIV DISEASE AND IMMIGRATION
(INCLUDING PUBLIC CHARGE)

In its last revision of the immigration law (P.L. 101-649), Congress directed the Secretary of

‘Health and Human Services to look to “current epidemiological principles and medical
standards” in assessing the need to exclude immigrant applicants on the basis of illness or
medical condition. Accordingly, the Public Health Service under the leadership of Secretary
Sullivan reexamined the list of diseases to be used for purposes of exclusion. Of the eight
diseases on the list, the Public Health Service determined that only infectious tuberculosis
should be retained as it alone was transmissible through the air and by casual contact. The
Commission unequivocally supports the proposed rule as put forward by the Secretary as it
reflects our best and most current public health knowledge.

The Secretary's proposal has proved controversial due primarily to the elimination of HIV
infection as a disease for which an individual may be excluded from entering the U.S. This
is extremely unfortunate, as the removal of HIV infection from the list of diseases justifying
the exclusion of aliens from the United States is an important step toward correcting false
perceptions regarding the spread of HIV. The public health community has been united in
its support of this action, having long recognized that regulations barring the immigration of

HIV-infected individuals will have a negligible effect on the spread of HIV in the United
tates. . .

 

 

 

In the absence of a sound public health rationale, a United States government policy of
continuing to restrict the entry of individuals who are infected with HIV would serve only
to reaffirm inordinate and inappropriate fear of HIV infected persons, and to incite
discrimination against these individuals. Such policies fail to recognize that it is not the
immigrant or traveler, but rather risk producing behavior that transmits HIV. Restrictive
policies, like this one, misdirect efforts toward aliens and away from those behaviors which .
do transmit HIV. In so doing, the policy does irreparable injury to our nation’s best efforts

_ to contain the spread of HIV by misleading the public regarding the risk and modes of HIV
_ transmission.

 

In addition, the exclusion policy interferes with our public health objectives by discouraging
members of immigrant communities in the U.S. from seeking testing, counselling and
treatment due to fear of adverse immigration consequences. Through misinformation,
misdiagnosis and breaches in confidentiality, HIV exclusionary policies exacerbate the
ignorance, fear, prejudice and discrimination surrounding HIV. Such policies undermine
both private and public outreach and education efforts that encourage voluntary, anonymous
and confidential HIV testing. This is of considerable concern since almost half of all
applicants for. permanent residence are legalization applicants who have lived in the U.S.
continuously since 1982. They are therefore not new migrants and if infected were almost
certainly infected here in the U.S. |

 

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It has been argued that HIV infected individuals should be barred from immigration into the
United States on the basis of the financial cost they will pose to the nation. It should be
noted that U.S. immigration laws are very detailed and complex. Individuals secking to come
to the U.S. for a temporary visit or to reside here permanently must meet stringent visa
eligibility criteria. Applicants who are HIV positive, like every other applicant, will be
obliged to satisfy all other immigration requirements, including financial requirements. |

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Public charge provisions of the Immigration and Nationality Act administered by the
Department of State and the Immigration and Naturalization Service require all applicants
for immigrant and nonimmigrant visas to demonstrate that they are not likely to become
public charges. Anyone who does not do so is denied a visa and precluded from cither
visiting or immigrating to the U.S. This is based on a “totality of circumstances” test which
considers an applicant's health, financial resources, and their ability to earn a living in the
future. As an added safeguard, the regulations provide that an alien who becomes a public
charge within five years of entry be deported. Elimination of HIV exclusion will in no way
lessen these restrictions on individuals who wish to immigrate to this country.

 

 

In fact, present protections. are sufficient and are less discriminatory than exclusionary
Schemes that would arbitrarily classify certain illnesses as presenting an economic threat to
the nation. Assessing costs means much more than simply adding up the average life time
cost of treating an individual with HIV disease. The following are only a few of the costs
which will weigh heavily on the nation in both economic and social terms: the cost to states
and cities of lost revenues from taxes, tourism and commerce, such as the estimated $20
million in spending expected during the upcoming VIII International AIDS Conference in
Boston; the costs of operating testing facilities, such as the estimated $4 million per year to
maintain the testing program for refugees; the cost to those fields with a desperate need for
skilled and educated employees; and, the cost to scientific progress through the serious side-
effect of jeopardizing further important scientific meetings which are crucial to the efficient
exchange of scientific information and progress in the midst of this accelerating pandemic.

 

In the long term, it is likely that the social costs associated with admission of HIV infected
immigrant applicants will be minimal. U.S. immigration law gives preferential immigration
Status to aliens with a family relationship with a U.S. citizen or legal permanent resident,
aliens with needed job skills or aliens who qualify as refugees. Aliens in other categories
amount to relatively few admissions. Thus, immigrant applicants who are approved for
permanent residence status are not indigent -- in fact, most are gainfully employed and

many work in those very occupations where the U.S. suffers from shortages of staff and
expertise.

Others immigrate to this country to be reunited with families who are able to provide them
with financial support. A 1981 study of U.S. census data found that immigrant families to
the U.S., from the time of entry to twelve years later, take substantially less funding from
public services than do U.S. national families. After twelve years immigrant families’ usage
of public services becomes about average. The study also found that within two to six years
immigrant families pay an average amount of taxes, and eventually pay more than US.
national families. Overall, it was found that immigrants contribute more economically than
they take in terms of public services. Individuals with HIV infection are still likely to be
employed and self sufficient during the estimated 10 or more years from infection to
development of clinical AIDS. Their economic contribution to our society over the course

of qilose many years will far outweigh the estimated lifetime cost of treating HIV infected
indivi .

 

The Commission must voice its deep distress over the encroachment of extraneous issues into

a decision that should be science-based and focused solely on public heath concerns. We
should not allow arguments based on misinformation, fear or discriminatory agendas to
triumph. To do so is to betray the heart and the inte ity of the federal government's role
in protecting and advancing the health of all its people. The Administration’s indecision

makes it appear that the nation’s public health process is to be governed by political pressure
and not sound science. |

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