“We’re trying to end the stigma and the discriminatory practice for a disease that doesn’t warrant exclusion for coming into this country,” said the director of the CDC’s division of global migration and quarantine, Dr. Martin Cetron. “We have to appreciate this is not a threat we face from abroad.” He acknowledged that “HIV is clearly a public health disease of significance,” but added that simply letting somebody with HIV into the country does not “immediately pose a risk to the public.”
The proposal could allow an average of about 5,000 HIV-infected people into the United States each year. And according to a CDC estimate published in the federal register, the lifetime medical costs of those admitted in just the first year would total almost $100 million. The United States is one of about 15 countries that prevent entry of HIV-positive patients, though it is possible to obtain a waiver under certain conditions.
Critics of the proposed regulation change are mainly worried about the cost or that infected immigrants and travelers could spread the disease. “It becomes a matter of collective responsibility,” explained Ira Mehlman, a spokesperson for the Federation for American Immigration Reform, a nonprofit organization which usually advocates stricter immigration law. “The American people shouldn’t be in a position where they have to pay for it.”
Congress voted to rescind the ban over a year ago under an AIDS-reform package pushed by then-President George Bush, but HHS has not yet removed AIDS and HIV from the so-called “no entry” list. Once removed, the HIV test would no longer be part of routine medical exams required for immigration or certain travel visas. Other diseases that bar entry include infectious leprosy, gonorrhea, syphilis, and active tuberculosis, among others.
“I sincerely hope we can continue to work in a bipartisan manner with the help of the public health, religious, LGBT and immigration groups to make this proposed rule final as soon as possible,” Senator John Kerry explained in a statement, referring to lesbian, gay, bisexual, and transgender groups (LGBT). He is widely acknowledged to be one of the key drivers of the proposal. But homosexual groups have certainly pitched in, as have some health officials and immigration organizations.
Victoria Neilson, legal director for the homosexual and transgender immigration lobbying organization Immigration Equality, noted that “ending the HIV travel and immigration ban removes a federally sanctioned stigma and sends a strong, clear message that the United States is working to end discrimination against people living with HIV.” The organization’s director of communications also noted that there have not been any major HIV/AIDS conferences because of the ban, and claims “it has undermined our commitment to equality.”
The Human Rights Campaign, the nation’s largest homosexual lobby, also supports the measure. “This regulation is unnecessary, ineffective and lacks any public health justification,” said the organization’s president, Joe Solmonese. “We are confident that this sad chapter in our nation's treatment of people with HIV and AIDS will soon be closed.”
One of the experts who support lifting the ban is Dr. Michael Saag, the incoming chairman of the HIV Medicine Association and the head of University of Alabama’s division of infectious diseases. After explaining that the ban was enacted when people and politicians mistakenly believed the virus could be spread by casual contact, he called the ban “a bit of an embarrassment.” He also added that he did not believe there was any scientific or public health rationale for the ban.
Among the critics of allowing the HIV-positive into America is John Vinson, the president of the American Immigration Control Foundation. “It seems rather odd to let people in with a health problem like that,” he said, noting that people have desires and may spread the disease in America. “Why bring on a problem on yourself when you don’t have to?”
The HHS cannot put a cost estimate on this legislation other than to say it would likely cost millions. This seems to be more of the same type of legislation that has led us to the point where the federal government has over an estimated $60 trillion in unfunded future obligations.