Wednesday, July 12, 2006

America's door shut to foreigners with HIV

America's door shut to foreigners with HIV
Critics say politics, `remnant of fear' keep 19-year-old ban alive
By Bonnie Miller Rubin
Copyright by The Chicago Tribune
Published July 12, 2006

In the early years of AIDS, when many people thought a deadly disease dubbed "the gay cancer" might be transmitted via drinking glasses or doorknobs, Congress added HIV to the list of infections that could prevent a foreign visitor from entering the country.

Nearly two decades later, as the international Gay Games begin in Chicago this weekend, the law still bars any HIV-positive foreigner from visiting the U.S., whether it is to play basketball, attend a business meeting or stand up in a family wedding.

Though immigration officials have granted a waiver to allow athletes to attend the games--just as they did in 1994, when the event was held in New York City--many health experts are frustrated and puzzled that the rule exists at all.

"The ban serves absolutely no scientific purpose," said Patricia Mail, president of the American Public Health Association "Our country has a long record of discrimination [against gays] and this is just one more example. ... This is strictly about politics."

The Immigration and Nationality Act denies visas to anyone with "a communicable disease of public health significance," and HIV was placed in that category in 1987. Only a handful of countries, including Saudi Arabia and Iran, have a similar policy regarding people with HIV.

Over the years, such mainline organizations as the American Medical Association and the World Health Organization have opposed the rule, saying there is no good reason to bar the HIV-positive from entering the country temporarily. Unlike infectious diseases such as tuberculosis, HIV is not spread by routine contact.

"Because of the way it's transmitted, [HIV] simply poses no threat to public health," Mail said.

Calls to a dozen health organizations turned up no dissenting views, though the Centers for Disease Control and Prevention declined to weigh in on the subject. "We didn't make the policy, so it's really not appropriate for us to comment," said a CDC spokeswoman.

Other than social conservative leaders, who insist that admitting infected tourists would accelerate the spread of disease, it's hard to find supporters of the policy. Abner Mason, a gay Republican appointed by former President George H.W. Bush to the Presidential Advisory Council on HIV/AIDS, said he wanted to hold a conference on the topic but "could not find anyone who could defend it."

Fear of political fallout may explain why the measure lives on, as several efforts in the early 1990s to overturn it in Congress failed amid public opposition. Gay Games organizers said they waited until after the November 2004 elections to apply for a waiver, lest candidates make political hay of the request.

Of 12,000 participating athletes representing 100 countries, perhaps fewer than 50 will be foreigners with HIV, said Gay Games organizer Kevin Boyer. That is only an estimate, he emphasized, as the decision to divulge health issues--whether allergies or HIV status--to the Gay Games is voluntary.

"We simply do not ask the question," Boyer said. "We ask about disabilities so we can accommodate visitors' needs while they're here," such as making sure wheelchair users are properly housed. The federal ban "offends me," he said.

Peter LaBarbera, executive director of the Illinois Family Institute, supports the HIV policy and said a waiver should not have been granted for the Gay Games. Two bathhouses are among the businesses providing financial support for the event, he noted.

"When you have bathhouses as sponsors, I don't think that people are just here to play softball," LaBarbera said.

Opponents of the policy say its true effect is to push HIV-positive visitors underground, as many choose to lie about their status rather than risk being turned away.

Some Web sites advise visitors on how to avoid detection by U.S. officials upon arrival, such as by rebottling AIDS drugs in neutral packaging or mailing them to a friend here.

"I imagine quite a lot of people lie," said Victoria Neilson, legal director of Immigration Equality, which addresses the impact of U.S. laws on the international gay and lesbian community. "The ramifications [of disclosure] are so severe that many people think it's simply not worth the risk."

In 2003, a small study from Brighton and Sussex University Hospitals in England surveyed 346 HIV-positive respondents and found that, of the 135 who had traveled to the U.S., all but two had done so illegally. Of the 83 on medications, 10 stopped treatment during their stay, running the risk of further health complications.

Blanket waivers to the policy are granted for certain "designated events," such as the Gay Games. HIV-positive travelers can try to get a waiver for personal business, but these are much tougher to obtain, advocates report. Immigration officials said they could not say how often waivers are granted.

"Not only do such requests take months to process, they are virtually impossible to get," said Vishal Trivedi of the Gay Men's Health Crisis in New York City, which has acted as an adviser to the Chicago games. "Actually, I don't know a single person who's been successful."

Though no medical tests are administered at airports and authorities are not supposed to detain visitors upon finding HIV medicine, Trivedi said it happens routinely.

That was confirmed by Cherise Miles, public information officer for U.S. Customs and Border Protection in Chicago. "If HIV meds are found, we would consult with public health officials at the airport," Miles said. "We'd want to know: `What are they? What are they used for?'"

Visitors who answer yes to the question: "Have you ever been afflicted with a communicable disease of public health significance?" would typically be detained, she said. It is "very, very rare" that someone is turned away for violating the ban at O'Hare. "But they will be deported if they have medical documents that state they have it ... or they admit it."

The HIV restriction dates to the height of the AIDS scare in the 1980s, when many affected Americans were fired from jobs, evicted from apartments and denied health insurance. In this climate, former North Carolina Republican Sen. Jesse Helms added HIV to the list of disorders that bar people from entering the U.S.

Louis Sullivan, secretary of health and human services to then President Bush, promised in 1991 that the ban would be lifted but backed down after coming under fire. Bill Clinton also promised during his 1992 bid for the White House that he would change the rule, only to succumb to political realities a year later. (Congressional foes tacked reauthorization of the ban onto a bill funding research at the National Institutes of Health.)

No serious effort to overturn the rule has been mobilized since, though John Kerry made repealing the policy part of his 2004 presidential campaign. Most activists who oppose the ban are waiting to see what happens at the polls in November, Trivedi said.

Ronda Goldfein, director of the AIDS Law Project of Pennsylvania, said slowing the spread of AIDS is not about specific people but specific behaviors, namely unprotected sex and the sharing of hypodermic needles.

"Sadly, [the ban is] a remnant of fear left over from another time, but the reactionary response remains," she said. "The questions we should be asking is what's really behind the ban? Homophobia? Fear of immigrants? It doesn't accomplish anything ... except force people to swallow a little more shame."



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