Bad Blood

To fight AIDS, lift the ban on immigrants with HIV

A year ago, in his 2003 State of the Union message, President Bush announced an unprecedented U.S. effort against the global spread of AIDS. After a slow start, the United States has come to recognize that AIDS, especially in Africa, is not just a humanitarian calamity but also a threat to international prosperity and stability. The president himself, by various accounts, has become a true believer. "To meet a severe and urgent crisis abroad," he said in that State of the Union speech last year, "tonight I propose the Emergency Plan for AIDS Relief—a work of mercy beyond all current international efforts to help the people of Africa."

He called for $15 billion over five years—nearly $10 billion in new money—to prevent 7 million new infections, treat 2 million infected people, and care for 10 million victims and orphans. Though AIDS activists wish for more, even skeptics acknowledge that the scale of this effort makes it a watershed.

So listen, people of Africa: Help is on the way. Just one thing. If you have HIV (the virus that causes AIDS), you know those life-saving medicines we'll be sending you? Be sure to hide them, like contraband, when you visit America, because if the immigration authorities discover them in your luggage, you may find yourself on the next plane back home. Better still, never set foot on U.S. soil. If you do get here, make sure the government doesn't find out about your HIV, or you will be deported. American law has a message for you: You have a vile contagion and are not welcome here. Stay out. Go away. Is that clear?

As of today, according to the United Nations and the World Health Organization, about one of every 12 adults in sub-Saharan Africa is living with HIV. Counting children as well, almost 30 million Africans have the virus. Unless they are lucky enough to qualify for special waivers, all of these afflicted people are barred from the United States by law. One-quarter of Zimbabwean adults thus cannot come here. One-fifth of South Africans are shut out.

The law bars aliens who have HIV whether or not they are sick (not everyone who has HIV gets AIDS) and even if they acquire the virus after they come to America. Of course, many resident aliens have HIV. They just keep their condition out of the sight of the public health authorities—the very people who most need to know about it. After all, if you come from a poor country, being deported with HIV can be a death sentence.

Dennis B. Bolt is a 45-year-old Nicaraguan national who has lived in the United States since he was 17 years old. Over the phone from his home in Miami Beach, he talks with a Spanish accent, but his affinities are clearly American. With a vocation as a chef, he has worked in various jobs, and he recently got his associate's degree in hospitality management. He and his partner, an operatic baritone, have been a couple for more than seven years and own their house together.

Bolt is HIV-positive. He says he knows for a fact that he was infected in the United States. Nonetheless, his application for legal permanent residence—a green card, as it is popularly known—will be rejected. His only hope is a long-shot bid for political asylum. If he is deported, could he go to Nicaragua? For HIV, he says, "There is no medical treatment in Nicaragua. It's not available and it's not affordable." Besides, when he goes there, he feels like a stranger. "My home is here," he says. "I've been here for 28 years. I'm going to lose my home and my partner" if forced to leave. He vows to fight to stay "with the last breath I have."

Keith (I have changed his name) is a Japanese national in his thirties who has lived in the United States since he arrived for college when he was 18. He found out he had HIV—which he contracted in the United States—while applying for his green card. Unable to stay, he hastily relocated to Canada, leaving behind his long-term partner. Like Bolt, Keith feels the United States is his home. In Japan, he says, "I don't even know how to rent an apartment or open a bank account." And so he lives as an American exile, a thousand miles from the person whom he would rely on if he got AIDS. (He is healthy.)

One HIV-positive foreigner who lives here tells of hiding his medications when re-entering after a trip abroad. "People feel like criminals just for having HIV and wanting to visit America," he says. "It's as if it's Iran or something."

The ban on aliens with HIV was first imposed administratively, by the Public Health Service, in 1987, when fear of AIDS was at its peak and the disease was effectively untreatable. As therapies became available, public health authorities soon came to believe that the policy merely drove the disease underground and thus was ineffective, if not counterproductive. The first Bush administration and then the Clinton administration tried to revoke it. To no avail: In 1993, Congress wrote the HIV ban into law. No other disease faces such a statutory ban.

Even in 1993, the ban made little sense. America was the world's epicenter of AIDS, exporting rather than importing the disease, and so aliens were far more likely to get HIV in America than to bring it in. Anyway, the policy never required an HIV test for entry; only when an alien seeks permanent-resident status, usually after having already been in the country for years, is the blood test routinely required. So the policy, as put into practice, is about kicking people out, not keeping them out.

Congress was worried about the costs of welfare and publicly funded care for immigrants with AIDS. A valid concern, but one addressed by the underlying immigration law, which bars aliens deemed likely to become a "public charge," whatever their disease. Today, diabetics and cancer patients can visit and live in the United States on showing they have insurance or resources to keep themselves off the welfare rolls; only people with HIV are barred, whether they are sick or not. This is discrimination, pure and simple.

And discrimination—legal discrimination singling out AIDS as an untouchable disease—was in some measure always the point. In the late 1980s and early 1990s, AIDS was a "gay disease," in the public mind if not necessarily in reality. In Senate debate in 1993, then-Sen. Jesse Helms, R-N.C., charged that President Clinton's effort to revoke the HIV ban was a sop "to the AIDS lobby and to the homosexual-rights movement which feeds it." He added, "The Clinton administration's kowtowing to this arrogant and repugnant political group is beyond belief."

Times change. In the end, even Helms changed. Now AIDS is ripping through Africa, with parts of Asia and India perhaps not far behind. President Bush is anxious to stop the scourge, which means, above all, fighting the denial, stigma, and discrimination that block prevention and treatment efforts. "The single biggest impediment to fighting AIDS is stigma," says Abner Mason, who chairs the international committee of the Bush administration's Presidential Advisory Commission on HIV/AIDS.

In that context, a law singling out and throwing out those with HIV is profoundly unhelpful. "There's no question that we're sending the wrong signal with the ban that is currently in place," says Mason. "The right signal is what President Bush has done, which is, say we're going to spend an enormous amount of money and time and energy getting treatment and care to people who need it in some of the poorest places in the world. The travel ban undermines that signal. We're trying to remove the stigma from having HIV and treat it like any other disease. Now is the time for the United States to get rid of this ban. The only effect of it now is just to create stigma."

Moreover, says Mason, some of the best people to provide treatment in Africa are Africans who are themselves infected. In other words, "Some of the best people to implement this program are people we can't bring into this country for training because of the HIV ban."

Mason says the AIDS council's international committee favors lifting the ban and will seek the full council's imprimatur, possibly in March. Then the recommendation would go to Bush, who would need to decide whether to take the case to Congress, where being seen as soft on AIDS is never popular.

The first Bush administration retreated from its effort to lift the ban at the first sign of political resistance. The Clinton administration tried barely harder, believing, probably correctly, that the cause was lost on Capitol Hill. A decade later, however, AIDS panic has subsided, HIV has become a global threat, and America has a president who promises to lead.

"The United States is in a tremendous position to fight this disease," says Mason, "and we need to do everything we can to get unnecessary barriers out of the way." Over to you, President Bush.