HIV and refugees: A reader answers my question

Before reading this post go back and read my post yesterday in which I asked how do HIV positive refugees get into the US.   A reader has kindly given us the information:

I hope I can shed a little light on refugees/HIV.

US immigration has certain conditions that are considered ” excludabilities”, such as certain crimes and certain medical conditions, particularly “Class A” medical conditions.

A “Class A” condition is something that is presently communicable and a threat to the public health in its present status.

For example, active TB is a Class A Condition, that prevents entry to the country. However, after treatment, the TB becomes “inactive” and is reclassified ” Class B” , which allows entry to the country provided that follow-up treatment is ensured so that the condition does not become active. That is a responsibility that the Volags must assume to ensure that class B refugees receive follow up treatment.

Some Class A conditions (of which HIV is one …and that status never changes) require a ” waiver”.

A waiver requires that other requirements be met, depending on the condition and application for waiver must be submitted prior to approval of an entry visa.

For HIV, the requirements are that a known medical provider must be named who will provide follow up care for the applicant, and a number of other requirements.

Several years ago, the waiver process was very complex and lengthy, and , in fact, many applicants died prior to the waivers being granted.

For other (non-refugee) immigrants, that old process is still in place, thus, most family based immigrant applicants are not able to complete the process since sponsoring relatives are usually not able to provide the financial means for their applicant relatives (who are usually not eligible for public medical assistance but require private insurance).

Since refugees are eligible for public medical assistance, this is not seen as a barrier, and the federal government has vastly streamlined the waiver process for refugees with HIV. (It’s important to note that the HIV status of refugee applicants is only discovered after their processing and initial approval under other criteria).

At present, the process simply requires that the prospective Volag accept the case and provide the contact information of an HIV medical provider who has agreed to provide care and follow-up and that contracted overseas entities provide counseling sessions to the applicant.

Approved refugees supposedly receive an orientation to their condition and counseling in prevention and other issues surrounding living with the virus.

In reality, there are problems. The overseas counseling seems to vary greatly. From personal experience, many refugees have a very spotty knowledge of HIV , how it is transmitted, etc. and are often in denial that they even have the virus. While they are required to sign forms stating that they are fully aware, the simple fact is that many are NOT aware . Additionally, because of confidentiality regulations, no one else is informed, INCLUDING SPOUSES, of the condition. (Obviously the sponsoring Volag is aware, but regulations again prevent them from sharing ANY information with anyone except directly to the medical provider).

In my experiences, it is very rare for HIV infected persons to inform their spouses (or other partners) of the conditions (state laws vary about disclosure, however. But in my state, it prevents disclosure to spouses without the HIV client’s written consent… and you can imagine that it’s rare for consent to be given).

Also, many refugees come from cultures where ” safe sex” practices are unheard of and would cause alarm to their partner if introduced, thus there is a lot of unsafe sex which can transmit the virus to their partners.

The confidentiality regs are so strong that it also prevents the medical provider from informing the Volag of any problems, thus preventing them from providing any specific counseling to the client. (Example…. An HIV positive man has not informed his wife, and continues to have unprotected sex with his wife….. he may tell the HIV counselor but the counselor cannot inform the Volag or the wife). This happens a LOT.

On the other hand, if left in their country of asylum (at least for most refugees), HIV is still truly a death sentence. That is no longer the case in the US and persons with HIV can lead long and productive lives. (I have a friend who is an HIV specialist MD and he sees it for most people as a lifelong condition much akin to TB, high blood pressure, Hep B or other diseases for which we fortunately have treatments to control it). I am thinking in particular of one woman who became infected through a rape and who was devasted and distraught for the longest time, but who is now in good health and functioning very well.

I could go on and on, and there really are a lot of problems and concerns, but at least I hope to have cleared up how refugees with HIV are allowed to enter the US.


Bhutanese arriving soon in Everett, WA

Here is another article about the Bhutanese refugees who have started to arrive in the United States from camps in Nepal.  It’s long but I encourage you to read the whole thing to better understand the situation with the Bhutanese since we are expected to take upwards of 60,000 of them over the next few years.  And, see what I have to say about problems with refugee resettlement.

Here is a segment from the beginning of this article by Krista Kaprolos at the Herald Net:

For about 100,000 people, living in Bhutan was more about basic survival than fairy-tale mountain living. They were driven out of Bhutan in the early 1990s, and ever since, they have been living in refugee camps in Nepal, where they aren’t allowed to work and are stuck at the bottom of an intricate caste system.

Now, more than half of those refugees, known as Lhotsampas, “People of the South,” are preparing to come to the United States. The first wave, a trickle of just a few families, came early this year.

Within weeks, 18 Bhutanese refugees are expected to arrive in Everett.

“Nepal is unable to integrate them,” said Jan Stephens of Lutheran Immigration and Refugee Service, the organization that will resettle the Bhutanese in Everett.

All but one of the 18 Bhutanese scheduled to come to Everett are under 30 years old, Stephens said. It’s likely that they speak English, which is taught in Bhutanese schools, but their heritage is one of rural mountain culture.

“The one potential downside is that it’s not a group of people who have lived in urban environments before,” said Joel Charny of Refugees International, an advocacy group in Washington, D.C. Charny visited the refugee camps in Nepal late last year.

Then, here is my input: 

While some refugee advocates welcome them, others worry that local agencies that contract with the federal government to find housing, jobs and perform other services can’t keep up with the number being resettled here. In many cases, refugees are offered services for a limited number of months, then must fend for themselves.

The process of refugee resettlement, which awards money to local agencies to care for the refugees, is flawed, said Ann Corcoran, author of Refugee Resettlement Watch, a blog that keeps tabs on resettlement trends.

It’s not realistic to expect refugees to become self-sufficient so quickly, she said. Another potential difficulty is if the refugee group rejects American culture. One reason some groups have done well is that they embrace the opportunities America offers.

“The Vietnamese came here and decided to work hard and become Americans,” she said. Others, such as some strict Muslims, are offended by what they find here and become isolated. 

I would rephrase that last line, to read instead of “become isolated” to read “choose to become isolated.” 

And, finally here is a little tidbit of news that is not reassuring:   some of these mostly Hindu and Buddhist refugees are, according to this article, polygamous. 

In most cases, the refugees will have little experience with modern homes, including refrigerators and other kitchen equipment. Polygamy exists among Lhotsampas, but it is not widespread.

Does anyone know if that is true?  Muslims practice polygamy as do some extreme Christian groups, but I guess I’m pretty ignorant about Hindus and Buddhists on that score.

See our previous posts on the Bhutanese here.


Spotlight on Refugees and Asylees in the US

A reader sent me a link to the Migration Policy Institute’s Migration Information Source yesterday with facts on refugees and asylees and some recent numbers of each admitted to the US.   Because things are hopping and time is in short supply we tend to try to get the news to you, but much of our original intent in writing this blog was to get basic information to citizens wishing to better understand this portion of US policy on immigration.

See this article entitled “Spotlight on Refugees and Asylees in the US” here for basic information and recent numbers.

Check out our category “where to find information” here.