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.


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