Bush has signed a bill that strips HIV from the list of "communicable diseases of public health significance" for which an alien can be barred admission to the US.
Some perspective please.
I did a definition search and do not understand why HIV is not "communicable." Sure, the means by which the virus is communicated are limited. However, HIV infection, particularly among African Americans and sexual minorities continues to exact an horrific toll.
Perhaps the more scientifically-minded among us can weigh in on the technical difference that makes leprosy a "communicable disease of public health significance" and HIV not.
What I am about to say will sound cold. I don't mean it to be; but I am a nationalist at heart and care about American interests much more than unassociated foreign interests.
The US may well have an interest in reducing the costs of HIV drug treatments to populations in other countries. We certainly have an interest in coming up with better treatments for our own people. I don't see any interest in bringing HIV infected persons to the US.
HIV is almost universally fatal. While the inevitable can be delayed with some extremely expensive medical treatment, the outcome is set from the moment that the virus begins its replication.
The article suggests that the bar doesn't matter anyway because there are so many persons who came here illegally to obtain treatment in the US. Even if this is true for persons from Mexico, the assertion doesn't take into account visas issued to persons from developing countries which are now subject to the bar.
Frankly, cold though it may be, I think being HIV positive, even if due to no fault of one's own, should be a bar to admission to the US.
Sunday, August 10, 2008
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My understanding of the bill, which I have been following off and on because it has an impact on my portfolio, is that it removes the requirement that HIV be on the list of communicable disease. In the 1990’s, based on an epidemiological evaluation of some sort, HHS recommended removing HIV from the list. Congressional reaction was swift, and HIV became the only disease on the list by law rather than HHS discretion. Having said that, since HHS still appears to be recommending HIV be removed from the list, the new law does have the effect of stripping the disease from the Immigration and Nationality Act. It will take a while for DHS and HHS to publish revised versions of the relevant CFR’s, so the change is not immediate.
I think the issue is not with the “communicable disease” part, but with the “of public health significance” part.
GV mentioned leprosy, and both diseases have similar profiles in that neither AIDS nor leprosy is curable, though both are treatable. [Leprosy is also known as Hansen’s Disease, though whoever in the medical community hated the teeny-bobber band enough to name leprosy after them must have had multiple pre-teen daughters running “M’Bop” on a perpetual loop for months]
At first I suspect that the difference is that AIDS is transmitted by active contact while leprosy is transmitted through passive contact. Active TB, which can be transmitted through passive contact, is also classified as of public health significance. On the other hand, gonorrhea and active syphilis are classified as of public health significance, but they require active contact to transmit, so go figure. (Unless, that is, the old tale of getting STD’s from dirty toilet seats has a kernel of truth to it.)
Title 42 of the Code of Federal Regulations defines “communicable disease of public health significance” by listing the applicable diseases. However, I’ve not been able to determine the underlying mechanism and standards for placing any given disease on the list. Thus, I am left echoing GV: Does anyone reading this blog know how the HHS Dept. determines the public health significance of any given communicable disease?
I actually think this is a good idea. I would like too all diseases removed from the list. It seems to suggest a patient with a disease on that list is less of a person than an otherwise qualified immigrant. A rather archaic view from the mid-ages.
I really don't see any public health benefit from this list either. I am pretty sure the bulk movement of people across the boarder does not fall within this law. There is not a requirement of a clean bill of health before one is issued a visa.
My caveat: if the person in question has health insurance, let 'em in.
If we're going to be paying for their (ridiculously expensive and ultimately useless) medical treatment and medications via medicaid, bar them.
"It [the barring of persons with contagious disease from admission to the US] seems to suggest a patient with a disease on that list is less of a person than an otherwise qualified immigrant. A rather archaic view from the mid-ages."
5Toe,
I am intrigued. Please flesh out this idea.
I have long accepted the notion that "sovereignty" includes the inherent right to exclude. Your comment suggests that this concept is not your touchstone for immigration.
I would love to hear more.
The notion that exclusion from the United States is less than humane treatment begs the question of just what admission to the United States is. Is admission a privilege or a right? A privilege is discretionary and can be revoked at will. A right may be denied, but the burden of justification rests on the party denying the right. If it is a right, the next question is if it is a human right. If so, then the justification for the denial of that right must be a highly focused and appropriately crafted response to a compelling need of the State. To deny a human right on any other basis is inhumane.
However, I cannot classify the crossing of international borders as a right, let alone a human right. Admission to the United States is a privilege, and must be a privilege, if nations are to retain their sovereignty.
I’m still scratching my head about meaning of the phrase “of public health significance.”
GV,
The issue for me is not so much as a sovereign's right to exclude, but whether the exclusion is reasonable or has any impact for public health.
The recitation of leprosy shows how outdated the statute really is. Leprosy is effectively eliminated in much of the world, only pockets of high incidence areas remain in a small number of developing countries. (Check this WHO page for the current status of global elimination of leprosy. http://www.who.int/lep/en/) Leprosy is not only treatable, the complete clearing of the pathogenic bacteria can be reliably achieved using multi-drug therapy. It is still a communicable disease, but it hardly is a public health threat. Yet it still remains on the book.
If you can recall the public sentiment toward HIV in the late 80's and early 90's, I am sure you can see some similarity of the treatment of leprosy in the middle ages. I am not surprised law makers at that time reacted to the public sentiment and put HIV infection in the same group of leprosy.
A practical question is whether having a law like this actually does anything. Most people who travel internationally does not fall under the statute. The US does not require anyone who enters the country to submit to HIV testing. My guess is that it law does absolutely nothing to affect the transmission of any disease across the boarder.
So why do we have this law again? To show the US takes a stance against HIV infection, or HIV infected persons?
You raise an interesting point...
If only immigrant visa seekers have to submit to an HIV test, is there a point to the exclusion?
I think IpsitDixit hit on the most significant distinction and argument... For the most part, non-immigrants are barred from public health benefits. Thus, the expensive, and ultimately ineffective, treatments are provided, if at all, by foreign entities. Immigrants, on the other hand, are given access to a range of services.
At present, the balance is struck between the state's interest in limiting the financial impact of the disease and various interests in admitting aliens who have the virus through a complicated waiver process - If there are sufficient equities to obtain the waiver, the US bears the costs of treatment.
So, I toss the question back to you in this form:
Public policy, including the bearing of expenses for health-care, is a hallmark of state sovereignty. If HIV is a communicable disease of public health significance, in the eyes of the legislature, isn't that determination sufficient for the exclusion of persons with HIV; or is there an inherent right to access to treatment in other nations, irrespective of the determination of their legislatures?
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