Phobia at the Gates
Twelve countries ban HIV-positive visitors, nonimmigrants and immigrants from their territory: Armenia, Brunei, Iraq, Libya, Moldova, Oman, Qatar, the Russian Federation, Saudi Arabia, South Korea, Sudan and . . . the United States. China recently acted to remove its ban on HIV-positive visitors because it feared embarrassment ahead of the Olympics. But America's ban remains.
It seems unthinkable that the country that has been the most generous in helping people with HIV should legally ban all non-Americans who are HIV-positive. But it's true: The leading center of public and private HIV research discriminates against those with HIV.
HIV is the only medical condition permanently designated in law -- in the Immigration and Nationality Act -- as grounds for inadmissibility to the United States. Even leprosy and tuberculosis are left to the discretion of the secretary of health and human services.
The ban can be traced to the panic that dominated discussion of the human immunodeficiency virus two decades ago. The ban was the brainchild of Sen. Jesse Helms (who came to regret his initial hostility toward people with HIV and AIDS). President George H.W. Bush sought to drop the ban, but in 1993, after a scare about Haitian refugees, Congress wrote it into law.
I remember that year particularly because it was when I, a legal immigrant, became infected. With great lawyers, a rare O visa (granted to individuals in the arts and sciences), a government-granted HIV waiver and thousands of dollars in legal fees, I have managed to stay in the United States. Nonetheless, because I am HIV-positive, I am not eligible to become a permanent resident. Each year I have to leave the country and reapply for an HIV waiver to reenter. I have lived in the United States for almost a quarter-century, have paid taxes, gotten married and built a life here -- but because of HIV, I am always vulnerable to being forced to leave for good. After a while, the stress of such insecurity gnaws away at your family and health.
I am among the most privileged non-Americans with HIV. Others live in fear of being exposed; many have to hide their medications when entering the country for fear of being discovered by customs or immigration. Couples have been split up and torn apart. International conferences on HIV and AIDS have long avoided meeting in the United States because of the ban, which violates U.N. standards for member states.
This law has lasted so long because no domestic constituency lobbies for its repeal. Immigrants or visitors with HIV are often too afraid to speak up. The ban itself is also largely unenforceable -- it's impossible to take blood from all those coming to America, hold them until the results come through and then deport those who test positive. Enforcement occurs primarily when immigrants volunteer their HIV status -- as I have -- or apply for permanent residence. The result is not any actual prevention of HIV coming into the United States but discrimination against otherwise legal immigrants who are HIV-positive.
Would treating HIV like any other medical condition cost the United States if such visitors or immigrants at some point became public dependents? It's possible -- but all legal immigrants and their sponsors are required to prove that they can provide their own health insurance for at least 10 years after being admitted. Making private health insurance a condition of visiting or immigrating with HIV prevents any serious government costs, and the tax dollars that would be contributed by many of the otherwise qualified immigrants would be a net gain for the government -- by some estimates, in the tens of millions of dollars.
In the end, though, removing the ban is not about money. It's a statement that the United States does not discriminate against people with HIV and does not retain the phobias of the past. That's why repeal has been supported by a bipartisan group of senators, including Republicans Gordon Smith and Richard Lugar and Democrats John Kerry and Barack Obama, in an amendment to the reauthorization of the President's Emergency Plan for AIDS Relief. They know that immigration and public health policy should not rest on stigma or fear. For the Bush administration, removing the Helms ban would be a final, fitting part of its admirable HIV and AIDS legacy.
It's also worth remembering that we are talking about legal immigrants and visitors, people who go through the process and seek to participate and contribute to this country. Making HIV the only medical condition that legally prevents someone from immigrating or even visiting is a signal to people with HIV that they have something to be ashamed of. That stigma is one of the greatest obstacles to tackling HIV across the world. The United States has done much to reduce this stigma; it makes no sense to perpetuate it in its own immigration policy.
People with HIV are no less worthy of being citizens of the United States than anyone else. All we ask is to be able to visit, live and work in America and, for some of us, to realize our dream of becoming Americans -- whether we are HIV-positive or not.
Andrew Sullivan is a senior editor at the Atlantic magazine and former editor of The New Republic.