Stigma Remains an Obstacle to Treatment

By Brittney Johnson
Washington Post Staff Writer
Tuesday, August 5, 2008

Many patients still duck around the corner and wait for Metrobuses to pass so they can run unseen into one of the Whitman-Walker clinics -- the area's largest nongovernmental providers of HIV/AIDS services, according to Justin Goforth, director of Whitman-Walker's medical adherence unit.

More than 20 years into the HIV/AIDS epidemic, stigma is still a major barrier to getting tested and treated, Goforth said.

"If we could freely talk about [HIV] like we freely talk about someone with diabetes or cancer, people would get the support that is so important to health care," he said.

Perhaps nowhere is the shame greater and the support more lacking, disease counselors say, than among recent Latino immigrants. Deep cultural beliefs (for example, that women who insist on condom use are promiscuous, and that men who are sick are weak or not manly) and religious values (that sex outside marriage is wrong) discourage open talk about sexually transmitted diseases, they explain. Now, they say, the public health challenge posed by such beliefs is compounded by anti-immigrant sentiment and local legislation targeting those living in the country illegally.

Fearful area residents are putting off testing longer and traveling farther from home to get it following widely publicized campaigns in some Virginia counties to deport undocumented immigrants.

Undocumented Latinos "know that if [government officials] find out they are [HIV-]positive, their chance of changing their immigration status is almost zero," said Miguel Mejia, Whitman-Walker's Latino care coordinator. Last week President Bush approved a measure that could allow HIV-positive persons to enter the country or obtain legal residency; current law prohibits this. The decision now rests with the Department of Health and Human Services.

Public health workers in Virginia are not permitted to ask patients about their immigration status. But patients' fears to the contrary have been fueled by new laws in Loudoun and Prince William counties that allow police to ask anyone for immigration papers and direct jail officials to report all foreign-born inmates to federal immigration authorities.

"We have to get the word out through the grapevine that what's going on at the local level for immigration enforcement does not impact your access to HIV services," said Sue Rowland, executive director of Virginia Organizations Responding to AIDS, a nonprofit umbrella group that advocates for people living with HIV/AIDS.

Last year Rowland and other members of the Northern Virginia HIV Consortium compiled a question-and-answer sheet to help people understand their right to access HIV services, regardless of local measures that bar illegal immigrants from receiving other social services. But last week the document was still not available in Spanish or online.

According to the Virginia Department of Health, "Citizenship and immigration status shall not be included as a factor in VDH eligibility requirements."

Spokesmen for the Loudoun and Prince William health departments said they can't tell whether fewer undocumented people are seeking HIV/AIDS services.

At Whitman-Walker's Northern Virginia clinic, however, Goforth said, he has noticed an increase in undocumented residents who say they feel safer there than at government clinics. Dilcia Molina, a psychologist at La Clinica del Pueblo, a District clinic that primarily serves Latinos, said she sees about three patients a week from Virginia seeking HIV services in the District for the same reason.

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