“I’m just sitting here getting sicker without help,” Fernanda said last month from a migrant shelter on the outskirts of this border city.
Until January 2019, the U.S. government allowed applicants for asylum to stay in the United States, where they could access urgent medical care while their cases were reviewed. Then the Trump administration introduced the Migrant Protection Protocols (MPP) — known as “Remain in Mexico” — and began turning asylum seekers back at the border to wait outside the United States for their hearings.
U.S. Customs and Border Protection said exemptions would be available for asylum seekers with severe medical conditions. But some critically ill migrants still are sent back to Mexico. Others are put on planes to Guatemala to apply for refuge there; still others are swiftly deported under a new, expedited removal program.
The U.S. Court of Appeals for the 9th Circuit struck down MPP last month, but the Supreme Court has ruled that the administration may continue to enforce it while its appeal is considered. The policy continues despite the coronavirus, though immigration attorneys say that at least some hearings have been canceled.
The experience of asylum seekers with HIV/AIDS shows just how unevenly enforced — and how dangerous — the new asylum infrastructure is for migrants with life-threatening diseases. They’re often rebuffed by immigration agents upon presenting their medical papers.
“The screening process completely disregards physical and mental health needs,” said Kathryn Hampton, an officer with the asylum program at Physicians for Human Rights. “These are medical conditions that can deteriorate until someone dies because they don’t get the care they need.”
For some with HIV/AIDS, the disease and the stigma around it were major reasons they fled their home countries in the first place. In several cases, they’ve waited in Mexico for their hearings as their immune systems weakened.
A spokesman for U.S. Customs and Border Protection said the agency determines whether “an alien is amenable for the Migrant Protection Protocols” on a “holistic case-by-case basis, to include medical considerations as appropriate.”
“CBP consults with medical professionals where appropriate in making such determinations,” spokesman Matthew Dyman said. “There are different levels of granularity, facts and circumstances that are unique to each case.”
“If specific medical issues guaranteeing exemptions were to be standardized and made public,” Dyman said, “they would be exploited by human smugglers.”
Daniel, a 20-year-old man with HIV, was threatened in his native Venezuela for his opposition to the government of President Nicolás Maduro — a government the United States also opposes. By 2017, as Venezuela descended into political and economic turmoil, his antiretroviral drugs were no longer reliably available. Without medicine, his T-cell count dropped below 200, the threshold from HIV to AIDS. He tried to get medication in neighboring Colombia, but failed.
Daniel, who like Fernanda used only one name for fear of discrimination, arrived at the U.S. border at Eagle Pass, Tex., in October. He showed an immigration officer a pile of his medical paperwork, including a document that showed his fragile T-cell count. Under the Migrant Protection Protocols, he was sent back to Mexico with a court date. Waiting in the city of Piedras Negras, he searched for two months for HIV medication. He lost weight. His skin yellowed.
The Mexican Health Ministry says it provides HIV medication to migrants for three months while they await their U.S. asylum hearings. But in border cities, treatment can be difficult for migrants to find. And for many, three months isn’t nearly enough. Many asylum seekers wait in Mexico for twice that time for their cases to be resolved.
U.S. immigration agents don’t provide any information to asylum seekers about where to obtain medical care before they are returned to Mexico, advocates say.
“Many of the [migrants] do not know that they can access treatment,” said María Elena Ramos Rodríguez, director of Programa Compañeros, a program in Ciudad Juárez that has treated several asylum seekers with HIV.
Daniel hired an attorney last month, who put together a “parole packet” pleading that he be allowed into the United States on medical grounds. In a letter, Daniel asked Customs and Border Protection for “support to continue my treatment so I can live a normal life.”
His attorney, Scott Weaver, wrote more bluntly: “The applicant seeks parole because he is HIV positive and can no longer obtain the medication he needs to survive in Mexico.”
Immigration officials declined in October and again last month to parole Daniel in the United States. He managed to find a short-term prescription for antiretrovirals, but it expired at the end of last month. He then found another short-term prescription.
“The officers just said, ‘No, go back to Mexico,’ ” Weaver said. “They don’t seem to care about their fellow human beings.”
Another Honduran asylum seeker in Ciudad Juárez ran into the same problem. She was initially able to access HIV medication through Mexico’s Seguro Popular, a public insurance program. But the program was canceled in January; migrants say a new program has made it harder to access medical services.
“After that, she struggled to get even limited medical attention,” said Luis Guerra, a staff member with the Catholic Legal Immigration Network.
Public health analysts here say President Andrés Manuel López Obrador’s cuts to the country’s health budget could impact HIV/AIDS prevention and treatment.
“HIV in Mexico is once again a time bomb that will explode,” Aram Barra of Open Society Foundations told the International AIDS Society conference last year in Mexico City. Last month, HIV patients in Mexico City protested a shortage of antiretroviral drugs in front of the national palace.
The United States is now sending some asylum seekers, including those with medical conditions, to seek refuge in Guatemala. Those migrants have almost no access to legal assistance, and their cases are difficult to document. Immigration lawyers have identified ailing pregnant women put on planes to Guatemala City under the program. Doctors and immigration attorneys worry that more-severe cases are being kept from them.
“There’s no way to know who is placed in these programs,” said Linda Rivas, executive director of Las Americas Immigrant Advocacy Center in El Paso. “That’s the terrifying thing to me. We aren’t even able to fight for them.”
In its “MPP Guiding Principles,” Custom and Border Protection says “aliens” with “known physical/mental health issues” are “not amenable” to the program — that is, they should not be sent back to wait in Mexico.
But lawyers and advocates say the standard is vague and enforced arbitrarily. Even migrants with HIV/AIDS who had attorneys have been sent back to wait in Mexican migrant shelters.
More than 60,000 asylum seekers have been processed under the program since it began in January 2019.
“It’s like throwing darts in the dark,” said Nicolas Palazzo, a staff attorney at Las Americas who helps asylum seekers request medical exemptions.
Fernanda, the 21-year-old Honduran woman, is waiting at a shelter on the outskirts of Ciudad Juárez with her young daughter. They sleep on a mattress in a living room with several other migrant families.
Fernanda recently fell ill with flu-like symptoms. She ran out of her HIV medication months ago and worries that her immune system is starting to fail.
“It symbolizes the hollow protection that MPP offers,” said Alexis Lucero, her lawyer.
She fled Honduras after her HIV status was made public and she was accused falsely of trying to infect members of the community. Local criminal groups showed up at her house, threatening to kill her.
In fact, she said, she contracted the disease from her first and only sexual partner, the father of her child.
When she arrived in Mexico, she was afraid to share her HIV status at the migrant shelter. U.S. immigration officials didn’t explain where she could find treatment in Mexico after she disclosed her condition. She’s afraid to ask around about where she can refill her antiretroviral drugs.
“I’m worried that people here will find out that I have HIV, and then what will happen? Will they kick me out or come after me?
“I thought the U.S. agents would understand, that they would allow me to get help in America. But they sent me back here and I didn’t know what to do.”
This article was initially published on Feb. 28, 2020. It has been updated to include subsequent rulings by the U.S. Court of Appeals for the 9th Circuit and the Supreme Court.
Gabriela Martínez in Mexico City and Nick Miroff in Washington contributed to this report.