As of Thursday, August 13, the comment letter has been submitted, and no further organizations can be added.

Please sign the organizational comment letter to end the HIV ban.

As many of you no doubt know, for over two decades there has been a ban on travel or immigration to the U.S. for foreign nationals who are HIV positive.  Last summer, Congress acted to remove the statutory ban on HIV, restoring jurisdiction to the Department of Health and Human Services to determine whether HIV constitutes a “communicable disease of public health significance.”  On July 2, 2009, HHS issued proposed regulations which would remove HIV from this list, and thereby remove HIV as a ground of inadmissibility.  The comment period closes on August 17, 2009 and we intend to submit this organizational sign-on letter on Thursday August 13, 2009.  Please email vneilson@immigrationequality.org if you have any questions.

Docket ID:  CDC-2008-0001
Docket Title: Medical Examination of Aliens – Removal of Human Immunodeficiency Virus (HIV) Infection from Definition of Communicable Disease of Public Health Significance
RIN:    0920-AA26

We support the proposed rule that would that would lift the immigration ban on visitors and immigrants living with HIV, stop unfair mandatory HIV testing of immigrants and remove references to HIV from the scope of examinations in its regulations.  This change will restore the U.S. as a leader in the areas of human rights, equal treatment under the law and public health.

The undersigned organizations, representing civil rights, clinical, immigration, HIV advocacy, public health and other constituencies respectfully submit these comments on the proposed rule by the U.S. Department of Health and Human Services to revise the Part 34 regulation to remove “Human Immunodeficiency Virus” (HIV) infection from the definition of “communicable diseases of public health significance” and to remove references to “HIV” from the scope of examinations in its regulations.
 
The rationale for our support is as follows:

1. There is no scientific or public health justification for HIV-related restrictions on entry, stay, and residence.

According to the U.S. government’s own agencies, HIV is transmitted through bodily fluids, is not airborne and is not transmitted through casual contact.

Public health officials within the United States have acknowledged that there is no public health justification for excluding people with HIV.   When commenting on its own HIV-specific restrictions in 1991, the Centers for Disease Control and Prevention (CDC) stated: “The risk of (or protection from) HIV infection comes not from the nationality of the infected person, but from the specific behaviors that are practiced.  Again, a careful consideration of epidemiological principles and current medical knowledge leads us to believe that allowing HIV-infected aliens into this country will not impose a significant additional risk of HIV infection to the U.S. population, where prevalence of HIV is already widespread.”¹

From a public health perspective, encouraging people living with HIV to take antiretroviral drugs minimizes the likelihood of developing drug resistance by not skipping doses. In surveys done over the past decade, it appears HIV-specific entry and immigration restrictions have pressured some people to conceal their HIV status from U.S. immigration authorities by not bringing HIV medicines with them on international trips. Repealing this ban will allow HIV-positive travelers to continue their medication uninterrupted.

2. Restrictions on entry, stay and residence based on HIV status are discriminatory.

Since there is no evidence that a travel ban based on HIV status is an effective public health strategy, the differential treatment based on HIV status is discriminatory and not justified. The current policy promotes discrimination against HIV-infected immigrants and causes many immigrants to avoid HIV testing or treatment for fear of deportation and stigma.

This regrettable policy contradicts the historical leadership position of the United States in science, research and development, public health and in the global fight against AIDS. The current policy prevents or hinders people living with HIV, ironically including those who have benefited from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), from entering the United States and participating in critical meetings that shape global HIV policy and research.  Because of this policy, important public health meetings and HIV conferences such as those hosted by the International AIDS Society have not been held in the United States since 1990. 

3. The enforcement of HIV-related restrictions on entry, stay and residence can, and does, violate other human rights.

The implementation of HIV-related restrictions on entry, stay, and residence can also interfere with the rights to life, privacy, liberty, work and as CDC mentions even within their own justification for this rule, the right to protect the unity of the family.

4. HIV-related restrictions on entry, stay and residence can impede effective responses to HIV.

Since the beginning of the epidemic, it has been repeatedly recognized that it is essential to protect the rights and dignity of people living with HIV and to involve them in the response to HIV not only because it is right but because it leads to the most effective responses to HIV.  This has been confirmed by governments in the Declaration of Commitment on HIV/AIDS (2001)² and the Political Declaration on HIV/AIDS (2006).³  The Joint United Nations Programme on HIV/AIDS (UNAIDS) established an international task team on HIV-related travel restrictions and found that HIV-related restrictions on entry, stay and residence might be harmful to the public health of both citizens and travelers because they:

• Misdirect resources into intimidating screening and enforcement activities versus using these resources to expand voluntary HIV counseling and testing, prevention, treatment and care;
• Drive HIV prevention and care issues, as well as those living with HIV, underground, with negative outcomes for both individual and public health.

5. The costs to the United States taxpayer would not be as high as suggested in the proposed rule. 

While we fully support the proposed rule, we also have concerns about the presentation of the cost estimate model.  First, this estimate does not explicitly differentiate costs between public and private payers.  Significant proportions of these estimated costs would be paid for by other payers outside of the U.S. government such as private insurance and contributions by the individual or by his or her sponsor or family.  Most immigrants are not eligible to receive means-tested public benefits for five years after their entry into the U.S. All immigrants to the United States must document that they will not be a public charge.  

Second, the CDC acknowledges that people with HIV may consume fewer health care resources than immigrants with other conditions.  The costs of treating immigrants with other significant health concerns, e.g., heart disease, renal disease, diabetes, are not considered in determining immigration policy for individuals with these conditions and should not be a factor in setting immigration policy for people with HIV.

Finally, we explicitly support the approach to remove HIV testing from the routine medical examination of lawful permanent resident applicants.  Mandatory testing for HIV infection should no longer be required as described in the proposed rule. People living with HIV should be allowed to enter the U.S. or adjust to permanent resident status if they meet all other conditions of admissibility.  There are clear and important benefits to be accrued from HIV testing. Such testing, however, should not be mandated as part of the routine medical examination for entry into the United States.

For these reasons, we fully support the removal of HIV from the definition of “communicable diseases of public health significance” as well as to remove references to “HIV” from the scope of examinations in its regulations.  

If you have any questions or comments, please contact Victoria Neilson of Immigration Equality at (212) 714-2904 or via e-mail at vneilson@immigrationequality.org.

Thank you.

Signatories:

• Aarogya.com
• Accion Solidaria
• ACLU
• ACT UP Philadelphia
• Action against AIDS Germany
• Actions Traitements
• ADAP Advocacy Association
• Advocates for Youth
• AECOM/DOSA
• African Children And Familly Support
• African HIV Policy Network United Kingdom
• AIDA Family Services
• AIDES France
• AIDS Action Baltimore
• AIDS Action Council
• AIDS Action Committee of Massachusetts
• AIDS Action Europe
• AIDS Alliance
• AIDS Alliance for Children Youth & Family
• AIDS Alliance for Faith and Health, Inc.
• AIDS Calgary
• AIDS Care Ocean State
• AIDS Co
• The AIDS Coalition of Cape Breton
• AIDS Committee of North Bay and Area
• AIDS Committee of Cambridge Kitchener Waterloo and Area
• AIDS Committee of Windsor
• AIDS Foundation of Chicago
• AIDS Help
• AIDS-Hilfe Ahlen e.V.
• Aids-Hilfe Neumünster e.V.
• Aids-Hilfe Saar e.V.
• The AIDS Institute
• AIDS Legal Council of Chicago ALCC
• AIDS Network
• AIDSmeds
• AIDS & Mobility Europe
• AIDS Project Los Angeles
• AIDS Saint John
• AIDS Taskforce of Greater Cleveland
• AIDS Thunder Bay
• AIDS Treatment News
• AIDS Vancouver
• AGIHAS (PLWHA Support group) Latvia
• Aksion plus Albania
• aldo castillo-de leon
• All-Ukrainian Network of People Living with HIV/AIDS
• Alma
• Ambassadors of Change
• American Social Health Association
• American Gay
• AMIGOS
• AMREF
• Apoyo Positivo
• Article 42 of the Constitution
• Asher/Scott Partners
• ASISTA Immigration Assistance
• Association AIDES
• Association against AIDS - JAZAS Serbia
• Association DIAGONALE IDF
• Association of Nurses in AIDS Care
• Association "Pozityvus gyvenimas"
• Association de Lutte Contre le Sida Marocco
• AVAC: Global Advocacy for HIV Prevention
• BCCDC
• Belarusian AIDS Network Belarus
• Body & Soul
• Boulder County AIDS Project
• Breakthrough
• Bruce House
• CAEAR Foundation
• CALCSICOVA
• Cambodian People Living with HIV/AIDS Network (CPN+)
• Cameroon Coalition Against Malaria
• Canadian AIDS Treatment Information Exchange (CATIE)
• Canadian HIV/AIDS Legal Network
• Capital Region USA
• Caribbean HIV/AIDS Youth Network
• Cascade AIDS Project
• Center for Health Policy and Innovation
• Caribbean Vulnerable Communities Coalition
• Charity foundation Kolodets
• Chicago Recovery Alliance
• Christian Comission for Development in Bangladesh
• Cobb Immigrant Alliance
• Communities Delegation
• Community Access National Network
• Community Aid Uganda
• Companion NGO
• Consultant, International Health
• Courage Campaign
• Courtesy Associates
• Cyrus D. Mehta LLP
• Czech AIDS Help Society Czech Republic
• David Geffen School of Medicine at UCLA
• DC Fights Back
• DefendingDissent Foundation
• Delaware HIV Consortium
• Derechohabientes Viviendo con VIH del IMSS (DVVIMSS)
• Destination DC
• Deutsche AIDS-Hilfe e.V.
• DLE Investments
• Doors
• Doorway
• Dutch AIDS Foundation
• Dutch HIV Association
• EAC Inc
• East European & Central Asian Union of PLWH
• ELWA Hospital, Liberia West Africa
• EMO HIV Services
• Empire Justice Center
• EMPOWER
• Equality Illinois
• Estonian Network of People Living with HIV Estonia
• EU HIV/AIDS Civil Society Forum
• Eurasian Harm Reduction Netork
• European Aids Treatement Group (EATG)
• Fahamu
• Family Equality Council
• Finnish AIDS Council Finland
• Fixpunkt e.V.
• Frannie Peabody Center
• Frey Law Office
• Fundacion Salud y Comunidad
• Gama Adisa Quilombo
• GAT -Portugal
• Gardner Family Care Corp
• Gay Activist Alliance Africa
• GAYLIB
• Gay Men's Health Crisis
• Global Network of People Living with HIV
• GNP+NA
• Good Health Educators Initiative, Lagos, Nigeria
• Grant Management Solutions
• Greenwich House, Inc.
• Gregory House Programs
• Groupe sida Geneve
• Grupo Portuges de Activistas sobre Tratamentos de VIH/SIDA
• GSACS
• Harm Reduction Coalition
• Health and Social Development Bulgaria
• Health GAP (Global Access Project)
• Healthy Options Project Skopje Macedonia
• HIV & AIDS Legal Services Alliance
• HIV/AIDS Regional Services
• HIV-Danmark
• HIV Europe
• HIV-foundation Finland
• HIV Law Project
• HIV MANIFESTO group Norway
• HIV Medicine Association
• HIV-Sweden
• HOPE-Cape Town
• Housing Works
• Human Rights Watch
• Hyacinth AIDS Foundation
• IAVI European Network
• ICO "ECUO"
• ICRW
• ICW - International Community of Women
• ILASAP/GCAP/IRMA
• Immigrant Legal Advocacy Project
• Immigration Equality
• ImpAcTAIDS
• The indegeous community of women living with HIV
• Infectious Diseases Society
• INPUD
• Interior Health Authority
• International AIDS Society
• International AIDS Vaccine Initiative
• International Nursing Harm Reduction Network
• International Planned Parenthood Federation European Network
• International Planned Parenthood Federation - Western Hemisphere Region
• International Partnership for Microbicides
• International Women's Health Coalition
• Ishtar MSM
• Islamabad Christians Against Narcotics
• Jamaican Network of Sero-Positives
• John Mordaunt Trust
• Kazan Sar
• KHANA
• LE KIOSQUE
• LABO IST COTONOU
• L'A.R.C.H.E de l,Estrie
• La Raza Unida of the Bay Area
• Leadership Training Institute
• Legal Aid Society of Palm Beach County
• LILA Italy
• Living Hope Support Group
• Living Room, Inc.
• Los Portales Pharmacy
• Makerere University
• Marin AIDS Project
• Medical Foundation for AIDS & Sexual Health
• Medecins Du Monde
• Metropolitan Community Churches
• Michigan HIV/AIDS Council
• Microbicide Trials Network
• The Ministry of Caring, Inc.
• Minnesota AIDS Project
• MIRA Coalition
• Montenegrin Association Against AIDS Montenegro
• Multnomah county POZ
• Nashville CARES
• Nassau/Suffolk Care Network member
• NASTAD
• National AIDS Fund
• National AIDS Trust United Kingdom
• National Alliance of State and Territorial AIDS Directors
• National Association of People with AIDS
• National Center for Lesbian Rights
• National Gay and Lesbian Task Force Action Fund
• National Immigrant Justice Center
• National Immigration Project of the National Lawyers Guild
• National Immigrant Solidarity Network
• National Immigration Forum
• National Health and Education Committee (Burma)
• National Lawyers Guild
• National Women's Health Network
• NEPHAK
• New York Immigration Coalition
• NGO Fhoenix PLUS-Russia
• NGO Leqal Development and Democracy
• NGO Maria
• NGO Support to PLWHIV "Discordant"
• NordPol
• Northern Colorado AIDS Project
• North Shore University Hospital Center for AIDS Research & Treatment
• Northwest Immigrant Rights Project
• ODYSEUS Slovakia
• Oxford
• Partners in Health
• Partnership Project
• Pediatric AIDS Chicago Prevention Initiative
• Peel HIV/AIDS Network
• Perez
• PF "Answer"
• PILSM
• Population Council
• Positive Resource Center
• Positive Women's Network
• Pozfem
• Project Inform
• Projecte dels NOMS - Hispanosida Spain
• Projekt Information
• Queers Against Prisons- Philadelphia
• Raks Thai Foundation
• RAVANE+
• Rectal Microbicide Advocates
• RED HISPANA FLORIDA
• RFHL
• Regional public organisation "Community of People Living with HIV" - Secretariat of the Russian Union of PLHIV
• Release
• Research Unit in Behaviour & Social Issues Cyprus
• RMCHCS
• Rocky Mountain Immigrant Advocacy Network
• Romanian Angel Apeal Foundation Romania
• Rosenbaum Immigration Appeals
• Russian Harm Reduction Network
• SAGA ministry
• Sangha Metta
• Sensoa Belgium
• SERES
• Services, Immigrant Rights, and Education Networt
• Sexologist
• Sexual Health Clinic
• SisterLove, Inc.
• Sisters of Color United For Education
• SKUC-Magnus Slovenia
• Snehalaya Charitable Trust
• Social AIDS Committee Poland
• Society Association HIV-Latvia
• Soros Foundation Moldova Moldova
• South Asian Americans Leading Together
• STI AIDS Netherlands
• St. John's Cathedral HIV Education Centre
• Stony Brook University
• STOP AIDS - Gay Men's HIV Organisation Denmark
• Swaziland Positive Living
• Swiss AIDS Federation (Aids-Hilfe Schweiz) Switzerland
• TAMPEP International Foundation
• Tcell
• Terrence Higgins Trust
• The American Academy of HIV Medicine
• The Forum Link Project
• The International Community of Women
• The Legal Aid Society (NYC)
• The Translational Science Corp
• Tobago Oasis Foundation
• Treatment for Action Campaign
• Treatment Action Group
• TRT-5-France
• UCLA Clincal AIDS Research and Education Center
• UK Community Advisory Board
• UNALS
• Unitarian Universalist Association of Congregations
• United Methodist Church, GBCS
• United Way
• United Way Of Long Island
• University of California, Irvine
• University of Miami
• Urban Coalition for HIV/AIDS Prevention Services (UCHAPS)
• U.S. Positive Women's Network
• Village Care of New York
• Vivir en Positivo
• VYH en Contexto
• Waverley Care
• Werck & Werck
• WNY AIDS Network
• Women and Law-Swaziland
• Women Organized to Respond to Life-threatening Disease (WORLD)
• Woodhull Freedom Foundation
• World AIDS Campaign
• World Learning
• World Organization for Human Rights
• World Vision India

1. Public Health Service (1991), “Medical Examination of Aliens.” 56 Fed. Reg 2,484 (codified at 42 CFR 34).
2. UN Document A/RES/S-26/2 available on-line at http://www.un.org/ga/aids/docs/aress262.pdf
3. See para.20, UN Document A/RES/S-26/2.  Available on-line at http://data.unaids.org/pub/Report/2006/20060615_HLM_PoliticalDeclaration_ARES60262_en.pdf

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