Obama Administration Proposes to End HIV Immigration Ban

The Department of Health and Human Services, Centers for Disease Control and Prevention, have published a proposal to eliminate the current requirement that applicants for immigration to the United States (or for regularizing their status after arriving here) be tested for HIV and excluded if they are HIV+, subject to the possibility of obtaining a waiver.  Under the proposed rule, published in the Federal Register on July 2, both the exclusion and the testing requirement would be eliminated from 42 CFR Part 34, the location in federal regulations of medical exclusions.  See 74 Fed. Reg. No. 126, pages 31797-31809.

The proposal, accompanied by explanatory documentation, is an extensive document, as required by practice and custom to inform the public of the reasons for a proposed administrative action so that comments can be submitted and taken into account by the agency before issuing a final regulation.  In this case, comments are due to HHS by August 17, 2009.  They can be submitted via email to Part34HIVcomments@cdc.gov.  They can also be submitted in hard copy through regular mail to Division of Global Migration and Quarantine, CDC, US Department of HHS, Attn: Part 34 NPRM Comments, 1600 Clifton Road, NE, MS E-03, Atlanta, Georgia 30333.   There is also an all-purpose internet website for receiving comments on regs: http://regulations.gov.

Most the supplementary material concerns the history of the HIV ban, which was adopted during the 1980s prior to the major breakthroughs in medical treatment that have made HIV infection a manageable disease for those who have access to current treatment and who are lucky enough not to experience intolerable side-effects from treatment or develop resistance that can't be overcome by newer meds.  the new treatments, introduced in the mid-1990s, have caused the mortality rate associated with HIV to plummet, and it is anticipated that in the U.S. among those who can access treatment, lifespans may return to something like their pre-AIDS-crisis norms.

HHS makes the point in this document that the reason for the exclusion does not really apply to HIV infection, because it is not casually transmitted.  The document actually deals with this issue in a rather cursory manner.  It is clear that most of the analytical work behind this document relates to the questions of costs and benefits.  As part of its function as an administrative agency proposing a change in federal regulations, HHS/CDC is required to estimate the benefits and costs of the change as compared to the status quo or other alternative courses of action.  HHS/CDC identifies three potential courses of action with respect to the HIV ban - status quo, remove the ban but continue requiring testing, or remove the ban and discontinue requiring testing.  They are proposing the third, but indicate that they are open to arguments about whether testing, either mandatory or elective, should remain in the mix.  There is an interesting discussion about the pros and cons on the testing question.

Most significant is the attempt to quantify costs.  Here the great difficulty is the need to estimate incidence, especially when we are talking about immigration from a range of countries that varies widely in the quality of data available about HIV prevalence, and the even greater difficulty of estimating what portion of the immigrant pool in a given year is likely to be HIV-infected.  Furthermore, the data on costs of HIV treatment are a moving target, and there are a variety of ways that people may finance those costs in our economy, lacking a uniform national health care system of the type common in some other countries.  The best estimates they come up with is that changing the rule may generate millions of dollars in additional costs, but the exact amount is not certain because so many factual assumptions need to be made without really solid data to back them up.

Anyone who is interested in submitting a comment to HHS/CDC should probably click on the link below, print out the complete proposal for themself, and then address those issues on which they have relevant expertise to offer.  There is probably plenty of room for activist and advocacy comment, but the most valuable comment would come from people with relevant knowledge and access to information to case light on the points on which the proposal is vague or uncertain.

Here's the link:

http://edocket.access.gpo.gov/2009/E9-15814.htm

Once comments have been submitted, they will be available for viewing at http://www.cdc.gov//ncidod/dq.

Comments

[living with hiv]

I have been following this blog for quite a some time and I have found this blog to be very useful and informative. It is very good to know that Obama adminstration is ending the HIV Immigration Ban. This was a very inhuman law. We all know that AIDS is one of the most dreaded diseases in the world and it prevails in all the countries. So how could American administration impose such an unfair law?
Anyways, its going to be a part of history now.

Hiv home test

[Art Leonard]

Thanks for your comment. I recommend submitting a comment to HHS/CDC at the email address listed in my blog posting. While it is not purely a case of counting submissions on "each side" of an issue, it can be helpful have many comments endorsing the proposal to counterbalance those that may be submitted opposing it.