Happy HIV/AIDS Awareness Day - Thank you President Obama for Removing HIV Exclusion

As a part of HIV/Aids Awareness Day and in case anyone did not follow- On October 30, 2009, President Obama lifted the archaic policy of banning HIV positive individuals from entering the US.

Via New York Times:

At a White House ceremony, Mr. Obama announced that a rule canceling the ban would be published on Monday and would take effect after a routine 60-day waiting period. The president had promised to end the ban before the end of the year.

“If we want to be a global leader in combating H.I.V./AIDS, we need to act like it,” Mr. Obama said. “Now, we talk about reducing the stigma of this disease, yet we’ve treated a visitor living with it as a threat.”

The United States is one of only about a dozen countries that bar people who have H.I.V., the virus that causes AIDS.

President George W. Bush started the process last year when he signed legislation, passed by Congress in July 2008, that repealed the statute on which the ban was based. But the ban remained in effect.

It was enacted in 1987 at a time of widespread fear that H.I.V. could be transmitted by physical or respiratory contact. The ban was further strengthened by Congress in 1993 as an amendment offered by Senator Jesse Helms, Republican of North Carolina.

Because of the restriction, no major international conference on the AIDS epidemic has been held in the United States since 1990. Public health officials here have long said there was no scientific or medical basis for the ban.

According to the organization, Immigration Equality, the 11 other countries that ban HIV-positive travellers and immigrants are: Armenia, Brunei, Iraq, Libya, Moldova, Oman, Qatar, Russia, Saudi Arabia, South Korea and Sudan.

See my old posts here and here.

Jury Rules in Favor of Hospital for Deportation

I have blogged about the case of a Luis Alberto Jiménez who was deported....by a hospital- Martin Memorial Medical Center in Florida. Today, a jury in Stuart, Fla., decided Monday that Martin Memorial Medical Center did not act unreasonably when it chartered a plane and repatriated a severely brain-injured Guatemalan patient against the will of his guardian.

The New York Times reports:

The case of Mr. Jiménez, which was featured in an in-depth report in The New York Times last summer, is believed to be the first to test the legality of patient repatriations and to judge the liability of the hospitals that undertake them. Such repatriations are a relatively rare but widespread practice, especially in cases involving catastrophic injuries or serious illnesses, where patients need continuing care that is not covered by Medicaid because of their immigration status.

The jurors, all of whom were white, with no Hispanics among them, declined to discuss the verdict; one said, “It was a very tough decision.”

Mr. Jiménez’s cousin and legal guardian, Montejo Gaspar, filed the lawsuit seeking nearly $1 million to cover the costs of providing care for Mr. Jiménez in Guatemala and seeking damages for what he essentially saw as the hospital’s kidnapping and deportation of his profoundly disabled cousin.

A Mayan Indian from the highlands of Guatemala, Mr. Jiménez paid a smuggler to transport him to the United States about a decade ago so he could work as a gardener and send money home to his wife and two sons. He had been living in Stuart with Mr. Gaspar for just under a year when a drunken driver in a stolen vehicle plowed into his car in the winter of 2000.

Now 37, Mr. Jiménez, who cannot walk and has the mental age of a child, lives in a one-room house in a remote village, tended by his elderly mother. He is largely confined to his bed and suffers from routine seizures. When The Times visited him last summer, he had not received medical care for over five years.

Here is the Wall Street Journal Blog.

Removal of HIV Exclusion this year?

Foreigners who have HIV would be allowed to travel and immigrate to the United States under a plan by federal health officials to lift a 22-year ban on infected visitors that critics say was unnecessary from the start.

Officials at the Centers for Disease Control and Prevention are seeking public comment through Aug. 17 on the proposal, which would remove HIV from the list of diseases that can bar entry to the country and do away with HIV testing as part of medical exams for permanent residence and, in some cases, travel visas. For the full story, click here.

(HT: ImmigrationProf Blog)

See this report by Human Rights Watch on the deadly barriers that HIV positive migrants face entitled "Discrimination, Denial, and Deportation: Human Rights Abuses Affecting Migrants Living with HIV,"

Andrew Sullivan on Michael Jackson

One of the best pieces I have read on Michael Jackson's passing is by Andrew Sullivan:

There are two things to say about him. He was a musical genius; and he was an abused child. By abuse, I do not mean sexual abuse; I mean he was used brutally and callously for money, and clearly imprisoned by a tyrannical father. He had no real childhood and spent much of his later life struggling to get one. He was spiritually and psychologically raped at a very early age - and never recovered. Watching him change his race, his age, and almost his gender, you saw a tortured soul seeking what the rest of us take for granted: a normal life.

But he had no compass to find one; no real friends to support and advise him; and money and fame imprisoned him in the delusions of narcissism and self-indulgence. Of course, he bears responsibility for his bizarre life. But the damage done to him by his own family and then by all those motivated more by money and power than by faith and love was irreparable in the end. He died a while ago. He remained for so long a walking human shell.

I loved his music. His young voice was almost a miracle, his poise in retrospect eery, his joy, tempered by pain, often unbearably uplifting. He made the greatest music video of all time; and he made some of the greatest records of all time. He was everything our culture worships; and yet he was obviously desperately unhappy, tortured, afraid and alone.

I grieve for him; but I also grieve for the culture that created and destroyed him. That culture is ours' and it is a lethal and brutal one: with fame and celebrity as its core values, with money as its sole motive, it chewed this child up and spat him out.

I hope he has the peace now he never had in his life. And I pray that such genius will not be so abused again.

Also, completely unrelated to Michael Jackson, but also posted by Andrew Sullivan is 'A Milestone on the HIV Ban.'

Americans Traveling to Mexico for Healthcare

We have all heard about medical tourism, people going to other countries to get better healthcare. Interestingly, many Americans assume that immigrants come here to get better treatment when in reality many American leave the country to go elsewhere to get better treatment. A new study by the UCLA Center for Health Policy Research states that nearly 1 millions Californians seek medical care in Mexico annually.

Driven by rising health care costs at home, nearly 1 million Californians cross the border each year to seek medical care in Mexico, according a new paper by UCLA researchers and colleagues published today in the journal Medical Care.

An estimated 952,000 California adults sought medical, dental or prescription services in Mexico annually, and of these, 488,000 were Mexican immigrants, according to the research paper, "Heading South: Why Mexican Immigrants in California Seek Health Services in Mexico."

"What the research shows is that many Californians, especially Mexican immigrants, go to Mexico for health services," said lead author Steven P. Wallace, associate director of the UCLA Center for Health Policy Research, which conducts CHIS. "We already know that immigrants use less health care overall than people born in the U.S. Heading south of the border further reduces the demand on U.S. facilities."

Even Governor Schwarzenegger acknowledges that immigrants are needlessly scapegoated on budget issues

New Study on Immigrant Health Care

An article in the Journal of the American Academy of Physicians Assistants analyzes the cost of health care for immigrants. Just as the uninsured population of undocumented immigrants is high, their use of health care services is low.

The full article can be found on the JAAPA website at:

http://www.jaapa.com/Immigrant-health-care-in-the-United-States-What-ails-our-system/article/130524/

(HT: Immigration Law Reform Blog)

More on Autism among the Somali Population in Minneapolis

Confirming the fears of Somali immigrants in Minneapolis, the Minnesota Health Department agreed that young Somali children there appeared to have higher-than-usual rates of autism. The New York Times reports:

Though health officials emphasized that their report was based on very limited data, they concluded that young Somali children appeared to be two to seven times as likely as other children to be in classes for autistic pupils.

Dr. Sanne Magnan, the state health commissioner, said the finding was “consistent with the observations by parents,” who have been saying for more than a year that alarming numbers of Somali children born in this country have severe autism.

Dr. Magnan said possible next steps included extending the study to Minneapolis suburbs or other cities with Somali populations or doing a study based on medical diagnoses that would try to determine autism rates statewide.

There have been anecdotal reports of higher autism rates among Somalis in some American cities, and no formal studies. A small study in Sweden reported high rates among Somali schoolchildren in Stockholm.

Responding to the Health Needs of Refugees: Minneapolis, MN

Another part in the 'Remade America' series by the New York Times describes the difficulties of treating the health problems of refugees and immigrants, using Minneapolis, MN as an example city:

Many arrive with health problems seldom seen in this country — vitamin deficiencies, intestinal parasites and infectious diseases like tuberculosis, for instance — and unusually high levels of emotional trauma and stress. Over time, as they pick up Western habits, some develop Western ailments, too, like obesity, diabetes, and heart disease, and yet they often question the unfamiliar lifelong treatments these chronic diseases need.

Some also resist conventional medical wisdom or practices, forcing change on the hospital. The objections of Somali women to having babies delivered by male doctors has led Hennepin, gradually, to develop an obstetrical staff made up almost entirely of women.

Doctors here say that for many of these newcomers, the most common health problems, and the hardest to treat, lie at the blurry line between body and mind, where emotional scars from troubled pasts may surface as physical illness, pain and depression.

If they were not treated here, where would they be treated?

Autism among the Somali Population in Minneapolis

Autism is terrifying the community of Somali immigrants in Minneapolis, and some pediatricians and educators have joined parents in raising the alarm. But public health experts say it is hard to tell whether the apparent surge of cases is an actual outbreak, with a cause that can be addressed, or just a statistical fluke. The New York Times reports:

In an effort to find out, the Minnesota Department of Health is conducting an epidemiological survey in consultation with the federal Center for Disease control and Prevention. This kind of conundrum, experts say, arises whenever there is a cluster of noncontagious illnesses. Since the cause of autism is unknown, the authorities in Minnesota say it is hard to know even what to investigate.

A small recent study of refugees in schools in Stockholm found that Somalis were in classes for autistic children at three times the normal rate.

Calls to representatives of Somali groups in Seattle and San Diego found that they were aware of the fear in Minneapolis but unsure about their own rates. Doctors familiar with the Somali communities in Boston and Lewiston, Me., had heard of no surges there.

Speculation is rampant about possible causes: living conditions in Somalia or in refugee camps in Kenya; traditional medicines; intermarriage; genetic predisposition; vitamin D deficiencies due to a lack of sunlight; and, of course, vaccines. But each theory has weaknesses.

Somalis began arriving in Minneapolis in 1993, driven out by civil war; now their population in Minnesota is estimated at 30,000 to 60,000. The city is welcoming and social benefits are generous, but many live a life apart as conservative Muslims, the women in head scarves and long dresses. Many Somali men have jobs as taxi drivers or security guards; others are accountants or run shops in the mini-malls catering to Somalis.

One question I would have is what is the rate of Autism in Somalia? When I worked with the Somali community in Birmingham, England, many of the women talked about Autism, but talked about it a way where they would say that their children "caught the disease here." Autism is a Western diagnosis and it is possible that many people in Somalia have it, but do not know what it is. Although this would not determine the cause, it would at least be able to lead to an understanding about whether this is a problem in immigrant communities or a problem among Somalis.

Trauma Among Muslims in America

The terrorist attacks of September 11, 2001 catalyzed a wave of research on the traumatic effects of the tragedy on residents across the US. However, according to research in a recent issue of the Journal of Muslim Mental Health (Volume 3, Number 2, 2008), Arab and Muslim Americans were largely ignored from these studies, revealing the lack of sufficient support for this community from Western mental health services and professionals.

The papers presented capture the perspectives of immigrants, second and later generation individuals, refugees, imams (Muslim religious leaders), and mental health providers. Articles include:

• An examination of the role of imams in Muslim mental health promotion in the wake of September 11, 2001, focusing on twenty-two mosques in New York City
• A study of the impact of media upon Iraqi refugees in the US, which finds that refugees’ exposure to coverage of the war in Iraq bears physical and mental effects comparable to war-related death or injury of family and friends
• An exploratory study of the effects of the September 11, 2001 terrorist attacks on the Arab American community of New York City, in which participants discuss fear of hate crimes, stigmatization, and isolation; concerns that are compounded by barriers to social and mental health services.
• A groundbreaking empirical study based on interviews of fifty social work practitioners servicing Muslim clients residing in Canada

Sexually Assaulted Female Immigrants Denied Reproductive Rights

Current U.S. immigration detention policy includes locking up women who have been raped and then denying them access to abortion services. Kevin Sieff writes in the Texas Observer:

In 2008, 10,653 women were detained by U.S. Immigration and Customs Enforcement (ICE). According to agency spokeswoman Cori Bassett, 965 of those women — nearly 10 percent — were pregnant. Many of them, were raped on their way to the United States—a journey known to be dangerous for any willing to take it, but especially so for women. For pregnant women in immigration detention facilities, it is virtually impossible to obtain an abortion. “Preliminary records indicated that during fiscal year ’08 and ’09 to date, no detainee has had a pregnancy terminated while in ICE custody.” Not a single one.

With the prevalence of rape among immigrants and the government’s increasingly stringent immigration enforcement policies, ICE’s treatment of pregnant detainees has become particularly relevant in recent years.

Medical services within ICE detention facilities, including requests for abortions, are handled by the Division of Immigration Health Services, a subagency of the Department of Health and Human Services. The division has sometimes scrambled to fulfill its growing responsibilities, since ICE was created out of the now-defunct Department of Immigration and Naturalization Services.

The joint policy of the division and ICE is to not fund elective procedures, including abortions. On its “Detainee Covered Service Package,” the division lists abortion as an example of commonly requested procedures that are “not covered but can be requested in the event of an emergency situation.” “ICE must pay for the termination of a pregnancy if a physician determines that the continuation of a pregnancy is life-threatening for the mother.”

ICE’s policy on abortion is markedly different than that of its sister organization, the U.S. Bureau of Prisons, which requires that each pregnant inmate receive counseling to help her decide “whether to carry the pregnancy to full term or to have an elective abortion,” according to federal regulations. If a detainee asks for an abortion, the prison’s clinical director “shall arrange for an abortion to take place.”

Why do we Still Have HIV Exclusion?

The Senate last year repealed the law banning HIV+ people from visiting or immigrating to the U.S.

So why is the policy still in place?

Why are green card applications from HIV+ applicants still getting denied?

Nobody seems to know.

Sign the Letter to President Obama!

Dear President Obama,

We write to urge you to order the Department of Health and Human Services ("HHS") to publish a proposed rule to remove HIV from the HHS list of communicable diseases of public health significance as soon as possible.

As a former co-sponsor of the President's Emergency Plan for AIDS Relief ("PEPFAR"), we are sure you are aware that this landmark legislation included a provision which struck the statutory language that required HIV to be designated a communicable disease of public health significance. In response to concerns about the potential increased costs to the U.S. health care system of removing HIV from the list, PEPFAR also raised future visa fees as an offset. On July 30, 2008, President Bush signed PEPFAR into law completing the first step in a two step process to end the ban.

President Obama signs SCHIP

President Obama signed into law the 2009 Children's Health Insurance Program Reauthorization Act (CHIPRA - H.R.2). Passed with bi-partisan support in the House and Senate and with unwavering support by President Obama, the bill reauthorizes the successful Children's Health Insurance Program (CHIP), which provides states with federal dollars to provide health coverage to our nation's children. The bill also takes an important step to ensure all children in the U.S. have the opportunity to be healthy by removing the five-year waiting period for many legal immigrant children and pregnant women and allowing states to use federal funding to provide health coverage through the CHIP and Medicaid programs to these future citizens.

Streamlined Process for HIV Exlcusion Enacted

According to the DHS Fact Sheet:

• Under the new regulation, U.S. Department of State consular officers overseas will now have the authority to grant non-immigrant visas to otherwise eligible HIV-positive people who meet certain requirements, instead of waiting for a special waiver from DHS.

• In fiscal year 2007, the average processing time for DHS to make decisions on such consular recommendations (for the issuance of non-immigrant visas and authorization for temporary admission) was 18 days. The final rule streamlines this process, and will make visa authorization and issuance available to many otherwise eligible HIV-positive travelers on the same day as their interview with a U.S. Consular officer.

• The final rule applies only to foreigners who are HIV-positive and seek to enter the United States as visitors for up to 30 days; these individuals still must meet all of the other normal criteria for the granting of a U.S. visa. The issuance of visas under the rule will also be subject to certain criteria designed to ensure an HIV-positive person’s activities while in the United States do not present a risk to the public health.

• Visas issued under this final rule will not publicly identify any traveler as HIV-positive.

Previously, the U.S. Department of State had to make individual recommendations on HIV-positive travelers to DHS, which then conducted a case-by-case evaluation to determine an applicants temporary admission to the United States. The State Department would occasionally recommend, and DHS approve, group waivers for events at the United Nations or other international gatherings in the United States.

Since 1952, U.S. law and regulation have made persons “who were afflicted with any dangerous contagious disease” ineligible to receive a visa to enter the United States. People infected with HIV have been inadmissible to the United States since 1987, when Congress directed the U.S. Department of Health and Human Services (HHS) to add HIV to its list of diseases of public health significance. Accordingly, foreigners infected with HIV have been ineligible to receive U.S. visas without a waiver by the U.S. Government.

HHS is currently beginning the rulemaking process to remove HIV from the list. In the meantime, the DHS HIV Waiver Final Rule fulfills the President’s promise to create a streamlined process for otherwise eligible HIV-positive individuals to gain temporary admission to the United States. On Dec. 1, 2006, President Bush directed the Secretaries of State and Homeland Security to initiate a rulemaking that proposed a categorical waiver for otherwise eligible foreigners who are HIV-positive and who seek to enter the United States on short-term visas.

The US removes the HIV Exclusion ban?

While some are ecstatic about the PEPFAR reauthorization bill that not only directed $50 billion to halt the spread of HIV/Aids in developing countries, they also eliminated the 21 year old ban on HIV-positive visitors and immigrants. Others warn that even if the bill passes, the Department of Health and Human Services (HHS) maintains the final word on the ban. Although HHS officials previously expressed a willingness to remove the ban, they may delay the decision until the next administration takes office.

Lesotho Children Dialing 800- 22-345 for help

In the two months since the government of Lesotho launched the county's first national child helpline, almost 500 orphans and vulnerable children have picked up the phone to demand assistance and an ear. The government of Lesotho, with support from UNICEF, the Global Fund to Fight AIDS, Tuberculosis and Malaria, various non-governmental organisations (NGOs) and the Lesotho Telecommunication authorities, opened the lines to the service on April 30, 2008. The toll-free number - 800 22 345 - opens a channel of communication between children and service providers, offering 24-hour counselling, support and protection services

467 calls had already been dealt with. In 160 cases the caller hung up immediately, and in 279 cases children were seeking information and general counselling.

Womens Commission Releases Report on Disabled People Fleeing from Conflict

The Women's Commission for Refugee Women and Children today released "Disabilities among Refugees and Conflict-Affected Populations," the first major report to address the critical needs of a virtually invisible population: refugees and people displaced within their own countries who suffer from physical, sensory or mental disabilities

Reuters:

The report is the culmination of a six-month project led by the Women's Commission and co-funded by the United Nations High Commissioner for Refugees (UNHCR). It is based on fact-finding missions to Ecuador, Yemen, Jordan, Thailand and Nepal (as well as significant field input from Darfur and Kenya), interviews with United Nations agencies and local organizations on the ground, and focus group discussions with refugees and others uprooted from their homes. Colombian, Somali, Iraqi, Burmese, Bhutanese and Sudanese populations were studied in camps and urban environments, in both emergency and protracted situations, with a particular focus on women, children and adolescents.

Among the greatest challenges identified by the report were the identification of and accumulation of real data on the numbers of people with disabilities. This population is currently not counted in refugee registration drives or identified in data collection rounds. The World Health Organization (WHO) estimates that there are 600 million people with disabilities worldwide--between 7 and 10% of the world's population. Based on this estimate, the Women's Commission believes that between 2.5 and 3.5 million of the world's 35 million displaced people also live with disabilities; however, among those who have fled conflict or natural disasters, the number may be even higher.

The report notes serious problems with the physical layout and infrastructure of the camps--few services are accessible to people with disabilities, including toilets, shelters and health facilities. In general, no special accommodations are made for getting food and other supplies that refugees with disabilities need on a daily basis. Many are housebound, rarely leaving their shelters. Not surprisingly, their voices go unheard in decision-making activities for their communities.

"Disabilities among Refugees and Conflict-Affected Populations" also reveals a disparity between refugee camps and urban areas: in camps there is a greater awareness about the needs of the disabled and better services than in urban environments, where refugees with disabilities are unable to access services offered by the host government and virtually no one is providing special assistance to them. The Women's Commission also found greater discrimination and stigmatization towards the mentally disabled population; assistance programs, when available, tend to focus on those with physical and sensory disabilities.

Yet, key findings also include a few positive developments, in particular with regard to children in refugee camps. Many children with disabilities are attending primary schools, some of which have special education teachers. For the parents of the disabled, some camps offer support groups as well as home visits for instruction in sign language, Braille and rehabilitative exercises.

To reinforce the report's findings and improve protection and services for refugees with disabilities, the Women's Commission created a resource kit to provide practical guidance for UNHCR and humanitarian agency field staff. Major recommendations include making refugee camps accessible to people with disabilities and ensuring that they have full and equal access to the mainstream services that other refugees receive.

Paul Farmer on 60 Minutes

For more on Paul Farmer, read Mountains Beyond Mountains

HIV and the Peace Corps

It would appear that the Peace Corps with its lofty goals of promoting understanding between countries discriminates against volunteers that are HIV positive but healthy.

The American Civil Liberties Union on behalf of Jeremiah S. Johnson is suing the Peace Corps after Mr. Johnson was asked to leave the Peace Corps when the country director of the Ukraine discovered that he was HIV positive.

"Mr. Johnson, 25, who was HIV-negative when he joined the Peace Corps, had been teaching English to middle and high school students in Rozdilna, Ukraine, since December 2006. While in Kiev this past January for a Russian language program attended by other Peace Corps volunteers, Mr. Johnson received a midservice medical exam and consented to an HIV test. The results came back positive. He was given two days to shut down his work, pack up his belongings in Rozdilna and head back to Washington."

With all of work the Peace Corps does in dealing with HIV-AIDS around the world, it should know better than to discriminate against its own volunteers.

But, perhaps the Peace Corp is not doing enough in general as recipient countries want more skilled volunteers.

Sports school gives hope to Colombian refugees in Ecuador

Race walking, a sport that won Ecuador its only gold medal, is giving hope to some Colombian refugee children a chance at a new life in Ecuador. The Race Walking School in Cuenca, which is known for the training of Ecuador's finest athletes has opened its doors to the refugees in hopes the program will help children settle into their new life.

"Joakim Daun, a Swedish intern with the UNHCR office in Cuenca, came up with the idea of starting the scholarship programme. A former athlete, Daun said he recognized the power of sports as a tool for personal development and as an engine for integration."

According to UNHCR estimates, Ecuador is home to at least 180,000 people who have fled Colombia because of the internal conflict in that country. Only 55,000 have applied for asylum.