Image: Free HIV/Aids test in El Salvador
Oscar Rivera  /  EPA file
A nurse in San Salvador, El Salvador, takes blood for a free HIV/AIDS test last month. Under changes proposed by U.S. health officials, HIV-positive visitors and immigrants from foreign countries would no longer be barred from entry.
By JoNel Aleccia Health writer
msnbc.com
updated 7/17/2009 7:00:26 PM ET 2009-07-17T23:00:26

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.

“We’re trying to end the stigma and the discriminatory practice for a disease that doesn’t warrant exclusion for coming into this country,” said Dr. Martin Cetron, director of the CDC’s Division of Global Migration and Quarantine. “We have to appreciate this is not a threat we face from abroad.”

The proposed rule comes more than a year after Congress voted to repeal 1987 restrictions on HIV-positive immigrants as part of a package of AIDS reforms proposed by President George W. Bush.

Although that removed the legal requirement that HIV-infected people be excluded, the Health and Human Services department has final say over whether the disease remains on the no-entry list.

“HIV is clearly a public health disease of significance,” Cetron said. “But in simply allowing in someone who’s HIV-positive, that individual doesn’t immediately pose a risk to the public.”

As it stands now, HIV is among several diseases that require exclusion, including active tuberculosis, infectious gonorrhea, syphilis and infectious leprosy. Also on the list are little-known sexually transmitted conditions such as chancroid, lymphogranuloma venereum or LGV, and granuloma inguinale. CDC officials said they may consider removing those conditions in the future, but wanted to move first to align health regulations with the new HIV statute.

Foreigners also can be excluded if they have quarantinable diseases designated by a presidential executive order and if they're affected during outbreaks that are public health emergencies of international concern.

‘No scientific or public health rationale’
Infectious disease experts and AIDS advocates already are cheering the plan to remove the HIV ban, which was enacted at a time when people — and politicians — wrongly feared that the disease could be spread through casual contact, said Dr. Michael Saag, incoming chairman of the HIV Medicine Association.

“There is no scientific or public health rationale for excluding people with HIV infection from the U.S.,” said Saag, who also heads the division of infectious diseases at the University of Alabama at Birmingham. “Frankly, it was a bit of an embarrassment, even then.”

But immigration critics say they’re leery of the proposal that could allow an average of 4,275 HIV-infected people into the country annually, with a lifetime medical cost of about $94 million for those admitted during the first year, according to CDC estimates published this month in the Federal Register.

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“It becomes a matter of collective responsibility because of the cost,” said Ira Mehlman, a spokesman for the Federation for American Immigration Reform, a nonprofit group based in Washington, D.C. “The American people shouldn’t be in a position where they have to pay for it.”

Others are concerned that HIV-positive visitors and immigrants will spread the disease.

Critics worry about cost, transmission
“It seems rather odd to let people in with a health problem like that,” said John Vinson, president of the American Immigration Control Foundation based in Monterey, Va. “With HIV and the way it’s spread, people have desires and they’ll act on those desires and spread it to other people. Why bring on a problem on yourself when you don’t have to?”

About 1 million immigrants move to the U.S. each year, and about 6.6 million people visit using nonimmigrant visas, according to State Department statistics. The new rule would authorize entrance for those formerly barred solely because they have HIV, and it would eliminate the disease from the routine medical exams now required for immigration and for certain travelers.

More than 1.1 million people in the U.S. are infected with HIV and more than 250,000 remain undiagnosed, according to CDC estimates. Every year, about 56,000 people in the U.S. are newly infected with the virus.

The travel and immigration ban was first enacted by Congress in 1987, and upheld in 1993, at a time when AIDS was believed to be death sentence and people thought it might be spread by kissing or sharing towels, said Carl Schmid, deputy executive director of The AIDS Institute based in Washington, D.C. and Tampa, Fla.

“It was a very hysterical reaction,” Schmid said.

Visitors could seek waivers to the law, but many feared branding themselves as HIV-positive and jeopardizing future citizenship, advocates said. Because medical exams are required for travelers only at the discretion of overseas or U.S.-based immigration officials, some people simply would hide their HIV status, Saag said.

In the past two decades, HIV has become a manageable, chronic condition that can be controlled with drugs sothat patients can live a normal lifespan, Saag said. HIV treatment is generally cheaper and more widely available in other countries than in the U.S., said Saag, so people wouldn’t necessarily be motivated to come to the U.S. for care.

U.S. among 12 countries that bar entry
During that time, the U.S. has not been able to host a scientific conference on HIV because of the ban, Saag said. The rule puts the nation in the company of a dozen countries that deny entry to HIV-infected people including Armenia, Brunei, Iraq, Libya, Moldova, Oman, Qatar, the Russian Federation, Saudi Arabia, South Korea and Sudan.

“It’s like a rogues’ gallery,” Saag said.

The vote by Congress last summer to lift the travel ban was one of several provisions of the President’s Emergency Plan for AIDS Relief,  or PEPFAR, a widely praised accomplishment of the Bush administration.

If people not familiar with the issue are surprised at the proposal to reverse the ban, it's likely because they haven't kept up on the progress of HIV spread and treatment, said Phil Curtis, director of government affairs for the AIDS Project of Los Angeles.

"Especially people who are not at high risk for HIV, they may go around with very outdated and fearful ideas about this disease that just don't hold up under educated scrutiny," Curtis said.

It’s not clear when a new rule would take effect, but Schmid and Saag said most advocates are hopeful it could happen before the end of the year.

“Then end is in sight, definitely,” Schmid said.

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