Impact of Immigration Policieson HIV/AIDS Care Access and

Retention

Catalina Sol

Chief Programs Officer

La Clinica del Pueblo

La Clinica del Pueblo Serves uninsured and low-income Latino

immigrants in DC area with comprehensive health care

Majority of clients are Central American immigrants with history of war and trauma, rural origin, limited access to health care, lengthy process to obtain legalization in US

Since its inception in 1993, La Clinica has been a Latino community-based organization

La Clinica’s HIV Department Provides HIV care and prevention services

since 1985 Funded locally with Ryan White since 1993

for direct services, directly-funded by CDC since 1998 for prevention

Services include primary medical care, case management, mental health and substance abuse services,, support groups, interpreter services, outreach, group interventions for vulnerable populations, CTR, system navigation

Barriers to Detection and Early Intervention

Lack of linguistically and culturally appropriate, geographically accessible services

Lack of access to health care Health beliefs and attitudes related to

knowledge of disease Stigma

Barriers to Care for HIV Positive Latinos Conflicts between work and medical care Instability/lack of availability of housing Lack of family/support structures Lack of linguistically and culturally

appropriate services, particularly mental health services

Stigma

Immigration and Daily Life

What does it mean to be undocumented?– Progressive criminalization of administrative status --

• Relationship to police, law enforcement, state/government entities• Effect on physical and mental health

– Inability to obtain basic documents –social security #, ID• Driving, banking, home renting or ownership, access to services• Effect on social insertion and stability

– Inability to obtain safety net benefits• Effect on socioeconomic status, relationship to employer• Notable exception – Ryan White, ADAP

– Extreme vulnerability with respect to employer

Immigration and Daily Life What does it mean to have a work permit?

– Legalization, opportunity for identification– Temporary state– Still no benefits – Poorly understood category

What does it mean to have a green card (permanent residence)?– Permanent legalization, official “entry” to US– Still no federal safety benefits (must wait 5 years) – Medicaid,

Section 8, Food Stamps What does it mean to be a citizen?

– Vote– Benefits

Immigration Policy – HIV specific History of Immigration policy with respect to

HIV/AIDS is a policy of exclusion

Life during the HIV Ban– Consular testing– Testing as condition of legalization– Life or death dimension of risk when exploring permanent

residence option

HIV Ban lifted Jan 2010!

Immigration Policy, general

Even without ban, immigration policy poses multiple barriers to “entry” to low-income immigrants living with HIV– Family Based

• Sponsor

– Employment based– Asylum– Refugee– Public charge issues– Length of time

Impact of Immigration Policies -- States

Increasing number of states imposing restrictions on access to services for immigrants

Impacts on access for Ryan White• process for determining eligibility can be exclusionary• Confusing for eligibility workers – not immigration experts!• Public perception among immigrants• Where state funding for HIV is significant, excluding immigrants

for services

Impact of Immigration Policies -- Individuals

Hostility towards immigrants, bigotry, reinforced by policies

Service providers – confused, fearful, unsure of how to proceed without hurting clients

Fear of immigrants, frequently disproportionate and based on traumatic experiences, seems to be more and more warranted

Recommendations

Voice of public health community must be louder in national dialogue on immigration– Negative impact on public health of immigration

policies– Cost savings of inclusion– Cost burden of exclusion, including non-health

areas– Health as a human right

Recommendations

At service provider level:– Reinforce availability of Ryan White services for

immigrants– Examine how access points may be excluding immigrants

unnecessarily– Ask about immigration status only to determine eligibility,

ask the question correctly– Do not reinforce fears of patients, but be informed– Make alliances with community-based organizations that

work with immigration issues to brief them on special needs of HIV positive patients