Welcoming the HIV-positive

By Felix Salmon
November 25, 2009
apply for a green card as of January 4. But I don't like this part of the article:

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File under “about time too”: HIV-positive immigrants will be able to apply for a green card as of January 4. But I don’t like this part of article:

Mark Krikorian, executive director for the Center for Immigration Studies, said the decision to remove HIV as a bar was based on politics, not science. “It was clearly a politically motivated move,” Krikorian said, adding that the decision could have real consequences — more HIV cases and more costs. “It is extra healthcare spending that we wouldn’t have otherwise.”

An analysis by the Centers for Disease Control and Prevention showed that in the first year, an estimated 4,275 people infected with HIV could come into the U.S. at a cost of about $25,000 each.

The Center for Immigration Studies, the article never points out, is an anti-immigration and pro-deportation pressure group which can be counted on to oppose any kind of increase in the number of green cards being given out for any reason. And the CDC report starts off by saying this:

The incremental impacts of the rule should be a comparison between the arrival of an HIV-infected immigrant and the arrival of an HIV-negative immigrant. Presumably, HIV-related healthcare expenditures will be different, but there are a variety of health expenditures that the HIV-infected immigrant may not incur that other immigrants may incur (e.g., certain types of cancer, diabetes, heart disease). It is not clear that, over the course of a lifetime, on net an HIV- infected immigrant would consume more health care resources than other immigrants. Furthermore, HIV treatment yields benefits that offset the expenditures, including increased life expectancy and productivity.

In other words, although HIV-related costs will obviously be higher, other costs will be lower, and there’s no indication that an HIV-positive immigrant will cost more overall.

And even if you concentrate only on HIV-related costs, it turns out that “about $25,000″ comes from this:

The primary estimate of the present value of lifetime medical costs for persons identified as HIV-infected in Year One is $94 million in the first year.

What we’re talking about here, then, is the present value of lifetime medical costs, no matter who pays for them; in most cases the cost will be paid mainly by the immigrant, and be paid into the US medical community. And $94 million divided by 4,275 is less than $22,000, not “about $25,000″. And remember that this number is nowhere compared to the present value of lifetime medical costs for someone who is HIV-negative. What’s more, the $94 million uses a very low 3% discount rate; if you increase the discount rate, the present value of future costs comes down sharply.

The important thing to concentrate on here is that the US is finally putting to an end a period of official discrimination which dates back to the days when people thought that HIV could be transferred by people sharing towels. Here’s the CDC report again:

In 2004, the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the International Organization for Migration (IOM) issued the ‘‘UNAIDS/ IOM Statement on HIV/AIDS-related travel restrictions’’ which provides guidance to governments regarding addressing the public health, economic, and human rights concerns involved in HIV-related travel restrictions. This document concludes that HIV-related travel restrictions have no public health justification.

There are a dozen countries that deny entry if a person has HIV. These countries are: Armenia, Brunei, Iraq, Libya, Moldova, Oman, Qatar, the Russian Federation, Saudi Arabia, South Korea, Sudan, and the United States.

This proposed rule will remove the United States from the list of countries that continue to have entry restrictions for HIV-infected individuals.

I’m sure that Mark Krikorian would love for the US to remain on that list of shame, but most sane people will be very happy that we’re finally leaving it. There’s no excuse for any state action which serves to perpetuate the stigma associated with HIV-positive status.

(Via Drum)


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Felix, I think your math is based upon the fundamentally false assumption that the immigrant and not the government will end up paying for the treatment cost of HIV. If we are going to have universal care (which seems likely), that assumption fails.Furthermore, I think your math regarding the annual cost is flawed. Because the $95m number is the present value of lifetime care, it cannot simply be devided by the number of people infected to determine annual cost of care per person.

Posted by Brad Ford | Report as abusive

Brad, you’re right, it’s not an annual cost of care per person, it’s a lifetime cost of care per person, for one year’s cohort of immigrants.

Posted by Felix Salmon | Report as abusive

Thank god for sane thinkers out there. I really appreciate this move by the US administration. I think the justification of additional spends on positives is a illogical conclusion based on paranoia about the disease. Positive people have a tough time “living” and the virus is not fully responsible for making it difficult. Its the stigma that does half the killing.

Posted by Jay | Report as abusive

But they’ll still have to swear a monotheist religious oath to get in.

Posted by Pete Cann | Report as abusive

I’m sorry…I don’t see what the problem is keeping a known lethal disease carrying population out of the country. Why is it a positive thing to permit infected individuals to come to this country and possibly add more possible exposure to the populace?

Posted by Skippy | Report as abusive

How did they enforce this law anyway? Do you have to take an HIV test to get a green card? I think lots of HIV+ men come to this country from Europe, Australia and other parts of the world for the stupid circuit parties in SF, NY, Chicago, Miami, etc, at least as tourists. What a dumb law.

Posted by tc | Report as abusive

This is a great moment in US immigration law. The cost seems to require someone to actually take healthcare, without insurance, which is a bit weird on a holiday?

Posted by Matthew | Report as abusive

Felix Salmon is, of course, lying. CIS isn’t “anti-immigration”. From their site (cis.org/aboutcis.html): “The Center is animated by a pro-immigrant, low-immigration vision which seeks fewer immigrants but a warmer welcome for those admitted.”

tc, yes, you do need to take an HIV test to get a green card. And 24Ahead, “pro-immigrant, low-immigration” is code for “much less immigration, much more deportation”. Which is anti-immigration in my book.

Posted by Felix Salmon | Report as abusive

Why not have Salmon and other Jews pay for the sick immigrants they want to see here?

Posted by Giovanni | Report as abusive

Without prejudice, i would insist that if communicable diseases, or is it costly diseases, be consistent with anti-HIV admittance of aliens to the USA. Meaning, if communicable, then a blanket shutout of this population. If cost is the issue, then throw out any cancer(thats a few, but you knew that),diabetes, sickle cell, asthmatic, etc(geez this is going to be a long list). Include any ‘possibility of cost’ to eliminate even more expensive aliens entering(dont forget any special diseases more prone to specific ethnic groups, keep it fun and discriminate) Now my opinion. Hurray for USA being removed from this list of pro-discrimination based on health, or more accurately, economic ‘health’ status((many hiv pos. people are healthy))). How absolutely civil and industrial! That pesky ethical and moral ‘thing’ gets in my way all the time. I consider myself fiscally republican but morally liberal. Human beings have equal rights, USA being(okay ‘reclaiming’ is better)THE role model for the world with human rights and all that jibberish. Gotta love the ivory towers. One final comment:I dont really like some of that list that we shared. Very last season, don’tcha think?

Posted by Steven | Report as abusive

Political correctness has gone too far in the Unitied States. Why would we give Green Cards to anyone with HIV. Do we not have enough problems in this country.

Posted by joycewallace | Report as abusive

The CDC report says that HIV reduces one’s chances of getting “certain types of cancer, diabetes, heart disease.” Because they’re going to die sooner? Not to be too technical, but that’s nuts. Those with HIV are living longer all the time thanks to medical advances.Personally, I find the “anti-immigration and pro-deportation” types much more sensible than the “pro-immigration and anti-deportation” crowd.

Posted by Mike | Report as abusive

We do not neeed additional burden. In reality they should remain in their home countries where thier families is, Where they might get better caring.

Posted by CN | Report as abusive

Every HIV person deserve to live like others. i disagree with any restrictions imposed on them.

Posted by Dew | Report as abusive

You should have seen what the Philippine immigration put me through just so I could be a resident. It was chest xrays (TB), stool tests, urine tests, blood tests, HIV tests, health tests (including mental health), police clearances both state and federal, finger prints state and federal, just so I can live in the Philippines. If I had one small trace of any disease or sickness I would have been refused. This is very common throughout the world. So why is it that a western country is frowned upon when it applies the same rules as other countries do?

Posted by Lance Baker | Report as abusive

Taxpayers in America already gave $700 billion of their hard-earned money to bail out corrupt banks with lousy management. Taxpayers in America already gave $1 trillion their hard-earned money to support the 7 million people who live in Israel. People who shouldn’t have purchased homes in the first place get special adjustments and people who shouldn’t be living in the West Bank get free money to be there. Of course we should definitely let anyone with a fatal disease immigrate to the USA and receive free medical treatment compliments of the Taxpayers. While we are at it, let’s bring back Ebonics in the public schools and require all new immigrants to learn Ebonics as part of the U.S. citizenship requirement.

Posted by Viyada York | Report as abusive

Your “in other words” after your second quote is wrong. The quote says that health costs can’t be considered a factor since there are numerous other unpredictable health costs like (adult onset) diabetes, heart disease, or cancer.You put words in their mouth when you say “other costs will be lower,” since HIV+ people can still get diabetes, heart disease, and cancer.That said, I had no idea that this restriction existed, so I’m indifferent that it’s been lifted.