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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