We thought the cruel practice of tearing apart families at the U.S.-Mexico border was over -- we were wrong. Even after a federal judge officially halted this cruel practice in 2018 amid public outcry, Customs and Border Protection (CBP) appears to be finding ways to subversively continue separating families, this time by leveraging stigma against people living with HIV. In July 2019, CBP chief of law enforcement Brian Hastings claimed that this practice was justified because HIV is a "communicable disease under the guidance." Reports confirm that CBP has indeed separated families affected by HIV. In November 2018, while seeking asylum, three Honduran daughters were permanently separated from their father based on nothing more than his HIV status. One can only imagine how many other families have been traumatized based on similar flawed policy.
As family doctors and HIV specialists who care for immigrant communities affected by HIV, we call for action prohibiting family separation based on HIV status. There is no scientific or public health basis for separating HIV-affected families, and the repercussions are devastating.
This is not the first time HIV/AIDS status has been stigmatized in the setting of immigration. Stigma against HIV/AIDS has been linked with racism and xenophobia since the earliest days following its discovery. In 1993, a ban on immigration targeting people living with HIV was codified into U.S. law, which was rightfully lifted in 2009 when HIV was removed from the list of "communicable diseases of public health significance." However, 10 years later, HIV status is still used to deny immigrants entry into the U.S., and this is thinly disguised as a public health concern.
The truth is that people living with HIV who take antiretroviral medications and suppress the virus to consistently undetectable levels in their bloodstream simply cannot transmit HIV to others; a scientifically backed and widely accepted concept known as "undetectable equals untransmittable", or U=U. Furthermore, HIV is only transmitted through sexual contact or sharing IV needles; not through casual contact. This is why the Centers for Disease Control and Prevention (CDC) long ago eliminated HIV from relevance in its immigration guidelines.
It is clear that CBP has not demonstrated any interest in protecting the health and human rights of immigrants. Quite the contrary: Current practices at border detention facilities demonstrate a complete disregard for the health and humanity of those within their walls. The squalid, overcrowded conditions place detainees at risk of outbreaks of communicable diseases like the flu and chickenpox -- and recently, several infants and children have died of preventable diseases while detained. CBP even had the nerve to announce that they will purposely withhold lifesaving vaccinations from detainees, essentially guaranteeing many more outbreaks that will certainly lead to more deaths.
Simply put, holding individuals living with HIV in inhumane conditions and denying them lifesaving antiretroviral treatment is a public health and human rights emergency. In May 2018, Roxsana Hernandez, a detained transgender Honduran woman living with HIV, died of AIDS-related complications resulting from untreated HIV. An independent autopsy suggests lifesaving antiretroviral medication was withheld from her while she was in CBP's custody, further exposing the hypocrisy of the aforementioned policies. This incident exemplifies a troubling and well-documented pattern of abuse and human rights violations against queer and transgender people in detention facilities, including those living with HIV.
In our work providing care for immigrants and other historically marginalized communities in our clinic every day, we see firsthand how HIV-related stigma exacerbates structural barriers that immigrants already face. We have seen the consequences of poor access to medications and primary care, as well as the repercussions of oppressive structural policies. These challenges impact not only individual patients, but lead to intergenerational trauma that reverberates throughout families and communities, especially when they have already faced life-threatening persecution due to their HIV diagnosis in their countries of origin.
In response to this flawed practice, HIV advocacy organizations have launched a call to end family separation at the border, close the detention camps, and restore human rights. We, as family doctors bearing witness to the traumatic effects of this practice, join in this call. We must ensure the end of family separation through explicit CBP and Department of Health and Human Services policy.
Separating children from their parents on the basis of HIV status has no medical, legal, or ethical grounds. And we must advocate further. As is well documented in a formal complaint filed by over a dozen advocacy organizations including the Transgender Law Center and Southern Poverty Law Center, the clear inability of CBP to provide adequate health care and mental health care to people living with HIV and LGBTQ detainees is resulting in an ever-growing number of egregious human rights violations. We are painfully overdue for a complete dismantling and overhaul of our broken border enforcement system, and a deep examination of the structural racism, xenophobia, and stigma underlying and sustaining our country's problematic immigration policies.
The authors are family physicians and HIV specialists who provide care for patients at the Family Health Center HIV Clinic based in the San Francisco public-health safety net system. The views expressed in this op-ed represent the personal opinions of the authors and not their affiliated institutions.
