Kaisernetwork.org (Washington, DC)
2 October 2008
Politics and Policy
Newspapers Examine Efforts, Reaction to Easing Ban on HIV-Positive Visitors to U.S.
[Oct 02, 2008]
Some HIV/AIDS advocates are "being cautious with their optimism" regarding new immigration rules for HIV-positive visitors as well as HHS efforts to remove HIV from the list of diseases barring entry into the U.S., the San Francisco Chronicle reports (Fulbright, San Francisco Chronicle, 10/2).
A law that made foreigners living with HIV/AIDS inadmissible in the U.S. was repealed in July when President Bush signed the United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act. HHS determines which diseases are inadmissible and first placed HIV on the list in 1987. This decision was later codified by U.S. immigration law. With the statutory immigration ban now lifted, HHS is in the process of removing HIV from the inadmissibility list.
Under the new Department of Homeland Security rules, HIV-positive applicants who meet "all other normal criteria for the granting of a U.S. visa" will have the opportunity to receive a temporary, non-immigrant visa from U.S. consular offices overseas, according to a DHS statement. Under previous regulations, HIV-positive people were barred from entering the U.S. unless they received a special waiver (Kaiser Daily HIV/AIDS Report, 9/30). The new rules, like previous regulations, also require that HIV-positive visitors present proof that they are not a public health risk or that they would not create potential costs to any government agency, according to CQ Homeland Security. In addition, the new DHS rules require visitors to prove that they will have enough antiretroviral drugs and financial assets or health insurance to cover any hospitalizations during their stay. The new rules apply only to non-immigrant, 30-day visas, CQ Homeland Security reports. Homeland Security Secretary Michael Chertoff said, "This regulation significantly improves the opportunities for individuals seeking to visit the U.S. who were previously inadmissible because of an HIV infection."
According to CQ Homeland Security, HHS has not provided a timetable for the removal of HIV from the list of diseases barring entry to the U.S. (Webber, CQ Homeland Security, 10/1). However, Amy Kudwa, a DHS spokesperson, said that HHS likely will remove HIV from the list within one year, the Chronicle reports. She added that she expects the new DHS regulations to be in effect by Friday.
Reaction
"We will be very happy if they in fact get HIV completely removed from the list," Brian Moulton, associate counsel for the Human Rights Campaign, said, adding that officials "need to make the entry requirements for those with HIV the same as any other person." According to Moulton, the previous regulations were enacted at a time when people did not entirely understand how HIV is transmitted and there was hysteria surrounding the virus. "Public health officials had an understanding that it wasn't a risk to have people with HIV walking down the street, but the general public and some elected officials still had a misunderstanding," he said, adding, "Fear and ignorance drove the legislative process."
Judith Auerbach, deputy executive director for science and public policy at the San Francisco AIDS Foundation, said that the new waiver process is not what advocates want. "It is a partial solution that affects a subset of people and does not eliminate all the barriers," she said, adding, "We want all the language eliminated, the regulatory as well as the statutory. There is no grounds for it; it is a discriminatory practice" (San Francisco Chronicle, 10/2).
Victoria Neilson, legal director for Immigration Equality, said that the new visa process "continues to place a burden on HIV-positive travelers, unlike anything placed on anyone with any other disease." She added, "We're troubled that this regulation is coming out now and further codifying the HIV ban and waiver requirements just three months after Congress issued a mandate that it wants HIV removed from the list of communicable illnesses of public health significance. DHS shouldn't be focusing on fine-tuning the waiver application progress."
According to Neilson, consular officers overseas also have no method of determining during a visa interview if an antiretroviral is "medically appropriate" for an HIV-positive person or if they would engage in high-risk behavior. Joe Amon, director of the HIV and human rights program at Human Rights Watch, said the new regulations are "very indicative of the kind of stigma and discrimination that is often put against people living with HIV." He added, "People with HIV take responsibility for their behaviors all of the time, and people at-risk need to be aware and adopt protective behavior as well." According to Neilson, the new visa process would eliminate 18 days from the application process (CQ Homeland Security, 10/1).
Link to this story.
Science & Medicine
Researchers Find HIV Has Existed Among Human Populations for 100 Years
[Oct 02, 2008]
HIV has existed among human populations for about 100 years, decades earlier than previously believed, according to a study published Wednesday in the journal Nature, the Los Angeles Times reports (Engel, Los Angeles Times, 10/2). HIV/AIDS was not recognized formally until 1981, and scientists previously estimated its origin at around 1930. However, the new study, led by Michael Worobey of the University of Arizona, found the origin of HIV to be between 1884 and 1924, with a more focused estimate at 1908. Worobey said that the new result "is not a monumental shift, but it means the virus was circulating under our radar even longer than we knew" (Ritter, AP/Google.com, 10/1).
The research is based on lymph node tissue from an HIV-positive woman who died in the Democratic Republic of the Congo in 1960, then the Belgian Congo. The tissue specimen was one of more than 800 preserved in ice-cube-size blocks of paraffin at the University of Kinshasa. The researchers compared that sample with modern HIV strains to determine its mutation rate. They then matched that rate with the oldest sample of the virus -- from a 1959 blood sample taken from a man who also lived in the Belgian Congo -- and traced their common ancestor to between 1884 and 1924, which represents the first appearance of the virus in humans before it mutated (Los Angeles Times, 10/2). "Those old sequences helped calibrate the molecular clock, which is essentially the rate at which mutations accumulate in HIV," Worobey said, adding, "Once you have that rate, you can work backward and make a guess of when the ancestor of the whole pandemic strain of the AIDS virus originated. It is that ancestor we are dating to 1908 plus or minus about 20 years" (Steenhuysen, Reuters Africa, 10/2).
Worobey said that further research is unlikely to determine that the spread of HIV began any earlier than the late 19th century. "I think we're pretty close to where's it's going to end up. It's possible but unlikely we'd find some branch on the evolutionary tree that went deeper," he said (Innes, Arizona Daily Star, 10/2).
It has long been believed by HIV/AIDS experts that HIV descended from a chimpanzee virus. Although it is believed that the chimpanzee virus was transmitted to people in Africa when the animals were killed for bushmeat, the number of other people who contracted the virus were so few that it did not obtain a durable foothold, according to the AP/Google.com (AP/Google.com, 10/1).
According to the researchers, the spread of HIV increased as a result of urbanization during the colonial era (AFP/Yahoo! News, 10/1). "Cities are kind of ideal for a virus like HIV," Worobey said, adding that urban areas provide the virus the opportunity to spread to other people (AP/Google.com, 10/1). Steven Wolinsky, a study co-author from the Feinberg School of Medicine at Northwestern University, said that increased urbanization during the colonial era meant not only more potential hosts for HIV living closer together but also commercial sex work and other high-risk behaviors (Los Angeles Times, 10/2).
Anthony Fauci -- director of NIH's National Institute of Allergy and Infectious Diseases, which helped fund the research -- said the study is "clearly an improvement" over the previous estimate of 1930, calling the advance a "fine-tuning." The AP/Google.com reports that experts are not surprised that HIV circulated among humans for about 70 years before being recognized because an infection usually takes years to produce obvious symptoms, a lag that can mask the role of the virus and which would explain initial low levels among Africans (AP/Google.com, 10/1). Jim Moore, an anthropologist at the University of California-San Diego who was not affiliated with the study, said the fact that HIV could have spread unnoticed for decades is credible, given mortality rates in Africa during the colonial period. "The conditions then were horrendous in terms of how Africans were treated," he said, adding, "People dying of AIDS would have been part of the background" (Los Angeles Times, 10/2). The study also received funding from the David and Lucile Packard Foundation (Arizona Daily Star, 10/2).
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