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Impact of Immigration Policies on HIV/AIDS Care Access and Retention

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Title: Impact of Immigration Policies on HIV/AIDS Care Access and Retention


1
Impact of Immigration Policieson HIV/AIDS Care
Access and Retention
  • Catalina Sol
  • Chief Programs Officer
  • La Clinica del Pueblo

2
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

3
La Clinicas 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

4
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

5
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

6
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

7
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

8
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!

9
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

10
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

11
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

12
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

13
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
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