You Can't Make This Stuff Up Dept.: Celebrity journalist Andrew Sullivan's mad idea to allow unrestricted immigration for people with HIV [see Steve Sailer's comments] is one step closer to being a reality - thanks to a late Clinton rule "clarification" that remains unremarked upon by the Bush administration. And, of course, unreported in the press.  

On its face, U.S. law bars admission of HIV-positive individuals.  However – and it's a very big "however" - the bar may be waived for refugees in order to assure 'family unity,' for humanitarian purposes, or for reasons of 'public interest.'

Prior to the Clinton rule change, the intending refugee had to meet two requirements in order to receive the waiver – [1] establish that his or her admission to the U.S. would not endanger the public health; and [2] furnish proof of registration with a U.S. agency, say a state Medicaid agency, which consents to bear the costs associated with medical treatment of the refugee.

The second requirement was proving difficult. "Almost no one" was getting waivers according to a State Department source.  Solution: do away with the requirement. After all, the services under Medicaid and the Ryan White CARE Act, a federal AIDS program, are automatically available to refugees anyway. So why require the prior consent of the agency dispensing them?

Arguing in support of the rule change, Surgeon General David Satcher advised then-INS Commissioner Doris Meissner that "the country's commitment to providing service to HIV-positive individuals provides adequate support for refugees who are HIV-positive upon their admission to the United States and during their transition to full participation in our society." 

I wonder if the authors of the Ryan White CARE Act intended for its benefits to be extended to the world?  Perhaps HIV really will be the ultimate solvent of national sovereignty, as its partisans like to argue.

About 515 HIV-positive refugees arrived under the eased waiver requirements from the date of the rule change in June, 1999 through April, 2001.  This is not a flood and is probably a fraction of those HIV-positive individuals who immigrate here illegally or who simply evade screening while legally immigrating.  But several factors favor the growth of the legal entry of HIV-positive refugees, which will inevitably increase the legal entry of the HIV-positive. 

Firstly, the number of African refugees admitted to the U.S. has tripled in the last 2 years. Africa has been the main source of HIV-positive refugees so far (an exact source-country breakdown is not available because HIV entrants are not tracked by country).  Approximately 18,000 were admitted as refugees from Africa in the year 2000. This number will likely double in the next 2 years, according to State Department sources.  An African specialist in the State Department and an official at CDC, both of whom asked to remain anonymous, told me that "easily" 10% of African refugees from sub-Saharan Africa will have HIV.   

As "international burden sharing" becomes the norm in foreign policy it will be increasingly difficult to, well, not share the burdens of those countries where AIDS is hitting hardest.   There has even been serious discussion—if one regards the editorial pages of the New York Times as a forum where serious discussion takes place—of including African AIDS assistance as part of a comprehensive slavery reparations plan. 

No doubt, granting immigrants access to services under the Ryan White CARE Act will come to be seen as the least of U.S. obligations.

The politically-correct CDC refuses to discuss anything like an average rate of infections transmitted per HIV-positive individual.  Nevertheless, I suspect such a transmission rate has been calculated. (Alas, despite federal agitprop about the importance of openness on the subject, HIV – and above all HIV and immigration - remains the strictest of taboos in government circles.)

But there's good news from our unsleeping federal government! It has already taken steps to ensure that communicable disease will not, after all, be imported with our HIV-positive refugees.  The government requires that, before arriving on U.S. shores, all  HIV-positive refugees sign a document promising to take a U.S. government course in "safe sex" - thereby establishing, of course,  that "their admission to the United States will not compromise the public health."

So that's OK then!

Isn't it?

And if there is a mishap somewhere, and one infection becomes 10 infections, hey, there's always the Ryan White CARE Act!

Right?

November 27, 2001