HIV/AIDS Services for Immigrants Detained by the United States

1. HIV/AIDS Services for Immigrants Detained by the United States Daney Ramirez January 18, 2010 HPA 430

2. Overview • Detention and Immigration Policy • Detention Facilities • ICE’S HIV/AIDS Policy and Procedures • HIV/AIDS Treatment • Treatment • Reported failures • Policy Recommendation • Policy Venue • Media • Supportive Stakeholders

3. Detention and Immigration Policy • In the 1990s detention became an integral part of United States immigration policy • 1996: Antiterrorism and Effective Death Penalty Act (AEDPA) and the Illegal Immigration Reform and Immigrant Responsibility ACT (IIRAIRA) • Expanded mandatory detention • The US Immigration and Customs Enforcement Agency (ICE): enforcement unit of the Dept. of Homeland Security (DHS) incarcerates: • Undocumented persons • Legal permanent residents • Asylum seekers • Families • Unaccompanied children

4. Detention Facilities • ICE reported that detainees from developing countries are held an average of 89 days • Facilities: • Service processing center (SPC) • Private contract facilities (CDF) • Federal Bureau of Prison facilities • Intergovernmental service agreement (IGSA) facilities • State and local government facilities • 65% of detainees are housed in local jails • ICE contracts with county facilities

5. ICE’s HIV/AIDS Policy and Procedures • Detention Operations Manual (DOM): sets 38 standards for conditions in immigrant detention • establishes minimum conditions and procedures for many aspects of detention, including legal access, medical care, and discipline. • “apply only to Service Processing Centers and Contract Detention Facilities; some provisions, italicized in the text, apply only as “guidelines” for local jails and other facilities contracting with ICE” • HIV/AIDS Detention Standards • requires medical staff merely to “promote”, rather than to provide, accurate diagnosis and medical management “to the extent possible” • No reference to current clinical guidelines, testing and counseling, confidentiality or access to specialty care • National Commission on Correctional Health Care, the American Public Health Association, World Health Organization, and UNAIDS guidelines

6. HIV/AIDS Treatment “Victoria’s condition steadily worsened during the month of July, and she began to vomit blood, and blood appeared in her urine. The detainees in Pod 3 at San Pedro became increasingly concerned for her welfare as she became too weak to sit up in her bunk. Victoria was seen in the medical clinic, but she was told only to take Tylenol and drink large amounts of water...she died a week later.” —excerpt from a cellmate’s account of the death in immigration detention of Victoria Arellano, a 23-year-old transgender detainee with HIV/AIDS

7. HIV/AIDS Treatment HIV CD4 T cells ability to fight infection Disease Monitoring: • Monitor CD4 cell count • HIV viral load Disease Treatment: • ART therapy • Prophylactic drugs

8. HIV/AIDS Treatment Reported Findings from Interviews Human Rights Watch: • Failed to deliver complete anti-retroviral regimens in a consistent manner. This practice creates a risk of drug resistance that endangers the health of the detainee and can impact public health. • Failed to conduct the necessary monitoring of detainees’ clinical condition, including CD4 and viral load testing as well as resistance testing. These tests are fundamental to effective treatment of HIV and AIDS. • Failed to prescribe prophylactic medications when medically indicated to prevent opportunistic infections. • Failed to ensure continuity of care as detainees are transferred between facilities, including failure to ensure access to necessary specialty care. • Failed to ensure confidentiality of medical care, exposing detainees to discrimination and harassment.

9. Other Issues with ICE Management • DHS fails to collect basic information concerning HIV/AIDS cases • Freedom of Information Act: • # of detainees with HIV/AIDS • Information is not tracked • Only monitor facilities once a year

10. Policy Recommendations • Establish and monitor legally binding standards for HIV/AIDS treatment • Equivalence in care standards compared to that provided to regular detainees • International and CDC standards • Endorsement by Obama’s Office on National AIDS policy • Include immigrant detainees in National HIV/AIDS strategy • “Increasing Access to Care and Improving Health Outcomes for People Living with HIV” • Surveillance of HIV/AIDS

11. Policymaking Venue • Federal Level • U.S. Dept. of Homeland Security • Division of Immigration Health Services • Immigration and Customs Reinforcement • U.S. Government Accountability Office • Office on National AIDS Policy • DHS Office of Inspector General

12. MEDIA • News Articles • “New Scrutiny as Immigrants Die in Custody” (2007) • “Illegal Immigrants Received Poor Care in Jail, Lawyers Say” (2007) • TV Shows • Target immigrant populations • International AIDS Conference 2012

13. Supportive Stakeholders • National Immigrant Justice Center • Amnesty International • United Nations Special Rapporteur for the Human Rights of Migrants • International AIDS Society • US Congress and the Obama Administration’s interest in passage of a bill that would define and guarantee a right to medical care for all detainees.

14. References • Human Rights Watch, Chronic Indifference: HIV/AIDS Services for Immigrants Detained by the United States (New York December 2007.) • Venters, H. D., & Keller, A. S. (2009). The Immigration Detention Health Plan: An Acute Care Model for a Chronic Care Population. [Editorial Material]. Journal of Health Care for the Poor and Underserved, 20(4), 951-957. • Venters, H. D., McNeely, J., & Keller, A. S. (2009). HIV screening and care for immigration detainees. Health Hum Rights, 11(2), 89-100. • Office of National AIDS Policy. National HIV/AIDS Strategy. http://www.whitehouse.gov/administration/eop/onap/

15. Suggestions • THANKS