According to the 1990 national census, only 0.8% of the U.S. population is Native American. That is, 246 million inhabitants are either immigrants or descendants of immigrants. Yet, many of them seem to forget their origins and espouse an "I?m-in-close-the-door" kind of mentality. This seems to be the reason behind the troubling success of anti-immigrant actions, such as Proposition 187 in California that was approved by 59% of the voters in the November 1994 election. This initiative, in its original formulation, went as far as to deny elementary schooling to children of undocumented residents.

A particular case of anti immigrant legislation is the one that refers to HIV. Foreign-born men and women who are HIV positive and declare so may be forbidden entry into the U.S. unless they obtain special waivers. Undocumented aliens who are HIV positive and already in the country may be denied the possibility of becoming permanent residents (i.e., obtaining a green card). These regulations apply almost across the board with only a few being granted hard won exceptions.

There are two main arguments put forth to support these regulations: 1) Infection control--trying to prevent individuals diagnosed with a contagious disease from endangering public health; and 2) public charge--not using tax payers? contributions to pay for the care of ill foreigners. Even a summary analysis of these arguments shows that they are mere smoke screens underpinned by discriminatory intents.

HIV is not a contagious disease per se, the way tuberculosis is. Rather, contagion is dependent on specific behaviors in which the infected individual may or may not engage. Although past research has shown that some HIV positive people continue to engage in risky behavior, by no means can it be said that all infected people do. Therefore, to penalize a whole group given the behavior of some is to consider all its members guilty rather than innocent, a presumption that goes against our legal traditions. Furthermore, as Dr. Norbert Gilmore of the McGill Centre for Medicine, Ethics and Law points out, (personal communication, 1998), the potentially risky behavior of immigrants would not pose a threat of HIV transmission to nationals if the latter were not engaging in such behaviors as well. If travel restrictions of HIV-infected people were legitimately aimed at infection control, all incoming travelers, including U.S. citizens returning from business or tourism abroad, should be held to the same standards. Ironically, this has been the policy applied by Cuba to its nationals (Bayer, 1989).

The argument of public charge merits careful study. For example, Zowall et al. (1992) compared the projected health care costs over ten years of illnesses associated with HIV and coronary heart disease (CHD) for the 1988 immigrants to Canada. The numbers of HIV and CHD were estimated from country-specific HIV seroprevalence data and national CHD mortality statistics. The analyses showed that the impact of HIV infection in immigrants to Canada was similar to that of CHD. The authors concluded that economic considerations could be arbitrarily applied to certain diseases thereby discriminating against specific groups of immigrants.

Speculating on some of the reasons underlying the movement against immigrants with HIV, Gilmore and Somerville (1994) state:

When people, as individuals, a group or society, are confronted with a frightening or intolerable situation their response can be to attempt to flee or escape from it; to control it by inactivating or destroying it, or its cause; to deny it; or to displace the fear it endangers such that its impact is eliminated or minimized. When escape or destruction is unavailable, unfeasible, or not chosen as response, then denial or displacement, or possibly both are likely to be involved in the response. The measures used to achieve this can include disidentification, depersonalization, stigmatization, scapegoating and ... discrimination. (P.1339)

In the U.S., HIV infection has occurred in already stigmatized populations (drug users, homosexual men, prostitutes, and street youth) and this fact is likely to amplify the tendency to discriminate against immigrants with HIV. Gilmore and Somerville (1994) see the division between "them" and "us" as an imaginary way of creating a sense of security among the population supporting the anti-immigrant legislation. Of course, it is a false security.

The situation concerning undocumented aliens infected with HIV who are already in the U.S. is of special concern. Most of these individuals state that, were they to return to their countries of origin, they would not have access to medicines that can potentially keep them alive. It is understandable, therefore, that very few are willing to return, choosing instead to go underground and risk deportation. Many of these individuals are infected but asymptomatic or doing very well with the help of medication, and all of them would prefer to earn their living and not depend on charity or public funds. Yet, the current legislation prevents them from legalizing their situation and becoming productive, tax paying members of society. Furthermore, fear of being identified as undocumented often interferes with health seeking behaviors, ultimately increasing health care costs due to late detection of infections and thus, paradoxically, contributing to a heightened risk for the general population.

One of the main assets of the U.S. is the diversity of its people. Different cultures, races, and ethnicities have contributed to create a vibrant and efficient society that praises itself for being leader of the world. Yet, where other western nations, like those of the European Union, are acknowledging the benefits of plurality and moving towards lowering barriers and consolidating international and inter-ethnic links, conservative forces in the U.S. operate with the anachronistic ideal of a homogeneous and isolated society. As psychologists, we need to reflect on this situation and contribute to an enlightened discussion.

During their September 1998, meeting, the Committee on Psychology and AIDS (COPA) dedicated part of its time to the analysis of the present situation concerning immigrants and HIV. COPA members reviewed the current immigration laws (Bau, 1977; Pendleton, 1997), and discussed the topic with Dr. Gilmore (McGill University) who was invited to address the group. A brainstorming session then took place for the purpose of identifying different ways in which professional psychology can become involved. Some of those ideas are presented below:

Research: Researchers are encouraged to explore issues of xenophobia and stigmatization of immigrants; fear of diversity; impact of legislation on access to prevention and mental health services; impact of policies on HIV testing, status disclosure, names reporting, prenatal mandatory testing, and contact tracing on health seeking behaviors; and perceptions of stigma related to HIV, sexual orientation, and injection drug use in various countries and in the U.S. In the course of their HIV-related research, investigators should also consider including in general assessments items related to current immigrations status of respondents; length of time in the U.S.; health coverage and access to health care; and whether respondents are HIV tested or not.

Clinical work: Clinicians working in institutional settings may advocate for the provision and on-going evaluation of culturally competent services for immigrant populations, including HIV prevention programs; routine discussion of fears concerning reporting of undocumented status to the Immigration and Naturalization Service; systematic identification of unique mental health issues of immigrants (refugee traumas, resettlement, acculturation, coming out in different cultural settings, etc.); ongoing linkages with immigrant legal advocates for cross-referrals; and assistance in asylum/refugee applications based on persecutions because of HIV status and/or sexual orientation

Advocacy and Policy: Psychologists may advocate for policies that enable immigrants with HIV/AIDS to access health and mental health care services as well as for Ryan White Care Act funding of such services. Psychologists may also play an active role in building relationships with organizations that routinely work on immigration issues, such as Human Rights Watch, Amnesty International, the American Red Cross, The Harvard Center for Health and Human Rights, etc.

Bayer, R. & Healton, C. (1989). Controlling AIDS in Cuba. The logic of a quarantine. New England Journal of Medicine, 320(15), 1022-1024

Bau, I. (1997). Immigration law. In Webber, D. AIDS and the Law. New York: Wiley Law Publications, p. 624.

Bau, I. (1997 with 1998 Suppl.) Immigration law. In Webber, D.W. AIDS and the Law. (3rd. ed.). Wiley Law Publications, New York, NY.

Pendleton, G. (1977). HIV and immigrants: A manual for AIDS service providers. Pp. 1-40.

National Immigration Project of the National Lawyers Guild (Boston, MA) and San Francisco AIDS Foundation (San Francisco, CA). Copyright 1997

Gilmore, N., & Somerville, M. (1994). Stigmatization, scapegoating and discrimination in sexually transmitted diseases: Overcoming ?them? and ?us.? Soc. Sci. Med., 39(9), pp. 1339-1358.

Zowall, H., Coupal, L., Fraser, R., Gilmore, N., Deutsch, A., & Grover, S. (1992). Economic impact of HIV infection and coronary heart disease in immigrants to Canada. Canadian Medical Association Journal, 147(9), 1163-1172.