In a long overdue move, the U.S. government is about to lift the 1987 ban that precludes people with HIV from traveling in or immigrating to the United States. The story of the HIV travel ban illuminates how disease, domestic politics, and notions of sexuality and morality can inform U.S. foreign policy – and shows why AIDS activists and much of the international health community derided the initial U.S. response to the most devastating pandemic of our age.
The HIV travel ban arose when limited scientific knowledge about AIDS collided with the conservative politics of the Reagan administration. In early 1987, the U.S. Public Health Service (PHS) officially added AIDS to the list of dangerous contagious diseases that barred aliens from entering the United States. While PHS noted that AIDS could not be spread casually and therefore did not constitute a contagious disease, politics trumped science. Still not satisfied, Ronald Reagan proposed an additional regulation calling for the exclusion of those testing positive for HIV infection, whether or not there were manifestations of AIDS.
On May 31st, Senator Jesse Helms (R-NC), a stalwart Reagan supporter, introduced an amendment to the $96 billion Supplemental Appropriations Act of 1987, adding HIV infection to the list of excludable diseases maintained by PHS. Senators voted for the legislation with only cursory discussion of the implications of the HIV immigration and travel ban enshrined in the so-called “Helms’s amendment.” The new policy took effect in December 1987.
Since its passage, the HIV travel ban has had a controversial history. In 1988, the World Health Organization argued that restrictive travel and immigration policies directed at people with HIV were irrational and without public health justification. In 1990, when U.S. immigration officials barred HIV-positive foreigners en route to the International AIDS Conference in San Francisco, over 70 organizations of many nationalities, including the International Red Cross, the British Medical Association, and the European Parliament, boycotted the meeting. Supporters of the U.S. travel ban countered that HIV-positive visitors posed a public threat and non-citizens with AIDS would create an undue burden on the U.S. health care system. In response, President George H.W. Bush issued a compromise measure by which HIV-positive non-citizens could receive a ten-day waiver to attend scientific meetings or special events. This policy revision did not, however, quell international criticism of the HIV travel ban. In May 1992, Harvard University announced it would withdraw its sponsorship of the Eighth International Conference on AIDS unless the U.S. government rescinded the restrictions on HIV-positive travelers. The announcement prompted the last-minute relocation of the meeting from Boston to Amsterdam. It has never again been held in the United States.
Amidst the international furor, Congress revised the Immigration and Nationality Act. The new Immigration Act of 1990 altered the wording of the original exclusion provision from “dangerous contagious disease” to “communicable disease of public health significance.” In response, in January 1991, the Centers for Disease Control called for the removal of HIV and all medical conditions other than active tuberculosis from the exclusions list. But the proposal triggered outrage among Christian conservatives who orchestrated a mass mailing campaign opposing the removal of the HIV-provision. In the U.S. House of Representatives, Representative William Dannemeyer (R-CA) and sixty-six fellow Republicans signed a public letter opposing the CDC recommendations. Finally, the PHS argued that because Congress adopted the HIV travel ban in the 1987 Helms Amendment, only Congress could invalidate the HIV exclusion. In March 1993, President Bill Clinton signed legislation codifying the exclusion of HIV-positive aliens, thus violating a campaign promise.
For the next 15 years, the United States had one of the most restrictive policies on the immigration and travel of HIV-positive people in the world. It compelled all non-citizens to attest that they were HIV-negative before being admitted to the United States for any reason – despite the obvious impossibility of enforcing this provision. At the same time, non-citizens living long-term in the United States were denied permanent resident categorization solely on basis of their HIV-positive status. While invoking its sovereign rights to control immigration and tourism, the U.S. government clung to policies suffused with the ignorance and bias toward HIV-positive people illustrated at the earliest stages of the AIDS pandemic. It disregarded the fact that for almost 25 years, it has been common medical knowledge that one cannot contract or transmit HIV casually. AIDS activists asserted that the HIV bar dissuaded immigrants unsure of their HIV status from getting tested; prompted HIV-positive immigrants not to seek to medical treatment until they had full-blown AIDS; and caused HIV-positive people seeking visas to lie on their applications and then enter the U.S. without their medications – situations posing exactly the threats to public health the 1987 ban aimed to prevent. Accordingly, public health experts and AIDS activists called for the United States to abandon the HIV exclusion and to align its travel and immigration policies with the global leadership demonstrated on PEPFAR, the President’s Emergency Plan for AIDS Relief, a five-year, $15-billion program instituted by George W. Bush in 2003.
In July 2008, years of lobbying efforts finally compelled Congress to repeal the statutory HIV immigration and travel ban. On July 17, 2008, roughly two weeks after the death of Jesse Helms – the champion of the HIV ban, the Senate voted 80 to 16 to repeal the exclusion. The provision was included in the legislation reauthorizing PEPFAR through 2013. It restored the authority of the Secretary of Health and Human Services (HHS) to remove HIV from the list of communicable diseases whose carriers are denied entry to the US. The repeal passed the House by a vote of 308 to 116 shortly thereafter. On July 30, Bush signed the PEPFAR legislation spending $50 billion over the next five years to fight AIDS, malaria, and tuberculosis in developing nations.
However, abolishing the HIV travel and immigration ban requires the HHS Secretary to promulgate a new regulation. As a result of cumbersome bureaucratic procedures and the change in presidential administrations, HHS has still not issued a revised rule and therefore HIV-positive students, tourists, business people, and foreign nationals remain barred from the US. It is far past time this injustice be rectified.
Tags: hiv/aids, Immigration, Jesse Helms, Ronald Reagan, TRAVEL
Laura Belmonte
Laura Belmonte is Associate Professor of History and Director of American Studies at Oklahoma State University. Her work includes _Selling the American Way: U.S. Propaganda and the Cold War_ and the anthology _Speaking of America: Readings in U.S. History_