HIV/AIDS Services for Immigrants Detained by the

United StatesDaney Ramirez

January 18, 2010 HPA 430

Overview 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

Detention and Detention and Immigration Policy 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

Detention Facilities 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

ICE’s HIV/AIDS Policy ICE’s HIV/AIDS Policy and Procedures 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

HIV/AIDS Treatment 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

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

HIV/AIDS Treatment 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.

Other Issues with ICE Other Issues with ICE Management 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

Policy Policy Recommendations 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

Policymaking Venue 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

MEDIA 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

Supportive Supportive Stakeholders 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.

ReferencesReferences 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/

Suggestions Suggestions THANKS