US: Restrictive immigration policies would undermine Public Health and economic stability

Expected Immigration Policies under a second Trump administration and their health and economic implications

Introduction

Immigration was a central campaign issue during the 2024 Presidential election with President-elect Trump vowing to take strict action to restrict both lawful and unlawful immigration into the U.S. Such actions would have stark impacts on the health and well-being of immigrant families as well as major economic consequences for the nation. As of 2023, there were 47.1 million immigrants residing in the U.S., and one in four children had an immigrant parent.1 Increased immigration boosts federal revenuesand lowers the national deficit through immigrants’ participation in the country’s economy, workforce, and through billions of dollars in tax contributions.

This issue brief discusses key changes to immigration policies that may take place under the second Trump administration based on his previous record and campaign statements, and their implications. President-elect Trump has indicated plans to restrict and eliminate legal immigration pathways, including humanitarian protections, and deport millions of immigrants, which would likely lead to separation of families, negative mental and physical impacts for immigrant families, and negative consequences on the nation’s workforce and economy.

Expected Policy Changes

Elimination of Deferred Action for Childhood Arrivals (DACA) Program

The future of the DACA program remains uncertain due to pending litigation, and President-elect Trump has indicated plans to eliminate it, which would lead to over half a million DACA recipients losing protected status. DACA was originally established via executive action in June 2012 to protect certain undocumented immigrants who were brought to the U.S. as children from removal proceedings and receive authorization to work for renewable two-year periods. During his prior term, President-elect Trump sought to end DACA but was blocked by the Supreme Court in 2020. The Biden administration issued regulations in 2022 to preserve DACA protections. In September 2023, a district court in Texas ruled the DACA program unlawful, preventing the Biden administration from implementing the new regulations while the case awaits a decision in the Fifth Circuit Court of Appeals. Under pending court rulings, while the Department of Homeland Security (DHS) is accepting first-time DACA requests, it is unable to process them. DHS is continuing to process DACA renewal requests and related requests for employment authorization. After the attempt to end DACA failed in 2020, the Trump administration saidthat it would try again to eliminate DACA protections, and, if the pending court ruling finds the program unlawful, the administration is unlikely to appeal the decision. There are over half a million active DACA recipients, a majority of whom are working and many of whom have U.S.-born children, who could be at risk of deportation if the program is eliminated.

A recent health coverage expansion to DACA recipients also is subject to pending litigation and would, if eliminated, leave many DACA recipients without access to an affordable coverage option. In May 2024, the Biden administration published regulations to extend eligibility for Affordable Care Act (ACA) Marketplace coverage with premium and cost-sharing subsidies to DACA recipients, who were previously ineligible for federally funded health coverage options. The regulation became effective November 1, 2024, allowing for enrollment during the 2025 Open Enrollment Period. In August 2024, a group of states filed a lawsuit against the federal government alleging that the ACA Marketplace coverage expansion for DACA recipients violates the Administrative Procedure Act. The case is currently under review at a district court in North Dakota and a decision is expected in the coming months. Elimination of the expansion could leave the nearly 100,000 uninsured DACA recipients it is estimated to cover without an affordable coverage option.

Changes to Public Charge Policy

President-elect Trump could reinstate changes to public charge policy that he made during his first term, which led to increased fears and misinformation among immigrant families about accessing programs and services, including health coverage. Under longstanding immigration policy, federal officials can deny entry to the U.S. or adjustment to lawful permanent resident (LPR) status (i.e., a “green card”) to someone they determine to be a public charge. During his prior term, President-elect Trump issued regulations in 2019 that broadened the scope of programs that the federal government would consider in public charge determinations to newly include the use of non-cash assistance programs like Medicaid and the Children’s Health Insurance Program (CHIP). Research suggests that these changes increased fears among immigrant families about participating in programs and seeking services, including health coverage and care. Prior KFF analysis estimated that the 2019 changes to public charge policy could have led to decreased coverage for between 2 to 4.7 million Medicaid or CHIP enrollees who were noncitizens or citizens living in a mixed immigration status family. The Biden administration rescinded these changes. However, as of 2023, a majority of immigrant adults said in a KFF survey that they were “not sure” about public charge rules, and roughly one in ten (8%), rising to about one in four (27%) of likely undocumented immigrant adults, said they have avoided applying for assistance with food, housing, or health care in the past year due to immigration-related fears (Figure 1). As of November 2024, President-elect Trump has not indicated whether his administration plans to reinstate his first term changes to public charge policy.

 

Expanded Interior Enforcement Actions

President-elect Trump has indicated that his administration plans to carry out mass detentions and deportations of millions of immigrants, including long-term residents, which could lead to family separations and negative mental and physical health consequences. President-elect Trump has stated that he will declare a national emergency and use the U.S. military to carry out mass deportationsof tens of millions of undocumented immigrants residing in the U.S., many of whom have been living and working in the country for decades. Such a policy could lead to family separations as well as mass detentions, which can have negative implications for the mental health and well-being of immigrant families and also put their physical health at risk. Tom Homan, who was the director of U.S. Immigration and Customs Enforcement (ICE) during the first Trump administration and has been selected as the incoming administration’s “border czar”, has said that it is possible to carry out mass deportations without separating families by deporting an entire family unit together, even if the child may be a U.S. citizen. As was the case during his first term, he may also carry out workplace raids as part of mass deportation efforts. Research shows that such raids can lead to family separations, poor physical and mental health outcomes for immigrant families, negative birth and educational outcomes for the children of immigrants, and financial hardship due to employment losses. Prior KFF research shows that restrictive immigration policies implemented during the first Trump administration, including detention and deportation led to increased fears and stress among immigrant families and negatively impacted the health and well-being of children of immigrants, most of whom are U.S. citizens.

Mass deportations could also negatively impact the U.S. workforce and economy, where immigrants make significant contributions. Immigrants have similar rates of employment as their U.S.-born counterparts and play outsized roles in certain occupations such as agriculture, construction, and health care. Research has found that immigrants do not displace U.S.-born workers and help foster job growth through entrepreneurship and the consumption of goods and services. Further, federal data show that unemployment rates for U.S.-born workers have not decreased between 2022 and 2023 and have remained similar to those for immigrant workers. In addition, immigrants, including undocumented immigrants, pay billions of dollars in federal, state, and local taxes each year. Mass deportation of immigrants could lead to workforce shortages in key sectors which could have negative economic consequences including an increase in the cost of essential goods such as groceries. Vice President-elect Vance has stated that immigrants are responsible for the U.S. housing crisis. While some studies show a link between immigration and rising housing costs, in general, economists are skeptical of immigration being a primary driver. Mass deportation of immigrants could also worsen housing shortages since immigrants make up a significant share of construction workers. Workplace raids can exacerbate existing labor shortages and have a negative impact on the local economies of the communities where they take place. Further, research shows that without the contributions undocumented immigrants make to the Medicare Trust Fund, it would reach insolvency earlier, and that undocumented immigrants result in a net positive effect on the financial status of Social Security. There also is likely to be a significant cost to taxpayers for the government to carry out large-scale detention and deportations.

Ending Birthright Citizenship

President-elect Trump has stated that he will sign an executive order to end birthright citizenship for the children of some immigrants despite it being a guaranteed right under the U.S. Constitution, which would negatively impact the health care workforce and economy. This proposed action would limit access to health coverage and care for the children of immigrants since they may not have lawful status. It could also have broader ramifications for the nation’s workforce and economy, potentially exacerbating existing worker shortages, including in health care. KFF analysis of federal data shows that adult children of immigrants have slightly better educational and economic outcomes than adult children of U.S.-born parents and make up twice the share of physicians, surgeons, and other health care practitioners as compared to their share of the population (13% vs. 6%) (Figure 2). Other research also has found that children of immigrants contribute more in taxes on average than their parents or the rest of the U.S.-born population, and that their fiscal contributions exceed their costs associated with health care, education, and other social services.

 

Reinstatement of “Remain in Mexico” Policy

President-elect Trump has stated that he will reinstate the “Remain in Mexico” border policy and that he may use military spending to carry out stricter border enforcement, which would leave an increased number of asylum seekers facing unsafe conditions at the border. The first Trump administration implemented Migrant Protection Protocols, often referred to as the “Remain in Mexico” policy, in 2019. Under this policy, asylum seekers were required to remain in Mexico, often in unsafe conditions, while they awaited their immigration court hearings. The Biden administration ended this policy in 2022, following some legal challenges, although it implemented a series of increasingly restrictive limits on asylum eligibility in 2023 and 2024 in response to a high number of border encounters. President-elect Trump said he plans to reinstate the Migrant Protection Protocols. He also has indicated that he will deploy the National Guard, as well as active duty military personnel, if needed, to the U.S.-Mexico border, although details of the plan remain unclear. Heightened military presence at the border can lead to increased fears among immigrant families living in border areas and using part of the military budget for border security could face legal challenges.

Restrictions on Humanitarian Protections

President-elect Trump said he plans to significantly limit the entry of humanitarian migrants into the U.S. during his second term by restricting refugee limits, shutting down the CBP One application for asylum seekers, and eliminating Temporary Protected Status (TPS) designations for immigrants from some countries.  During his first term, President Trump set the annual refugee admissions ceiling at its lowest levels, ranging from 50,000 in 2017 to a historic low of 18,000 in 2020. The Biden administration increased the limit to 65,000 in 2021, a level close to the annual ceilings prior to the first Trump term, and further increased the limits in 2022 and 2024 in response to humanitarian concerns. It is likely that President-elect Trump will reduce the admissions ceiling for refugees in his second term. The President-elect has also said that he will close the CBP One application created by the Biden administration which allows asylum seekers to seek lawful entry to the U.S. by making an interview appointment with the DHS. While there have been implementation challenges with the CBP One application, shutting down the application could lead to “mass cancellation of appointments” and possibly an increase in attempts to cross the border outside of ports of entry. President-elect Trump also has indicated that he will roll back TPS designations for some immigrants, including those from Haiti. TPS designations protect immigrants from countries deemed unsafe by the DHS from deportation and provide them with employment authorization but do not provide a pathway to long-term residency or citizenship. As of March 2024, over 860,000 immigrants from 16 countries were protected by TPS. Loss of TPS would put people at risk for deportation, which could contribute to family separation which in turn can have negative impacts on the mental and physical health of immigrant families, and broader negative consequences for the workforce and economy.

Endnotes
  1. KFF analysis of 2023 American Community Survey 1-year Public Use Microdata Sample.

Sweden: 96% of LGBTQI+ asylum seekers in Sweden rejected, violating legal protections

Asylum-seeking LGBTQI+ individuals deported on illegal grounds

Migration authorities are rejecting and deporting LGBTQI+ asylum seekers in violation of Swedish and international law. This is revealed by an extensive report by RFSL. “A legal scandal that continues in silence, behind confidentiality and secrecy,” says Aino Gröndahl, asylum law specialist at RFSL.

Despite the Swedish Migration Agency having taken several actions since RFSL’s last legal investigation in 2020, the situation for LGBTQI+ individuals seeking asylum in Sweden has not improved. A staggering 96 percent of the decisions and judgments reviewed in the new investigation were rejections, a higher percentage than the data RFSL’s asylum law specialist reviewed in 2020. The latest report also shows that illegal demands in SOGIESC asylum cases persist. This results in LGBTQI+ asylum seekers, who are entitled to protection in Sweden, being deported to countries where they risk persecution, torture, and the death penalty.

“Sweden continues to deport LGBTQI+ individuals on illegal grounds. It is a legal scandal that occurs in silence, behind confidentiality and secrecy. A shame for a country that claims to be a rule-of-law state,” says Aino Gröndahl, asylum lawyer at RFSL.

Stop the deportations of asylum-seeking LGBTQI+ individuals if safe and fair assessments cannot be guaranteed

RFSL is now calling for a decision and enforcement halt until safe and fair investigations, reviews, and assessments consistent with current law are guaranteed in SOGIESC asylum cases.

“The government must now ensure that the asylum process for LGBTQI+ individuals follows Swedish and international law. Until then, RFSL wants all illegal rejections and deportations of LGBTQI+ individuals to be stopped,” says Peter Sidlund Ponkala, Chairman of RFSL.

Summary of the Report

In the report “Rejection motivations in SOGIESC asylum cases in Sweden” RFSL has reviewed the Migration Agency’s assessments. This involves 1,360 decisions and judgments in SOGIESC asylum cases between November 2020 and May 2023. The report is authored by Aino Gröndahl, asylum lawyer at RFSL.

The report shows that:

  • The Migration Agency assessments of SOGIESC asylum cases violate Swedish and international law.
  • The Migration Agency continues to reject and deport asylum seekers on illegal grounds to countries that persecute and also apply the death penalty to LGBTQI+ individuals.
  • A full 96 percent of the decisions and judgments reviewed in the new report were rejections. This is a higher percentage than in the data RFSL’s asylum law specialist reviewed in 2020.
  • The right to an individual review and objective assessment is not met in SOGIESC asylum cases.
  • Discretionary requirements still occur, meaning that asylum seekers are required to have hidden their SOGIESC status in their home country to avoid persecution. This is despite discretion requirements having been prohibited in Swedish law for nearly two decades and in international law for over a decade.
  • Requirements for internal emotional processes and risk considerations in credibility and reliability assessments are solely based on stereotypes and prejudices about SOGIESC individuals. This violates, among other things, EU law and UNHCR guidelines.
  • The Migration Agency often demands that SOGIESC asylum seekers display negative emotions such as shame. This means that Swedish authorities condition the right to protection on LGBTQI+ individuals showing self-hatred to appear credible.

RFSL’s recommendations to the government

  • Halt decision-making and deportations until safe and fair investigations, reviews, and assessments consistent with current law are guaranteed in SOGIESC asylum cases.
  • Promptly appoint the investigation promised in the Tidö Agreement to review the legal safety in SOGIESC asylum cases.
  • Provide clear instructions and requirements to the Migration Agency for quality assurance in the investigation, review, and assessment of SOGIESC asylum cases.
  • Task the Migration Agency with continuously training all operational staff in the investigation, review, and assessment of protection needs based on sexual orientation, gender identity, and gender expression.
  • Task the Migration Agency with compiling statistics on SOGIESC asylum cases and the grounds on which an asylum case should be granted or rejected.

US : Report uncovers systemic abuse of LGBTQ+ and HIV-Positive immigrants in U.S. detention facilities

Report: No human being should be held here

A new report, “No Human Being Should Be Held Here,” claims that nearly a third of immigrant detainees interviewed (18 out of 41) were sexually assaulted while in the custody of federal immigration authorities. Almost all of those interviewed (35 out of the 41) reported being harassed for being LGBTQ+ or an immigrant in custody.

For this report, Immigration Equality, the National Immigrant Justice Center (NIJC), and Human Rights First (HRF) surveyed 41 LGBTQ and HIV-positive immigrants who were detained by CBP and ICE. This survey revealed:

  • Approximately one third of survey participants (18 out of 41) reported sexual abuse, physical assaults or sexual harassment in immigration detention due to their LGBTQ identity;
  • Nearly all of the participants (35 out of 41), reported being targets of homophobic, transphobic, xenophobic, racist, or other verbal and nonverbal abuse in ICE and CBP jails that included threats of violence and assault;
  • A majority of participants (28 out of 41) reported receiving inadequate medical care or asking for medical care and not receiving it while in ICE or CBP detention.
  • Nearly half of participants (20 out of 41) interviewed reported new or increased mental health symptoms while in detention, including hives, panic attacks, mental health crises, flashbacks, and self-harm;
  • Roughly half of participants (20 of 41) were subject to solitary confinement;
  • Nearly half of participants (18 of 41) reported having their sexual orientation, gender identity, HIV status or other confidential medical information disclosed in custody without their consent;
  • More than a quarter of survey participants (12 out of 41) reported that ICE or CBP separated them from their loved ones, whether a partner, spouse, or sibling;
  • Survey participants routinely struggled to access their attorneys or find one, while in ICE or CBP detention;
  • The majority of survey participants living with HIV (13 out of 17 participants) reported medical neglect or denial of medical HIV treatment.

Syria: Syrian trans woman’s HIV status shared by media, leading to deportation and death

Refuge trans woman deported by Turkey over HIV status killed in Syria

A Syrian refugee trans woman, who was deported by Turkey after her HIV status was exposed on social media, was killed by the Free Syrian Army in collaboration with her family in Syria.

Adana LGBTI+ Solidarity on July 27 announced that a Syrian trans woman who were deported by Turkish authorities to Syria over her HIV status were killed in there five days ago.

LGBTI+ news outlet KaosGL reported that she was killed by Free Syrian Army and her family.

On July 5, local news outlets and several social media users shared medical documents about the refugee woman with serious hate speech.

Even though it is illegal to disclose any person’s medical information in Turkey, authorities decided to deport the refugee woman instead of punishing those involved in the crime.

The Adana LGBTI+ Solidarity stated, “In Adana, a Syrian trans woman had her private health information shared without consent and faced hate speech. This violated her personal rights and privacy. Trans woman M.E. was deported through the Cilvegözü Border Gate following these events. Unfortunately, we learned that she passed away five days ago.”

US: New report reveals dire conditions for LGBTQ and HIV-Positive asylum seekers in U.S. immigration detention facilities

“No Human Being Should Be Held There”: The Mistreatment Of LGBTQ And HIV-Positive People In U.S. Federal Immigration Jails

Asylum in the United States is a lifesaving necessity for LGBTQ and HIV-positive people. For decades, many have fled to the United States to seek refuge from persecution and torture. However, the United States subjects hundreds of thousands of people yearly, including LGBTQ and HIV-positive people, to its massive network of jails and prisons. These jails, run by U.S. Customs and Border Protection (CBP) and Immigration and Customs Enforcement (ICE), are infamous for their inhumane and abusive conditions. For LGBTQ and HIV-positive people, these conditions routinely include high rates of physical and sexual violence, improper and prolonged solitary confinement, and inadequate medical care among other forms of systemic abuse and neglect.

For this report, Immigration Equality, the National Immigrant Justice Center (NIJC), and Human Rights First (HRF) surveyed 41 LGBTQ and HIV-positive immigrants who were detained by CBP and ICE. This survey revealed:

  • Approximately one third of survey participants (18 out of 41) reported sexual abuse, physical assaults or sexual harassment in immigration detention due to their LGBTQ identity;
  • Nearly all of the participants (35 out of 41), reported being targets of homophobic, transphobic, xenophobic, racist, or other verbal and nonverbal abuse in ICE and CBP jails that included threats of violence and assault;
  • A majority of participants (28 out of 41) reported receiving inadequate medical care or asking for medical care and not receiving it while in ICE or CBP detention.
  • Nearly half of participants (20 out of 41) interviewed reported new or increased mental health symptoms while in detention, including hives, panic attacks, mental health crises, flashbacks, and self-harm;
  • Roughly half of participants (20 of 41) were subject to solitary confinement;
  • Nearly half of participants (18 of 41) reported having their sexual orientation, gender identity, HIV status or other confidential medical information disclosed in custody without their consent;
  • More than a quarter of survey participants (12 out of 41) reported that ICE or CBP separated them from their loved ones, whether a partner, spouse, or sibling;
  • Survey participants routinely struggled to access their attorneys or find one, while in ICE or CBP detention;
  • The majority of survey participants living with HIV (13 out of 17 participants) reported medical neglect or denial of medical HIV treatment.

The executive branch and Congress can take steps to end this unnecessary suffering and protect the rights of LGBTQ/H individuals. These include steps to apply parole authority, issue guidance on vulnerable populations, support legislative action and phase out immigration detention. Read the full report here.

Turkey: HIV-Positive Syrian refugee fights for access to treatment in Istanbul detention centre

HIV positive Syrian refugee ‘left for dead’ in İstanbul removal center

Ahmed Aaabo’s treatment has been disrupted by bureaucratic hurdles after his temporary protection status was removed, says his lawyer.

Ahmed Aabo was only 10 years old when his family left him at the Turkish border in 2011, seeking a safer life amidst the Syrian civil war.

Granted Temporary Protection Status upon entering Turkey, Ahmed’s life took a dramatic turn about eight months ago after he donated blood to the Turkish Red Crescent, which revealed he was HIV positive.

Ahmed began receiving treatment at Haseki Training and Research Hospital in Fatih, İstanbul, where he regularly took his medication. However, his situation worsened due to administrative decisions and bureaucratic barriers.

Losing protection status

His temporary protection status was deactivated under the G-78 restriction code, which is used for foreigners who are deemed to pose a public health threat due to infectious diseases. This deactivation prevented him from accessing his medications.

In an attempt to understand his situation and secure his medication, Ahmed visited the Kumkapı Foreigners’ Branch Directorate. There, he was detained and handcuffed for allegedly residing illegally and transferred to the Hadımköy Removal Center.

His lawyer, Hasan Kocapınar, filed a lawsuit to halt the deportation process. While awaiting the court’s decision, Ahmed was moved to the Adana Removal Center, where he could not access his medication, further deteriorating his health.

Kocapınar managed to get Ahmed transferred back to İstanbul, where he finally received his medication, but the interruption in his treatment had already severely affected his health.

Appeal to authorities

Kocapınar emphasized that denying Ahmed his right to treatment is a human rights violation. “Ahmed’s health has severely deteriorated due to the deprivation of his right to treatment and erroneous administrative actions. We will pursue all necessary legal avenues to restore his treatment rights,” he said.

He urged the authorities to honor international agreements and provide Ahmed with the care he needs, highlighting that sending Ahmed back to Syria would endanger his life, especially given his HIV status, which would make him a target for extremist groups.

Kocapınar also noted that Ahmed only has a three-month supply of medication left and emphasized the need for the Directorate General of Migration Management and the Directorate of Migration Affairs to resolve the issue. “Ahmed is currently held at the Arnavutköy Removal Center, where he does not have adequate access to his treatment. This is a human rights violation, and Ahmed’s right to health and life must be protected,” Kocapınar asserted.

G-78 Restriction Code

This code is applied to foreigners who carry infectious diseases that could threaten public health and safety, resulting in an indefinite ban on their entry to Turkey.

European Union: Call to safeguard the right to asylum in Europe

HRW and Amnesty International among NGOs urging EU to safeguard right to asylum in Europe

Human Rights Watch (HRW) and Amnesty International plus other NGOs signed a joint statement Monday urging the European Union (EU) and its member states to “safeguard the right to territorial asylum in Europe.”

The statement refers to the EU Charter of Fundamental Rights and emphasizes EU member states’ responsibility under Article 18, which guarantees the right to asylum. Over 90 organizations, also including Oxfam and Save the Children, signed the statement.

The statement criticizes member states’ attempts to shift asylum procedures and refugee protection to countries outside the EU (third countries). Such externalization measures allow states’ to “evade their asylum responsibilities,” which the statement asserts undermines the international refugee protection system and compromises states’ “commitment to the rule of law.”

The signatories criticize the European Commission’s facilitation of these arrangements between member states and non-EU countries as policies seeking to “contain and deter” the migration of refugees toward the EU. This is despite the Commission’s earlier assertion that such policies were “neither possible nor desirable,” and given EU law, “not legally or practically feasible.” Arrangements between countries, such as the Italy—Albania migration agreement, were denounced in the statement as “shortsighted measures” that lacked “genuine human rights safeguards or monitoring mechanisms.”

The UNHCR Note on the “Externalisation” of International Protection establishes that such measures are in contravention of the 1951 Refugee Convention and fundamental principles of international cooperation, responsibility-sharing and solidarity as they are designed to “avoid responsibility or to shift, rather than share burdens.” The statement echoes these sentiments, pointing to the significant consequences of externalization. Current EU law and the recently adopted Pact on Migration and Asylum do not include provisions concerning shifting asylum processing and refugee protection measures outside EU territory.

The statement warns of the human rights violations that have arisen where models externalizing asylum procedures have been implemented. Assigning low and middle-income countries that are unable to provide effective protection are already collectively “hosting 75 percent of the world’s refugees” has resulted in human rights abuses as the EU lacks “adequate tools and competencies to effectively monitor or enforce human rights standards” outside its territory.

HRW’s Europe and Central Asia advocacy director Iskra Kirova said, “Instead of wasting further time and resources on proposals incompatible with EU law and human rights commitments, the EU should support humane, sustainable, and realistic reception and asylum processing policies in EU territory.”

Russia: Deporting migrants with HIV from Russia is not only inhumane but also economically unprofitable

State asked to stop expulsion of migrants with HIV

Automated translation via Deepl.com – For original article in Russian, please scroll down.

Representatives of the Regional Expert Group on the Health of Migrants in the EECA region called the current practice of deporting migrants with HIV in Russia not only inhumane but also economically unprofitable. Treatment of neglected cases, when a person hides their status and lives illegally, out of fear of deportation, costs the state more than 200 thousand rubles, the experts estimate. At the same time, if the law allowed them to live and be treated – at their own expense or at the expense of the migrants’ home country, a course of annual therapy would cost about 90 thousand rubles. In 2016, the ECHR already demanded that Russia completely refrain from discriminating against HIV-positive foreigners, but since then, the legislation has not changed.

The Regional Expert Group on the Health of Migrants in the EECA Region (REG) assessed the potential economic benefits of not discriminating against foreigners with HIV-positive status in Russia. The authors of the study concluded that allowing migrants to live and be legally treated in Russia “is not only more beneficial from a humanitarian and epidemiological point of view, but also from an economic one.

A 1995 law prohibits foreign nationals with HIV from entering, staying and residing in Russia. If foreigners who have been tested not anonymously are found to be HIV-positive, Rospotrebnadzor makes a decision on their undesirability to stay in the country. Experts point out that for fear of deportation, many migrant workers hide their disease. They do not take antiretroviral therapy and, in their serious condition, end up in hospitals where they cannot, by law, be denied emergency medical care. The authors calculate that if a patient were to receive the necessary therapy, the cost of treatment would be 83,084 roubles a year, or about 6,924 roubles a month. They note that these costs “with certain legislative amendments” could be paid by the country of origin.

However, if a foreigner with HIV infection does not receive treatment and, as a result, develops complications, inpatient treatment for 21 days and an antiretroviral therapy course will cost 228,572.6 roubles. This treatment option is covered by the budget of the Russian Federation.

The authors draw attention to the high prevalence of HIV infection in Russia, 54.8 people per 100,000 population. In countries from which migrant workers come most frequently, the rate is much lower: 14.2 in Tajikistan, 13.2 in Kyrgyzstan and 7.2 in Azerbaijan. They also cite a recent study by the Russian Ministry of Finance on the impact of HIV on economic and demographic development in Russia. According to the study, the annual loss of society from the uncontrolled spread of HIV infection is about 200 billion roubles. The researchers note that “one of the characteristic features of the current stage of HIV infection in Russia is the expansion of the hidden epidemic among labour migrants who are forced to keep their HIV status secret”.

According to the Central Research Institute of Epidemiology of Rospotrebnadzor, 37,389 HIV-positive foreigners have been identified in Russia since 1985, when the first case of infection was detected, until the end of 2019 (these are those who have been officially tested). In the same time period, the number of HIV-positive Russians has reached 1,420,975. Vadim Pokrovsky, head of the Federal AIDS Center, told Kommersant that given the ratio, the influence of foreigners on the epidemiological situation “is not that great. He said that in the late 1980s, when the infection was indeed found mainly in people arriving from abroad, there was “some sense” in screening them and sending them home. Within a few years, the number of Russians who were infected outnumbered the foreigners, he continued, but the deportations were supported by “hooray patriots,” who believed they were thus “saving Russia from HIV infection. Now, according to Mr. Pokrovsky, the main problem is economic, as treatment is lifelong, expensive and it is unclear at whose expense migrants will receive it.

“In order to implement the proposals in the study, the legislation would need to be amended accordingly. There is no doubt that this will meet with a wave of controversy,” says Mr Pokrovsky.

In 2016, the European Court of Human Rights (ECHR) found Russia guilty of violating the rights of HIV-positive foreigners who were banned from entering and staying in Russia if they had the disease. The year before, following a ruling by the Constitutional Court, it was ruled that if a migrant’s spouse, children or parents are Russian citizens, he or she cannot be expelled. However, the ECHR insisted on a complete rejection of discrimination against HIV-positive persons. The ruling stated that Russia was the only CoE country and one of 16 countries in the world to deport foreigners solely on the basis of their HIV status.

Coordinator of charitable programmes of the Civic Assistance Committee Varvara Tretiak (listed by the Ministry of Justice as a foreign agent) argues that finding a migrant with HIV is almost impossible: people “just go into the shadows”, live and work illegally. The Committee more often has to interact with refugees with HIV-positive status. Ms. Tretiak tells the story of an Uzbek national who sought asylum in Russia after fleeing the country for fear of being prosecuted for homosexuality. He tried to obtain a work permit and underwent a medical examination to do so. However, after being diagnosed with HIV, the “road in the legal field”, according to Varvara Tretiak, was closed to him. As a result, he moved to a third country.

One of the authors of the report, researcher Daniil Kashnitsky of the HSE Institute for Social Policy, told Kommersant that the results of the study will be sent to Rospotrebnadzor, the Ministry of Health and the Interior Ministry. Rospotrebnadzor told Kommersant that legislation on migration policy issues has been “optimized” in recent years. The Ministry also stated that they had not made “any decisions regarding undesirability of stay (residence) of foreign nationals or stateless persons from March 15 until December 15, 2020. The Ministry of Health told Kommersant that the agency “raises big questions about both the methodology and conclusions of the study.

Государство просят отказаться от практики выдворения мигрантов с ВИЧ

Представители Региональной экспертной группы по здоровью мигрантов в регионе ВЕЦА назвали действующую в РФ практику депортации мигрантов с ВИЧ не только негуманной, но экономически невыгодной. Лечение запущенных случаев, когда человек из страха выдворения скрывает статус и живет нелегально, обходится государству более чем в 200 тыс. руб., подсчитали эксперты. При этом если бы закон позволял им жить и лечиться — за свой счет или за счет родной страны мигрантов, курс годовой терапии стоил бы около 90 тыс. руб. В 2016 году ЕСПЧ уже требовал от России полного отказа от дискриминации ВИЧ-инфицированных иностранцев, однако с тех пор законодательство так и не изменилось.

Региональная экспертная группа по здоровью мигрантов в регионе ВЕЦА (РЭГ) оценила потенциальную экономическую пользу от отказа от дискриминации иностранцев с ВИЧ-положительным статусом в России. Авторы исследования пришли к выводу, что позволить мигрантам жить и легально лечиться на территории России «выгоднее не только с гуманитарной и эпидемиологической, но и с экономической точки зрения».

Закон от 1995 года запрещает иностранным гражданам с ВИЧ въезд в Россию, их временное пребывание и проживание. Если у иностранцев, прошедших тестирование не на условиях анонимности, выявлена ВИЧ-инфекция, Роспотребнадзор выносит решение о нежелательности их пребывания на территории страны. Эксперты обращают внимание, что из-за страха депортации многие трудовые мигранты скрывают заболевание. Они не принимают антиретровирусную терапию и в тяжелом состоянии попадают в больницы, где им по закону не могут отказать в экстренной медицинской помощи. Авторы подсчитали, что если пациент будет получать необходимую терапию, стоимость лечения составит 83 084 руб. в год, или примерно 6924 руб. в месяц. Они отмечают, что эти затраты «при внесении определенных поправок в законодательство» могут быть оплачены за счет страны исхода.

При этом если иностранец с ВИЧ-инфекцией не получает терапию, вследствие чего у него развиваются осложнения, стационарное лечение длительностью 21 день и курс антиретровирусной терапии обойдутся в 228 572,6 руб. Этот вариант лечения обеспечивается за счет бюджета РФ.

Авторы обращают внимание на высокую распространенность ВИЧ-инфекции в России — 54,8 человека на 100 тыс. населения. В странах, из которых трудовые мигранты приезжают чаще всего, показатель гораздо ниже: 14,2 — в Таджикистане, 13,2 — в Киргизии, 7,2 — в Азербайджане. Кроме того, они ссылаются на недавнее исследование Минфина России о влиянии ВИЧ на экономическое и демографическое развитие РФ. Согласно его данным, ежегодные потери общества от неконтролируемого распространения ВИЧ-инфекции составляют примерно 200 млрд руб. Исследователи отмечают, что «одной из характерных черт современного этапа распространения ВИЧ-инфекции в РФ является расширение масштабов скрытой эпидемии среди трудовых мигрантов, вынужденных держать свой ВИЧ-статус в тайне».

По данным ЦНИИ эпидемиологии Роспотребнадзора, в России с 1985 года, когда был обнаружен первый случай инфекции, до конца 2019 года было выявлено 37 389 ВИЧ-положительных иностранцев (речь о тех, кто прошел обследование официально). За это же время число ВИЧ-инфицированных россиян достигло 1 420 975 человек. Глава федерального центра по борьбе со СПИДом Вадим Покровский сказал “Ъ”, что, учитывая соотношение, влияние иностранцев на эпидемиологическую ситуацию «не такое уж большое». По его словам, в конце 1980-х, когда инфекция действительно обнаруживалась в основном у приезжающих из-за рубежа, в их обследовании и высылке на родину «был какой-то смысл». Уже через несколько лет число россиян—носителей инфекции значительно превышало число иностранцев, продолжает он, однако практика депортации поддерживалась «ура-патриотами», которые считали, что таким образом «спасают Россию от ВИЧ-инфекции». Сейчас, по мнению господина Покровского, основная проблема — экономическая, так как лечение пожизненное, дорогостоящее и непонятно, за чей счет мигранты будут его получать.

“Для того чтобы реализовать те предложения, о которых идет речь в исследовании, нужно внести соответствующие изменения в законодательство. Несомненно, это встретит волну споров»,— говорит господин Покровский.

Отметим, в 2016 году Европейский суд по правам человека (ЕСПЧ) признал Россию виновной в нарушении прав ВИЧ-положительных иностранцев, которым при наличии этого заболевания был запрещен въезд и пребывание в РФ. За год до этого, после соответствующего решения Конституционного суда, вышло постановление, что если у мигранта супруг, дети или родители — граждане РФ, его нельзя выдворять. Однако ЕСПЧ настаивал на полном отказе от дискриминации ВИЧ-инфицированных лиц. В решении говорилось, что Россия является единственной страной СЕ и одной из 16 стран в мире, которая депортирует иностранцев только на основании их ВИЧ-статуса.

Координатор благотворительных программ комитета «Гражданское содействие» (внесен Минюстом в список иноагентов) Варвара Третяк утверждает, что найти мигранта с ВИЧ практически невозможно: люди «просто уходят в тень», живут и работают нелегально. Комитету чаще приходится взаимодействовать с беженцами с ВИЧ-положительным статусом. Госпожа Третяк рассказывает историю гражданина Узбекистана, который, покинув страну из страха уголовного преследования за гомосексуализм, просил убежища в РФ. Он попытался получить патент на работу и для этого прошел медобследование. Однако после выявления ВИЧ «дорога в легальном поле», по словам Варвары Третяк, для него была закрыта. В результате он переехал в третью страну.

Один из авторов доклада, научный сотрудник Института социальной политики ВШЭ Даниил Кашницкий сообщил “Ъ”, что результаты исследования будут направлены в Роспотребнадзор, Минздрав и МВД. В Роспотребнадзоре “Ъ” заявили, что в последние годы законодательство по вопросам миграционной политики «оптимизируется». В ведомстве также заявили, что не принимали «решения о нежелательности пребывания (проживания) в отношении иностранных граждан или лиц без гражданства с 15 марта до 15 декабря 2020 года». В Минздраве “Ъ” сообщили, что в ведомстве «вызывают большие вопросы как методология, так и выводы исследования».

Jordan: Jordan’s HIV deportation policy threatens lives

Foreigners Living with HIV in Jordan Face an Impossible Choice

Government Mandates Reporting HIV Status, Deports People Living with HIV.

In Jordan, medical professionals and health facilities are mandated to report an individual’s HIV status to the government. Foreign nationals found to be HIV-positive are summarily deported regardless of the consequences to their health and safety and banned for life from returning.

Earlier this year, an Iraqi gay man living with HIV fled to Jordan to escape persecution he faced at home for being gay, yet he could not access HIV treatment without being immediately deported. When his health rapidly deteriorated, he could not seek medical attention for fear of being deported. Whatever decision he made would threaten his life.

Jordan also obliges nationals to undergo HIV testing when seeking employment in the public sector and for non-nationals obtaining work permits, and denies them jobs if they are HIV-positive. It also requires testing for non-nationals renewing residency permits. For LGBT people living with HIV, the stigma and discrimination by medical professionals and employers often bars them from accessing basic rights, without any legal recourse.

Abdallah Hanatleh, executive director of “Sawaed,” an Amman-based organization that facilitates access to HIV treatment, told Human Rights Watch that his organization documents dozens of deportations based on HIV status annually.

Jordan is not alone in this abusive practice. Gulf states including Saudi Arabia and the United Arab Emirates also deport people found to be HIV-positive without any provision for continuity of care. Worse yet, in Jordan, as in Saudi Arabia and the UAE, HIV-positive foreign nationals in the criminal justice system are denied adequate access to treatment in prison. “They are placed in solitary confinement, further isolating and stigmatizing them,” Hanatleh said.

International law prohibits deportations based solely on HIV status. Jordan should explicitly ban discrimination based on HIV status and stop deporting HIV-positive individuals under the principle of non-refoulement. This principle applies to asylum seekers and refugees, and for people with HIV, it means that governments are prohibited from returning them — depending on how advanced the disease — to places where they do not have adequate access to medical care and social support, or where they risk being subjected to persecution or degrading treatment on account of their HIV status.

Jordan should not mandate reporting of HIV status and employers should not be requiring HIV testing in the first place. People living with HIV should never be forced to forego lifesaving treatment in order to avoid deportation to danger.

Travel and long-stay restrictions for foreign nationals with HIV have no logical basis and have been deemed a human rights violation by the United Nations

Published in South China Morning Post on February 5, 2019

Visa restrictions for HIV-positive immigrants still in place in dozens of countries

  • Recent leak in Singapore of data of HIV-positive people renewed attention on its curbs on long-term stays by those who have the virus
  • Countries with restrictions include Russia and the United Arab Emirates; there’s no logical basis for them any more, UNAids says

A data leak of Singaporean medical records exposing the HIV-positive status of 14,200 people last month triggered concerns about a backlash for those whose health status was made public in a country that continues to stigmatise the disease.

But the case, involving the records of 8,800 foreign nationals who tested positive for HIV in Singapore, also shines a spotlight on the city state’s restrictive policies towards foreigners with HIV, who face barriers to staying in the country for more than 90 days unless married to a Singaporean national.

The records were leaked by a foreigner in just such a situation, American Mikhy Farrera Brochez, who was deported after serving jail time for drug-related crimes and fraud, including hiding his HIV status. He was able to access the records with help from his boyfriend, a Singaporean doctor.

Singapore is one of only a handful of developed nations that still have laws restricting the long-term stay of foreign nationals with HIV – laws that have been deemed a human rights violation by the United Nations.

“When this [1998] law was brought in there was a lot more fear of unknown issues around disease … but [today] the logic is just not borne out by any scientific or medical basis,” says Eamonn Murphy, UNAids regional director for Asia and the Pacific.

Instead, countries that still have such restrictions in place often do so because of “historical convention, ideology, or even passivity”, Murphy says. He notes that UNAids is renewing its focus on the issue this year, compiling a new report on national restrictions.

UNAids most recent comprehensive report on HIV-related travel and immigration laws in 2015 listed 35 countries with such restrictions.

However, incomplete data published in 2018 by UNAids named at least 18 countries that have policies restricting entry, stay or residence for people living with HIV. Information from many countries were left off the list, and will be updated this year to reflect the true extent. The same report found that 60 countries require testing for residence or other permits, including marriage, not limited to foreigners.

The exact numbers, however, are difficult to pin down, experts say. An independently researched global database counts 49 countries with HIV-related restrictions on long-term stay in 2018, based on information sourced from local embassies and reports from travellers and immigrants. Countries with restrictions include Russia, Singapore, and the United Arab Emirates.

“The data the countries present about themselves in diplomatic settings can be different from the policies that are actually executed,” says American epidemiologist Jessica Keralis, who has researched the public health impacts of such HIV-related restrictions.

For example, countries may not have regulations “on the books”, but employers can revoke visas for HIV-positive employees, or state insurance policy can make it difficult for immigrants to afford treatment, she says.

In other cases, official policy may not be known by regional or local officials and institutions.

These distinctions matter for HIV-positive immigrants, whether white-collar workers, migrant labourers or students, according to David Haerry, who publishes the Global Database on HIV-Specific Travel and Residence Restrictions, which names the 49 countries.

“Oftentimes people [sent abroad for work] don’t know and they fall in the trap: if you don’t know and you have to be tested on the ground, and then you are sent back on health grounds, your company knows,” he says. “It’s a big issue.”

Haerry receives daily emails through the database from people around the world wondering how to travel or relocate safely while living with HIV. In recent years, he’s seen restrictive policies become more of an issue for students looking to study abroad, but who fear the consequences of mandatory HIV testing even in countries where there is no explicit restriction on those who are HIV-positive.

For such situations, “we have no solution”, Haerry says.

Many national restrictions are holdovers from the 1980s, before the disease’s transmission was understood and the antiretroviral therapies and daily medications that can prevent its spread became widely available, according to UNAids’ Murphy. But he has seen progress globally.

A number of countries changed their policies after UNAids launched a 2008 campaign against the 59 governments that had bans at that time. The United States, South Korea and China were among the nations to remove restrictions in 2010, although South Korea retained some related to immigration, while China reportedly has mandatory HIV testing for some visas.

Singapore revised its own regulations in 2015 to allow people living with HIV to enter the country for short-term stays of less than three months, while South Korea in 2017 removed its final restriction, which mandated the testing of foreign teachers.

But conservative cultures, social stigma and inertia have kept some restrictions in play in other nations, experts say. The majority of such restrictions are found in conservative countries; more countries in the Middle East than anywhere else have them.

“The basis of discrimination is misconception and fear, and with HIV these boil down to drug use, men who have sex with men, and all these realities that countries don’t want to face,” says Peter Wiessner, who co-authors the global database. “There’s also xenophobia mixed in.”

That element can have a negative public health impact, according to Keralis.

“It communicates that HIV is a foreign contagion and a foreigners’ problem, and if [citizens] don’t mix with foreigners then they are not at risk,” she says. She notes that, paired with a lack of proper sex education, this can create a dangerous situation.

“There’s no incentive for people to seek more information or modify their behaviours,” she says.