impact of immigration policies on hiv/aids care access and retention catalina sol chief programs...
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Impact of Immigration Policieson HIV/AIDS Care Access and
Retention
Catalina Sol
Chief Programs Officer
La Clinica del Pueblo
La Clinica del Pueblo Serves uninsured and low-income Latino
immigrants in DC area with comprehensive health care
Majority of clients are Central American immigrants with history of war and trauma, rural origin, limited access to health care, lengthy process to obtain legalization in US
Since its inception in 1993, La Clinica has been a Latino community-based organization
La Clinica’s HIV Department Provides HIV care and prevention services
since 1985 Funded locally with Ryan White since 1993
for direct services, directly-funded by CDC since 1998 for prevention
Services include primary medical care, case management, mental health and substance abuse services,, support groups, interpreter services, outreach, group interventions for vulnerable populations, CTR, system navigation
Barriers to Detection and Early Intervention
Lack of linguistically and culturally appropriate, geographically accessible services
Lack of access to health care Health beliefs and attitudes related to
knowledge of disease Stigma
Barriers to Care for HIV Positive Latinos Conflicts between work and medical care Instability/lack of availability of housing Lack of family/support structures Lack of linguistically and culturally
appropriate services, particularly mental health services
Stigma
Immigration and Daily Life
What does it mean to be undocumented?– Progressive criminalization of administrative status --
• Relationship to police, law enforcement, state/government entities• Effect on physical and mental health
– Inability to obtain basic documents –social security #, ID• Driving, banking, home renting or ownership, access to services• Effect on social insertion and stability
– Inability to obtain safety net benefits• Effect on socioeconomic status, relationship to employer• Notable exception – Ryan White, ADAP
– Extreme vulnerability with respect to employer
Immigration and Daily Life What does it mean to have a work permit?
– Legalization, opportunity for identification– Temporary state– Still no benefits – Poorly understood category
What does it mean to have a green card (permanent residence)?– Permanent legalization, official “entry” to US– Still no federal safety benefits (must wait 5 years) – Medicaid,
Section 8, Food Stamps What does it mean to be a citizen?
– Vote– Benefits
Immigration Policy – HIV specific History of Immigration policy with respect to
HIV/AIDS is a policy of exclusion
Life during the HIV Ban– Consular testing– Testing as condition of legalization– Life or death dimension of risk when exploring permanent
residence option
HIV Ban lifted Jan 2010!
Immigration Policy, general
Even without ban, immigration policy poses multiple barriers to “entry” to low-income immigrants living with HIV– Family Based
• Sponsor
– Employment based– Asylum– Refugee– Public charge issues– Length of time
Impact of Immigration Policies -- States
Increasing number of states imposing restrictions on access to services for immigrants
Impacts on access for Ryan White• process for determining eligibility can be exclusionary• Confusing for eligibility workers – not immigration experts!• Public perception among immigrants• Where state funding for HIV is significant, excluding immigrants
for services
Impact of Immigration Policies -- Individuals
Hostility towards immigrants, bigotry, reinforced by policies
Service providers – confused, fearful, unsure of how to proceed without hurting clients
Fear of immigrants, frequently disproportionate and based on traumatic experiences, seems to be more and more warranted
Recommendations
Voice of public health community must be louder in national dialogue on immigration– Negative impact on public health of immigration
policies– Cost savings of inclusion– Cost burden of exclusion, including non-health
areas– Health as a human right
Recommendations
At service provider level:– Reinforce availability of Ryan White services for
immigrants– Examine how access points may be excluding immigrants
unnecessarily– Ask about immigration status only to determine eligibility,
ask the question correctly– Do not reinforce fears of patients, but be informed– Make alliances with community-based organizations that
work with immigration issues to brief them on special needs of HIV positive patients