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"Phobia at the Gates":
In today's Washington Post, Andrew Sullivan has a powerful op-ed about a U.S. immigration policy I didn't know existed: a ban on visitors who are HIV-positive. You really should read the whole thing, but here's just an excerpt:
  Twelve countries ban HIV-positive visitors, nonimmigrants and immigrants from their territory: Armenia, Brunei, Iraq, Libya, Moldova, Oman, Qatar, the Russian Federation, Saudi Arabia, South Korea, Sudan and . . . the United States. China recently acted to remove its ban on HIV-positive visitors because it feared embarrassment ahead of the Olympics. But America's ban remains.
  . . .
  The ban can be traced to the panic that dominated discussion of the human immunodeficiency virus two decades ago. The ban was the brainchild of Sen. Jesse Helms (who came to regret his initial hostility toward people with HIV and AIDS). President George H.W. Bush sought to drop the ban, but in 1993, after a scare about Haitian refugees, Congress wrote it into law.
  I remember that year particularly because it was when I, a legal immigrant, became infected. With great lawyers, a rare O visa (granted to individuals in the arts and sciences), a government-granted HIV waiver and thousands of dollars in legal fees, I have managed to stay in the United States. Nonetheless, because I am HIV-positive, I am not eligible to become a permanent resident. Each year I have to leave the country and reapply for an HIV waiver to reenter. I have lived in the United States for almost a quarter-century, have paid taxes, gotten married and built a life here -- but because of HIV, I am always vulnerable to being forced to leave for good. After a while, the stress of such insecurity gnaws away at your family and health.
  This law has lasted so long because no domestic constituency lobbies for its repeal. Immigrants or visitors with HIV are often too afraid to speak up. The ban itself is also largely unenforceable -- it's impossible to take blood from all those coming to America, hold them until the results come through and then deport those who test positive. Enforcement occurs primarily when immigrants volunteer their HIV status -- as I have -- or apply for permanent residence. The result is not any actual prevention of HIV coming into the United States but discrimination against otherwise legal immigrants who are HIV-positive.
  People with HIV are no less worthy of being citizens of the United States than anyone else. All we ask is to be able to visit, live and work in America and, for some of us, to realize our dream of becoming Americans -- whether we are HIV-positive or not.
  As I said, I didn't know this ban existed; now that I know of it, it sounds absurd. Unless there's some counterargument that I can't think of right now, it seems like a slam dunk that Congress should pass legislation ending the ban.
Archon (mail):
HIV, the first politically protected pandemic.

Oh yeah, there was no "scare about Haitian refugees," the fear was real. It was immigrants from the Haiti that brought HIV to New York and then it spread from there. It is funny how quickly politically correct history becomes.
5.14.2008 5:30pm
Anderson (mail):
Oh, this should be a good thread. "Harrumph! Isn't America allowed to exclude those infected with a deadly disease?" Let me go put some popcorn in the microwave.

OT, Paul Clement's resigning -- I would guess b/c there will be a new admin when the next SCOTUS term rolls around.
5.14.2008 5:31pm
Anderson (mail):
Even as I was typing ....
5.14.2008 5:31pm
OrinKerr:
Archon,

I'm curious, what do you think we should do with the ban? Do you think we should keep it? Given our understanding today of how HIV spreads, are you worried that if we end the ban, there will be an influx of HIV positive individuals who enter the United States and that the virus will "spread from there"?
5.14.2008 5:33pm
Archon (mail):
Yes we should keep the ban.

Absent contraction through blood transfusions and the such in the 1980's and some other extreme cases, you don't get HIV by accident. It takes purposeful behavior, again absent things like healthworker needle sticks, to contract it.

There are only two sure fire ways to get HIV - 1. Receiving anal sex and 2. IV drug use with an infected needle. If you have HIV, 99% of the time you have engaged in one of these behaviors and are likely to do it again. This increases the risk for the population in general to have people who have engaged in high risk behavior and have a high perpensity for continuing that behavior.
5.14.2008 5:38pm
Serendipity:
I wonder how many people realize that men who have had sex with another man at any point since 1976 are not allowed to donate blood. I would assume it is also only enforceable because of the donor's honesty. It's another nonsensical ban given that all blood is now tested before being used.
5.14.2008 5:39pm
Archon (mail):
Serendipity:

The reason the ban exists is because the HIV screening used for blood donors is not 100% effective. Every year there are a few cases of people infected because the screening is only something like 99.99999% accurate.
5.14.2008 5:40pm
Serendipity:

There are only two sure fire ways to get HIV - 1. Receiving anal sex and 2. IV drug use with an infected needle. If you have HIV, 99% of the time you have engaged in one of these behaviors and are likely to do it again. This increases the risk for the population in general to have people who have engaged in high risk behavior and have a high perpensity for continuing that behavior.



No, the only sure fire ways to contract HIV is to come into contact with the bodily fluids (blood, semen, vaginal fluid, breast milk) of someone who is seropositive. I can think of any number of ways this could happen that have nothing to do with anal sex or IV drug use.
5.14.2008 5:41pm
Steve:
Heh, Anderson, I admit I click on certain comment threads just to see the carnage.
5.14.2008 5:44pm
Anderson (mail):
If you have HIV, 99% of the time you have engaged in one of these behaviors and are likely to do it again. This increases the risk for the population in general

Leaving aside Serendipity's point, if *receiving* anal sex is what causes one to contract HIV, then having once done so, one is no more likely to spread HIV no matter how many, er, repetitions. No risk to the population in general.
5.14.2008 5:44pm
ramblindore:
Actually, just coming into contact with vaginal fluid isn't enough. I don't have the stats on hand, but I believe that a nonpositive male who has sex with a positive female has less than a 33% chance of contracting HIV from that specific type of contact. The numbers are much greater if the roles are reversed.
5.14.2008 5:46pm
rarango (mail):
From a public health perspective, the best intervention is the approach taken by Cuba--test everyone, and quarantine those who are positive--not politically correct, of course, but the Cuban public health folks didnt have to worry about that. The quarantine was lifted, as I recal in 2002, but many of the HIV positive Cubans are still in sanitoria throughout Cuba. Considering not many seem to want to immigrate to Cuba, a ban is probably not an issue.

I bring up the case of Cuba and HIV because their classic public health intervention--quarantine, while distasteful to those who are more interested in human rights aspects, nonetheless has resulted in an extraordinarily low rate of HIV infection.

To address Professor Kerr's 4:33 questions: since the US has chosen other HIV control measures short of quarantine, it really makes no sense from an epidemiological or public health response to limit HIV positive people. Thus no need to ban. Now were the US Cuba, given its intervention 20 years ago, it would make sense to limit HIV positive immigrants--were there any to limit.

The HIV positive issue--like any infectious disease--has a public health context and a political context. Should we, for example, permit individuals exposed to Margburg virus to enter the country? or cholorea? Infectious diseases all--just as HIV is.
5.14.2008 5:47pm
GMUSL '07 Alum (mail):
Serendipity, I don't agree with Archon, but not all bodily fluids (nor all activities) are equally effective at transmission. HIV is also present in saliva and tears (though I don't know about sweat).

This is why male homosexuals have a much higher rate of infection than heterosexuals, who in turn have a higher rate of infection than lesbians. Compare the rates of male-to-male transmission (high), male to female (somewhat high), and female-to-anybody (low). Anal sex is a very risky vector for both parties involved, whereas oral sex involving an infected woman is safe by comparison.
5.14.2008 5:48pm
rarango (mail):
please make that Marburg and Cholera--epidemiology is one thing, spelling is another.
5.14.2008 5:50pm
Serendipity:
Yeah, I was obviously generalizing. I think I've seen several studies showing that repeated unprotected sex between serodivergent couples doesn't necessarily result in seroconversion for the negative partner. But, those sorts of details are lost if people think you can only get HIV from receiving anal sex or shooting up IV drugs.
5.14.2008 5:50pm
J. F. Thomas (mail):
Although we shouldn't prohibit HIV+ people on that basis, isn't there some other way we can keep Andrew Sullivan out of the country?
5.14.2008 5:52pm
Anderson (mail):
I don't have the stats on hand, but I believe that a nonpositive male who has sex with a positive female has less than a 33% chance of contracting HIV from that specific type of contact.

I think we may have both read the Playboy Adviser that month, since that does sound familiar.

Anal sex is a very risky vector for both parties involved

I have never quite understood this, but it's been awfully low on my list of practical worries (somewhere above "Second Coming" but below "massive asteroid strike"), so I haven't bothered to figure it out.

Assuming no open sores on the active partner, why *is* anal sex with an HIV-positive passive "very risky"?
5.14.2008 5:52pm
NickM (mail) (www):
Andrew Sullivan earns a lot of money, and is able to pay his own medical costs (HIV drug treatment is very expensive). The average prospective immigrant with HIV cannot.

Immigrants with expensive medical conditions that the U.S. taxpayer would be on the hook to treat are not desirable on balance.

Nick
5.14.2008 5:52pm
J. F. Thomas (mail):
I bring up the case of Cuba and HIV because their classic public health intervention--quarantine, while distasteful to those who are more interested in human rights aspects, nonetheless has resulted in an extraordinarily low rate of HIV infection.

Which raises the question. What happens if a HIV+ Cuban enters the country? I bet Jesse Helm's head would explode.
5.14.2008 5:54pm
rarango (mail):
You are aware, Anderson, that you would most likely not be aware that you had an anal or rectal open sore--they don't have to be very large. Unless you had a proctological exam you are taking a major risk.
5.14.2008 5:55pm
Anderson (mail):
You are aware, Anderson, that you would most likely not be aware that you had an anal or rectal open sore--they don't have to be very large.

I was referring to what would presumably have to be a sore (etc.) on the penis, not within the anus.

What happens if a HIV+ Cuban enters ... Jesse Helms?

I edited that into a more interesting question. (The strike-through tag never works for me on this blog.)
5.14.2008 5:59pm
Dan Hamilton:

Leaving aside Serendipity's point, if *receiving* anal sex is what causes one to contract HIV, then having once done so, one is no more likely to spread HIV no matter how many, er, repetitions. No risk to the population in general.


You mean that Gays only have sex with ONE person. That there are no Bis. That drug users don't count. etc.

Nothing like allowing more people with an incurable deadly disease (that the infected don't seem to care that they are giving it to others) into the country.

If the spread of HIV/AIDS were to stop but that is impossible. Asking an infected Gay to not have sex is just to cruel. Better that he should spread the disease, after all they have pills for that now.

Keep them out. If you infect someone it should be charged as attempted murder and the sentance life in solitary. That is so they can't infect anyone else.

The way the US treats HIV/AIDS is just silly. If it hadn't been for the Gays it would have been treated like any other disease and far fewer would have died or been infected.
5.14.2008 5:59pm
alias:
Assuming no open sores on the active partner, why *is* anal sex with an HIV-positive passive "very risky"?

A long time ago, I asked someone a generation older than me this question, and his response was that there is a high correlation between people who have anal sex and people who are much more promiscuous than the average. Thus, the virus spreads more quickly in the anal-sex-having portion of the population.

I don't know if the medical community agrees or if that's just a stereotype.
5.14.2008 6:03pm
rarango (mail):
HIV/AIDS has long since since been foreclosed in terms of public health responses because it because a political issue. When the disease because a political issue, important public health interventions were closed. That seems to me to be a significant "teaching point."

Similarly, does anyone recall the heterosexual aids crisis so hyped by the media 15 years ago? the publication of Michael Fumento's book Myth of Heterosexual AIDS?. Fumento was excoriated, but with 15 years past, he was most definitely right and his critics most definitely wrong. AIDS has now, for most, been reduced to a chronic disease because of pharaceutical interventions and awareness about safe sexual practices. It is, however, still out there.
5.14.2008 6:06pm
Serendipity:
Actually if it hadn't been the gays, the government might have responded more quickly in the first instant, perhaps reducing how rapidly the disease spread. (Compare e.g. the response to Legionnaire's outbreak in 1976 and the initial G.R.I.D (as it was called at the time) outbreaks)
5.14.2008 6:07pm
rarango (mail):
apologies--its my steadfast refusal to use preview. First sentence in my 5:06 should read, HIV/AID has long since been immunized from a public health issue because it became a political issue. I'm Roger and I'm a non-previewer. my 12 step program starts tomorrow.
5.14.2008 6:09pm
cjwynes (mail):
Isn't the mix of drugs that HIV+ people have to take somewhat expensive? I imagine that, in general, an HIV+ person is likely to be a much larger drain on public health resources than an HIV-negative person, all else being equal. That alone is enough to justify excluding them, with the possible exception of people who come temporarily on work visas and whose company will vouch that their condition is covered by their insurer. No foreigner has a right to be in our country unless we choose to allow them here, and we ought not allow them to be here unless we are confident that the individual in question will be a benefit to our economy and not a burden.

God save us if socialist medicine were ever implemented, we'd need to do extensive health screenings at the border and turn away pretty much everybody from the 3rd world if we wanted to stay afloat.
5.14.2008 6:12pm
Soronel Haetir (mail):
The public health cost aspect becomes even more pressing if universal health care becomes a reality.
5.14.2008 6:12pm
Thorley Winston (mail) (www):
As I said, I didn't know this ban existed; now that I know of it, it sounds absurd. Unless there's some counterargument that I can't think of right now, it seems like a slam dunk that Congress should pass legislation ending the ban.


Well considering how many people object to illegal aliens who come into the United States and use the hospitals and send their children to school at taxpayer expense, I would imagine that many think it's probably a bad idea to make it easier for the ones with a deadly infectious disease to come in. Particularly not when the same politicians who might support lifting the ban are more likely than not the ones calling for "universal health care" that would presumably include treating that same deadly infectious disease at taxpayer expense.
5.14.2008 6:15pm
rarango (mail):
Professor Kerr: at least two posters have raised the issue of the long term medical cost to maintain HIV positive patients. Would cost be an appropriate reason to continue the ban? or should the ban be modified to permit HIV positive immigrants to enter assuming they can assume the cost of their meds.
5.14.2008 6:15pm
Archon (mail):
Anal sex is risky because the virus can easily enter the body through mucus membranes and there are plenty of those in the rectum and anus. I think the CDC pegs the chance of contracting HIV when engaged in unprotected anal sex with an infected partner at 1:4.

Conversely, absent extraordinary circumstances, men having heterosexual, unprotected vaginal sex have something like a 1:100,000 chance of contracting HIV. The difference is that HIV cannot enter the body through skin and the only mucus membrane on the penis is the urertha. Some researchers think that is is next to impossible for a non-IV drug using man who only has vaginal sex to ever contract the virus.

When a woman has vaginal sex with an infected male partner I believe the trasmission rate is about 1:400. Researchers think the difference between this and anal transmission is that the vaginal has certain enviromental conditions designed to prevent microbes from reproducing and this could inhibit the virus from entering a mucus membrane.

Even if you are exposed to a small amount of the virus, you body CD4 lympocyctes are capable of destroying HIV in small quantities before a full-blown infection sets in. Hence, you have to receive a large amount of virus to actually get HIV.
5.14.2008 6:18pm
Anderson (mail):
Anal sex is risky because the virus can easily enter the body through mucus membranes and there are plenty of those in the rectum and anus. * * *

Conversely, absent extraordinary circumstances, men having heterosexual, unprotected vaginal sex have something like a 1:100,000 chance of contracting HIV. The difference is that HIV cannot enter the body through skin and the only mucus membrane on the penis is the urertha.


In other words, then, a male inserting his penis into an HIV-positive person's anus has about as much chance of getting HIV as if he were inserting said organ into an HIV-positive person's vagina.

Not that there's any terribly good reason to take a 1:100,000 chance if condoms are available, but still.
5.14.2008 6:21pm
rarango (mail):
This topic has certainly piqued my interest from a public health standpoint. Assuming it's OK to let HIV positive people immigrate as both Andrew Sullivan and Professor Kerr advocate, should the presence of any infectious disease be a barrier for entry into the US? If so, which ones?
5.14.2008 6:23pm
OrinKerr:
Professor Kerr: at least two posters have raised the issue of the long term medical cost to maintain HIV positive patients. Would cost be an appropriate reason to continue the ban? or should the ban be modified to permit HIV positive immigrants to enter assuming they can assume the cost of their meds.

The issue of cost seems like the best counterargument, but it seems to me that there are a few responses. One option is the one you suggest: modify the ban to permit immigrants that can assume the cost of their meds. Second, I would want to know more about if the ban that exists now is in fact so easily evaded by simply not reporting. If that is true, then cost is relevant only for the presumably small segment of the population that (a) decides to self-report and (b) cannot afford meds. I would want to know how big that group is; as I suggest, I would be surprised if it was a large group.
5.14.2008 6:24pm
Randy R. (mail):
Well, if you ban people from immigrating to the US who have HIV, then there is a simple solution: Don't ever get tested for HIV! Then, voila, you can gain admittance into the US without any problem. If you think that treating the disease is better than not treating, and know that you might infect others, then this current policy encourages the opposite.

Some have complained that HIV people will burden the health care system of the US. Fine. then you will have no problem with people who just want to visit the US, since they will be going back to their home country, right? No burden on our health care.

And if burdens on the health care industry is what you are concerned about, then you should be trying to increase the number of diseases that prohibit you from entering our country. If you have high blood pressure, heart disease, diabetes, mental illness, cancer, obesity, are a smoker, engage in high risk sex, high risk sports or other high risk occupation, you will statisically become a burden upon our health care system, and you should be turned away, even as a tourist.

But of course, it's not really about any of this, is it?
5.14.2008 6:26pm
Thorley Winston (mail) (www):


Professor Kerr: at least two posters have raised the issue of the long term medical cost to maintain HIV positive patients. Would cost be an appropriate reason to continue the ban? or should the ban be modified to permit HIV positive immigrants to enter assuming they can assume the cost of their meds.


I would also ask Professor Kerr -- does he believe that it's okay for the United States to have an immigration policy that favors admitting people who are likely to be net financial contributors while trying to prevent the admission of people who are likely to go on public assistance?

And no saying "I'm against taxpayer funded public assistance or expanding it to cover the new entrants" isn't an answer. The fact is that the welfare state is here and the momentum is on the side of expanding it particularly in the area of health care services and merely wishing it away isn't going to cut it.
5.14.2008 6:26pm
Guest101:
I haven't read the Sullivan article, but does the U.S. maintain a similar policy with respect to other incurable diseases? If so, it doesn't seem completely unreasonable to me to include HIV, notwithstanding the fact that its transmission requires some voluntary (but hardly uncommon) conduct.
5.14.2008 6:29pm
Anderson (mail):
Btw, n.b. that the policy doesn't just apply to immigrants, but to *visitors*.

Of course, given how we treat some of our visitors, excluding as many visitors as possible on bogus grounds would arguably be doing them a favor.
5.14.2008 6:29pm
Anderson (mail):
Guest101, see this from the article:

HIV is the only medical condition permanently designated in law -- in the Immigration and Nationality Act -- as grounds for inadmissibility to the United States. Even leprosy and tuberculosis are left to the discretion of the secretary of health and human services.

Sully has "a rare O visa (granted to individuals in the arts and sciences)"; I guess "political science" is the idea here.
5.14.2008 6:32pm
Lior:
This discussion is a getting a bit silly. It's always been the case that countries refuse admission to people with dangerous infectious diseases. TB-positive people are also prohibited from entering the US. In the early 80s HIV was not well-understood, and it was not unreasonable to have a bad.

Today we have a much better understanding of HIV, its transmission modes, and of AIDS, so reconsidering the ban makes sense. The point is not the precise modes of transmission and the exact risks -- it's that we understand them well. The US admits people who are TB-antibody-positive, for example, but they are required to be on a course of antibiotics if they don't have a good explanantion.

I think everyone agrees that not letting an active case of AIDS could be is reasonable (but what if the person is coming for the purpose of getting medical care?). On the other hand, a blanked policy denying a long-term resident permanent residence (or citizenship) because he's HIV positive seems unreasonable to me.
5.14.2008 6:33pm
rarango (mail):
RandyR: I thought I could address your post by trying to distinguish medically between behaviors, chronic disease, infectious disease, visitors, and immigrants.
But alas--it isn't going to be worth my time or effort. Perhaps another poster could try it. Your post is a jumble of incoherence. I do hope you are a lawyer and not a public health official.
5.14.2008 6:34pm
Guest101:
Thanks, Anderson. In that case, this law is stupid-- and the fact that other diseases are not subject to the same policy pretty effectively undermines any argument based on health care burdens.
5.14.2008 6:38pm
GV:
For those concerned about the financial impact of admitting people with HIV, you might want to actually read the linked article, as it discusses that.
5.14.2008 6:44pm
Daran (mail):
To voice a very politically incorrect opinion: you refuse them access because they have a proven history of engaging in behavior that endangers themselves as well as others.

Same reason as why convicted felons are refused access. For all the talk about 'has paid his debt to society', 'needs a second chance', a lot of countries seem to prefer to close their borders.

In an ironic twist, a Dutch minister wanted to address this very issue during his visit to the US. However in the same month there was a huge scandal in the Netherlands about visitors to gay parties being drugged and intentionally infected with HIV positive blood.
5.14.2008 6:48pm
one of many:
Actually Sullivan is pushing the limits with "HIV is the only medical condition permanently designated in law -- in the Immigration and Nationality Act -- as grounds for inadmissibility to the United States. Even leprosy and tuberculosis are left to the discretion of the secretary of health and human services." The US ban does not actually prohibit all individuals with HIV from entering the country, it merely allows the US to prevent any individual with HIV from entering the US on that basis, which the INA also does for other diseases including leprosy and tuberculosis. Interestingly while leprosy and tuberculosis waivers come from HHS, HIV waivers come from the Attorney General (can be used to support the HIV treated differently from other diseases idea).
5.14.2008 6:49pm
KevinM:
alias wrote of "a high correlation between people who have anal sex and people who are much more promiscuous than the average"

Once you go, uh, back, you'll never go, uh, back.
5.14.2008 6:50pm
poul (mail) (www):
never rely on sullivan for actual facts. here's from
state dept:

"The immigration laws of the United States, in order to protect the health, welfare, and security of the United States, prohibit the issuance of a visa to certain applicants. Examples of applicants who must be refused visas are those who: have a communicable disease such as tuberculosis, have a dangerous physical or mental disorder, or are drug addicts; have committed serious criminal acts; are terrorists, subversives, members of a totalitarian party, or former Nazi war criminals" etc.

if tuberculosis and membership in a communist party are grounds for visa refusal, AIDS should be as well.
5.14.2008 6:54pm
AnonLawStudent:
To throw some hard numbers into the mix:

Estimated per-act risk of acquiring HIV, by exposure route:

Needle sharing IV drug use: 67/10000
Receptive anal intercourse: 50/10000
Receptive penile-vaginal intercourse 10/10000
Insertive anal intercourse: 6.5/10000
Insertive penile-vaginal intercourse: 5/10000
Receptive oral intercourse: 1/10000
Insertive oral intercourse: 0.5/10000

Source: CDC [Scroll about 3/4 of the way down to Table 1].

That being said, the transmission rate for each HIV positive individual averages over 4% per year. Source: Holtgrave, 35 J. AIDS 89 (2004). On the basis of a 1 in 25 chance that each infected person will infect another person in a given year, a prohibition on entry seems entirely valid from a public health perspective.
5.14.2008 6:55pm
Warmongering Lunatic:
Mr. Sullivan set up personal ads for bareback sex with strangers. Although he advertised his HIV-positive status, there is no mechanism by which he could exclude the HIV-negative from answering his ad, and accordingly he chose to risk spreading HIV to non-infected persons. So, Mr. Sullivan has deliberately transmitted the human immunodeficiency virus, with no effort to mitigate risk of transmission, potentially to persons who themselves may not have been HIV infected.

Now, from a pure libertarian perspective, that is acceptable. The only persons at risk of contracting HIV from Mr. Sullivan were persons who volunteered for it; any pass-along risk from them is the responsibility of those persons.

However, at any step back from that, we're stuck with the fact that it demonstrates that people who are known to be HIV positive spread the human immunodeficiency virus. Andrew Sullivan has done it himself, and though we can hope he did so only to persons who were already HIV-positive, we cannot know that.

Short of the strict libertarian standard, it would be a reasonable thing to exclude persons who spread HIV to other persons from the country. Since we cannot monitor HIV-positive immigrants to prevent them from spreading the virus, it thus becomes a reasonable thing to exclude persons who carry HIV from the country.
5.14.2008 7:05pm
SIG357:
People with HIV are no less worthy of being citizens of the United States than anyone else.

Eh? They seem a lot less worthy to me. The cost of treatment for HIV and AID's runs into the tens of thousands per dollar per year per patient. With all the people beating down the door to get here, why should we go with HIV patients?

In the past immigrants were turned back for having other infectious diseases, such as TB.
5.14.2008 7:16pm
Adam J:
Daran- "...they have a proven history of engaging in behavior that endangers themselves as well." And what behavior is that? Are you really assuming that all HIV cases were contracted as a result of unprotected sex by gay men?
5.14.2008 7:17pm
Anderson (mail):
never rely on sullivan for actual facts

Come on, folks, learn how to read. Sully writes:

HIV is the only medical condition permanently designated in law -- in the Immigration and Nationality Act -- as grounds for inadmissibility to the United States.

If he's wrong, then someone can quote the *statute* to the contrary.

The legal prohibitions on TB victims, etc., are very likely regulations -- "law," surely, but not statutes.

Sully chose his words carefully, but that doesn't make them false.

Mr. Sullivan set up personal ads for bareback sex with strangers. Although he advertised his HIV-positive status, there is no mechanism by which he could exclude the HIV-negative from answering his ad, and accordingly he chose to risk spreading HIV to non-infected persons.

Dude, don't choke on your own saliva, okay? If he "advertised his HIV-positive status," then I daresay that the non-infected persons knew what they were, uh, getting into.
5.14.2008 7:18pm
SIG357:
Anderson

see this from the article:

I'd be wary of taking anything Sullivan says on any topic as the truth. That applies in spades if the topic has a tie-in to gays.
5.14.2008 7:21pm
SIG357:
If he's wrong, then someone can quote the *statute* to the contrary.


Or you can quote the statute to that effect.
5.14.2008 7:23pm
SIG357:
I found no such provision in the Immigration and Nationality Act.

It does say this;

(a) Classes of Aliens Ineligible for Visas or Admission.-Except as otherwise provided in this Act, aliens who are inadmissible under the following paragraphs are ineligible to receive visas and ineligible to be admitted to the United States:

(1) Health-related grounds.-

(A) In general.-Any alien-

(i) who is determined (in accordance with regulations prescribed by the Secretary of Health and Human Services) to have a communicable disease of public health significance, which shall include infection with the etiologic agent for acquired immune deficiency syndrome,



But that is NOT what Sullivan is alleging.
5.14.2008 7:27pm
pete (mail) (www):
Randy R:

Fine. then you will have no problem with people who just want to visit the US, since they will be going back to their home country, right? No burden on our health care.


And since no one ever overstays a tourist/student/worker visa in the US there is no need to worry that a visitor will simply choose to stay here after they are supposed to leave.
5.14.2008 7:28pm
SIG357:
Link here to Immigration and Nationality Act.
5.14.2008 7:28pm
SIG357:
As I said, I didn't know this ban existed; now that I know of it, it sounds absurd.

You still don't know this ban exists, not as described by Sullivan.
5.14.2008 7:31pm
Anderson (mail):
Sig, I gotta run, but agreed that Sully should come up with a cite. I was just pointing out that he was being very specific about referring to *statutory* law. So he may well be b.s.'ing nonetheless.

I'll check back later &see if he's been busted or not.

But really, I was just checking in to see if anyone knows what's become of Clayton Cramer? I'm beginning to worry about him.
5.14.2008 7:34pm
ReaderY:
I am greatful that our First Amendment protects me from religious fundamentalists who would take away our right to choose to terminate unwanted fetal pregnancies and unwanted alien entries whose health issues might cause us psychological harm or require undue attention or care that might hurt our career and recreational aspirations

The right to choose freely is American's most basic, most fundamental right. Everyone knows that unwanted children are subject to a lot of abuse in this country, and freedom of choice exists for their own good, to prevent the harm that would come if the unwanted were permitted to enter our midst. But it's not appreciated that exactly the logic is applicable to aliens. The freedom to choose to exclude wanted aliens is really for the good of the aliens in exactly the same way that the freedom to choose to abort a fetus is for the good of the fetus. Sine extraterritorial aliens are no persons than fetuses are, no person is harmed by excluding them. What's really going on here is that religious fundamentalists feel offended a free society chooses not to force their religious beliefs down Americans' throats.

I am greatful that our constitutional freedom of choice is at work here to prevent persons with HIV from coming into existence through birth or naturalization. Termination and exclusion, by preventing personhood from forming in the first place, eases suffering by preventing suffering persons from getting created.

It's an exercise of our right to choose. It prevents suffering. It's the liberal thing to do.

Under our constitution the word "person" no more applies to an extraterritorial alien than it does to a fetus. If it's justifiable to abort fetuses to prevent persons from HIV from coming into existence through birth, it's equally justifiable to exclude aliens with HIV to prevent persons with HIV from coming into existence through territoriality or naturalization.
5.14.2008 7:43pm
Richard Aubrey (mail):
rarango.
Nice point about accepting those who can support the costs of their own treatment.
I believe a good many legal immigrants have a sponsor who promises to take care of them should they fall on hard times. How's that working out?
5.14.2008 8:05pm
Thorley Winston (mail) (www):
Here's a bit more comprehensive view of the Immigration and Nationality Act's listing of which Aliens are inelligeible for Visas or Admission for Health Reasosn




(a) Classes of Aliens Ineligible for Visas or Admission.-Except as otherwise provided in this Act, aliens who are inadmissible under the following paragraphs are ineligible to receive visas and ineligible to be admitted to the United States:

(1) Health-related grounds.-

(A) In general.-Any alien-

(i) who is determined (in accordance with regulations prescribed by the Secretary of Health and Human Services) to have a communicable disease of public health significance, which shall include infection with the etiologic agent for acquired immune deficiency syndrome,

(ii) except as provided in subparagraph (C) who seeks admission as an immigrant, or who seeks adjustment of status to the status of an alien lawfully admitted for permanent residence, and who has failed to present documentation of having received vaccination against vaccine-preventable diseases, which shall include at least the following diseases: mumps, measles, rubella, polio, tetanus and diphtheria toxoids, pertussis, influenza type B and hepatitis B, and any other vaccinations against vaccine-preventable diseases recommended by the Advisory Committee for Immunization Practices,

(iii) who is determined (in accordance with regulations prescribed by the Secretary of Health and Human Services in consultation with the Attorney General)-

(I) to have a physical or mental disorder and behavior associated with the disorder that may pose, or has posed, a threat to the property, safety, or welfare of the alien or others, or

(II) to have had a physical or mental disorder and a history of behavior associated with the disorder, which behavior has posed a threat to the property, safety, or welfare of the alien or others and which behavior is likely to recur or to lead to other harmful behavior, or

(iv) who is determined (in accordance with regulations prescribed by the Secretary of Health and Human Services) to be a drug abuser or addict, is inadmissible.

So basically the statute prohibits granting an admission or granting a visa (unless they get a waiver) to an alien who has any of the following:

(a) Any "communicable disease of public health significance" as determined by regulations promulgated by the Secretary of Health and Human Services,
(b) HIV -- specifically designated by statute
(c) Doesn't have proof that they were immunized against mumps, measles, rubella, polio, tetanus and diphtheria toxoids, pertussis, influenza type B and hepatitis B (specifically designated by the statute)
(d) Doesn't have proof that they were immunized against any other vaccine-preventable diseases as recommended by the Advisory Committee for Immunization Practices
(e) Persons with a physical or mental disorder or behavior (or a disorder that it likely to reoccur) that makes them a threat to the property, safety, or welfare of themselves or others as determined by regulations promulgated by the Secretary of Health and Human Services in consultation with the Attorney General
(f) Drug abusers or addicts as determined by regulations promulgated by the Secretary of Health and Human Services in consultation with the Attorney General

Seems to me that Sullivan's big distinction is that the decision to include HIV was determined through the legislative process through a bill that was passed by both Houses of Congress and signed into law by a President rather than promulgated through the administrative rule-making procedure through HHS like the other "communicable disease[s] of public health significance."
5.14.2008 8:16pm
Thorley Winston (mail) (www):
I believe a good many legal immigrants have a sponsor who promises to take care of them should they fall on hard times. How's that working out?


Good question, how well does sponsorship work in the case of a legal immigrant who falls on hard times? Do most of them in fact get enough help from their sponsor to enable them get back on their feet or is it just a ploy to get in the country and not enforced?

I'm actually curious about that because whether sponsorship does in fact work or whether it's just a meaningless formality is or IMO ought to be an important factor in deciding whether to increase the number of legal immigrants admitted into the United States as well as I think important in deciding to make allowances for some HIV-positive immigrants.

Of course it could be that while sponsors are able to help out their sponsored immigrant temporarily with the rent, groceries, and a few bills; it doesn't mean that they could afford to also pay for drugs on top of that. Or perhaps they could. Either way, I think some information on the effectiveness of sponsors in supporting their charges would be illuminating to the discussion.
5.14.2008 8:26pm
Warmongering Lunatic:
Anderson:

As I pointed out in the paragraph immediately following. Did you have fun insulting the caricature of me that exists only in your fantasies?

If our political consensus is anything short of libertarianism, then the fact of Sullivan's disclosure doesn't cut off the debate.

If my tax dollars wind up having to support HIV-infected Americans, even if they consented to the infection, then I have a direct interest in reducing such infections, even if it was spread consensually. Which means I have an interest in excluding immigrants who may spread the infection. Which, since I cannot predict which HIV-positive immigrants will have promiscuous unprotected sex, means I have an interest in excluding HIV-positive immigrants.

Now, I grant that it's probably sufficiently minor an interest, and the marginal gain from the rule is so slight, that I wouldn't call for the adoption of such a rule. But it similarly doesn't look like any sort of measurable injustice in a country so far from a libertarian consensus that I should bother to favor repeal. I'll save my outrage for significant subjects.
5.14.2008 8:35pm
Gregory Conen (mail):
How is "which shall include infection with the etiologic agent for acquired immune deficiency syndrome" not what Sullivan is alleging?

Apparently the law mandates HIV be treated as a communicable disease of public health significance, necessarily excluding infected individuals. All other diseases, technically, are at the discretion of the secretary of Health and Human services. So what Sullivan says is literally correct.

He is deceptive, in that 1)a list of required vaccinations is explicitly listed, and 2) gaining a waiver is no harder than for any other "communicable disease".
5.14.2008 8:42pm
SIG357:
How is "which shall include infection with the etiologic agent for acquired immune deficiency syndrome" not what Sullivan is alleging?

Uh, because that is not what Sullivan is allegeing? He says this;

HIV is the only medical condition permanently designated in law -- in the Immigration and Nationality Act -- as grounds for inadmissibility to the United States.

This is false. It's not technically correct. Any "communicable disease of public health significance" is treated the same as HIV, and several are listed in the act.
5.14.2008 9:00pm
SIG357:
Seems to me that Sullivan's big distinction is that the decision to include HIV was determined through the legislative process through a bill that was passed by both Houses of Congress and signed into law by a President rather than promulgated through the administrative rule-making procedure through HHS like the other "communicable disease[s] of public health significance."


Yes, but the entire act, including the language about "mumps, measles, rubella, polio, tetanus and diphtheria toxoids, pertussis, influenza type B and hepatitis B" was passed in the same bill. Was that some sort of evil plot against people with mumps?

Hell, we can cure people with mumps pretty easily. HIV has no cure.
5.14.2008 9:04pm
rarango (mail):
I note with interest that none of the supporters of HIV positive status have identified what communicable diseases they think should be restricted from entry into the United States.

Now being a libertarian, I don't particularly care if men engage in protected or unprotected sex with other men--But when they do, and it leads to further HIV outbreaks, then it does have external effects. At that point the gay community and their supporters clamor for research and pharmaceutical development to develop the antidotes for the disease which has been spread by their personal behavior. I for one would prefer they deal with those consequences without the public fisc expending a lot of money on their behalf. Ultimately their irresponsible behaviors will make them candidates for the darwin awards.

And here is the overarching fact that cannot be ignored: men who have sex with men are the single most significant cause of AIDS in the United States. As it turns out all of the "dying queer" genre of films and plays and books of the late 1980s have seeped into the political landscape. That political landscape, coupled with the visibility that the Hollywood community can trot out with their red ribbons and impassioned speeches at Oscar ceremonies, have transformed the AIDS epidemic from a public health issue to a political and cultural issue. So be it. Public health can deal with this--like the Cuban Government did--and very effectively. But political restrictions tie the hands of public health and force public health into a range of lesser responses.

AIDS in the United States (unlike most of the rest of the world) remains a disease that is predominately among gay men, or gay men and bisexual men To deny that is to deny the statistics of AIDS. Again, I don't personally care if gay men choose to infect gay men or anyone else who is foolish enough to have sex with them. That's their prerogative. The fact that an infectious disease has been transformed into a political cause has a detrimental effect on public health interventions. And the irresponsibility of gay men in their sexual proclivities has warped the landscape of pharmaceutical and biomedical research. Where could the dollars spent for aids could have spent? Who knows. But I suspect there a whole lot of other people suffering from diseases not caused by bad personal choices who could have been helped. This is a sad commentary on the political choices made by our elected officials.
5.14.2008 9:13pm
Randy R. (mail):
rarango: " I don't particularly care if men engage in protected or unprotected sex with other men--But when they do, and it leads to further HIV outbreaks, then it does have external effects. At that point the gay community and their supporters clamor for research and pharmaceutical development to develop the antidotes for the disease which has been spread by their personal behavior. I for one would prefer they deal with those consequences without the public fisc expending a lot of money on their behalf. Ultimately their irresponsible behaviors will make them candidates for the darwin awards. "

Wow, what a lot of disinformation in one post! As I suggested earlier, this ban on people with HIV status isn't really about protecting the public, but is about scary gay men who have too much sex.

First, the WHO estimates that the vast majority of AIDS cases worldwide are not gay men, but hetero men and women. So you aren't stopping infected gay men from entering the US, but people like yourself.

And most of them didn't get HIV from wild anal sex. Most got their infections through good old fashioned sex -- the type you have (or I presume you have).

AIDS could have been stopped in its tracks, but it was people like you who believed it's only a 'gay disease' and as long as it's limited to them, we'll let Darwin sort it all out. Had our gov't actually responded as they did with other disease outbreaks, there likely would not be an AIDS crisis in the world today.

But the worst comment is your last: "But I suspect there a whole lot of other people suffering from diseases not caused by bad personal choices who could have been helped."

AIDS has proven to be a strange and remarkable disease. It's been studied intensely for at least 20 years now, and we have little understanding of it. However, because of the intense study, it has lead to breakthrough progress in many other diseases and illnesses. Furthermore, it was only because of gay men lobbying the NIH and the FDA that forced them to speed up their process for approval for experimental drugs across the board.

Despite the snarky tone of your post, the fact is that you heteros have actually benefited quite a bit from the HIV -- it has forced through a lot of research that has benefited people of many diseases. The NIH lists all the crossover progress that has been made in various forms of cancer, other immune deficienty issues. causes and treatments of these various forms, and so on.

So to answer your question, we DO know that spending on AIDS has indeed warped the landscape of pharmaceutical and biomed research. And if you ever get ill, you will thank your lucky stars that the landscape was warped in this way because you will have benefited in ways you can't even imagine.
5.14.2008 9:51pm
Randy R. (mail):
rarango: "At that point the gay community and their supporters clamor for research and pharmaceutical development to develop the antidotes for the disease which has been spread by their personal behavior."

Great. So people who smoke deserve the lung cancer that they get. Afterall, they smoke knowing the risks. And we shouldn't spend any pubic funds on the research of lung cancer which was caused by their personal behavior.

Also, if you are fat and don't exercise, which often leads to diabetes and heart disease, too bad for you! You get the disease you deserve, since you should have refused those big meals and overindulgence in sweets. If you contract any illness that is a result of a personal behavior, then don't expect any expenditure of public funds or help or sympathy. You get what you deserve, right? I don't like smokers or fat people, and my tax dollars shouldn't go to help them in any way.
5.14.2008 9:57pm
John Burgess (mail) (www):
Anderson: For what it's worth, in the late 80s 'Nature' magazine published a study showing that the mere insertion of a sterile glass probe into rabbit rectums caused a major decrease in immune response. From that, I gather that anal sex simply adds an additional risk factor.

Thorley Winston: Pledging to provide financial support (if needed) in sponsoring an immigrant goes far beyond merely offering a few meals and a couch to crash on. When my father sponsored the Vietnamese interpreter that worked for him (along with the interpreter's family of five), he had to provide proof of ability to support the family totally (e.g., rent, food, tuition, clothing) for a period of five years.

There is some latitude on the part of Consular Officers in determining what level of financial ability defines 'support' in a given case. But on the whole, it's a serious question. Financial capability is even required in seeking a 'marriage visa' to bring a non-citizen into the US for the purpose of a wedding.
5.14.2008 10:16pm
Dr. T (mail) (www):
This thread started because of Andrew Sullivan's misrepresentation of the law, its basis, and its effects. Unfortunately, some thread comments contain arguments from ignorance.

The ban on HIV positive foreigners was not a knee-jerk fear response by ignorant legislators (though many such beings exist). The ban serves two purposes: to cut down on the spread of HIV (by not enlarging the pool of carriers) and to avoid having to pay the medical expenses of HIV-positive foreigners. Anti-retroviral therapy for HIV-positive patients costs tens of thousands of dollars per year, and treatments may be needed for more than ten years. AIDS patients can run up annual medical bills in excess of $50,000 due to repeated hospitalizations, cancer treatments, and recurrent infections. Even if the foreigners are multimillionaires who can pay their bills, why would we want to let them roam our nation, spread disease, and compete for space in our already crowded HIV clinics?

Mr. Sullivan argues that short visits should be allowed. I disagree: we know that many foreign visitors have unofficially and illegally changed their status to permanent residents. That's bad enough when they are healthy; it's especially bad when they are ill.
5.14.2008 10:35pm
Toby:

Dude, don't choke on your own saliva, okay? If he "advertised his HIV-positive status," then I daresay that the non-infected persons knew what they were, uh, getting into

Actually, no saliva choking here. If everyone who comes into the country sings an avidavit that they will be responsible for all their own medical expenses, then they can have sex with prcupines for all I care.

Many simply do not want to spend their retirement money on others. If we get Nationalized Healt Care, I hope they do ad fat epople, aerobically unfit people, and even those who are genetically susceptible to early lingering deaths to the list.

Of course, remove socialized medicine and diversion of research dollars from the political table, then we are back to the standard, as far as I am converned, that my grandmother, born in the 19th century taught me. Anything that is out of the street and so does not scare the women and horses is OK by me.

Just don't talk of spittle while you are asking me to pay for it.
5.14.2008 10:36pm
The General:
why would we want more sick people here? It defies logic. Oh wait. Logic doesn't come into play when crafting policy anymore. Nevermind.
5.14.2008 10:38pm
Waldo (mail):
Interesting posts. It does seem that HIV is singled out as being equivalent to other communicable diseases by legislation. Unlike the others, which can be de-listed by regulation, HIV is automatically considered equivalent to any disease that would bar entry. What makes less sense is that we don't test for HIV, which means the law is essentially unenforceable. On the other hand, Andrew Sullivan does not seem to have had difficulty getting a waiver.

Making HIV equivalent to other communicable diseases isn't really accurate either. Unlike TB, measles, etc, HIV isn't transmitted through casual contact. If people with TB were being routinely allowed entry, I'd be worried. After all, either my kids or I could contract the disease by sitting next to someone infected at the airport or on mass-transit. That just doesn't apply with HIV.

Nevertheless, there is a cost associated with HIV. If we think the cost is large enough, why not require testing before granting temporary or permanent residency (visitors don't really concern me)? We already have mandatory testing in the military. If someone has HIV, let them in, but allow anyone who believes, with probable cause, that they contracted it from a non-citizen to access the testing record. Then let the civil court system sort out damages. If you're worried about ability to pay, require insurance.
5.14.2008 11:13pm
Randy R. (mail):
The General: "why would we want more sick people here?"

Then all sick people should be denied entry to the US. But we don't do that. Talk about defying logic!

Need I mention that we have no problem bringing in very bad people who are also sick so that they can get treatment here in the US. The deposed Shah of Iran was one of them. Recently, there was an article in the NY Times about the head of one of the major crime syndicates in Japan, who was responsible for killing lots of people and other organized crime, was admitted by the FBI into the US for a liver transplant. Sick people have always been welcome as long as you have money or something else that we want to promote.

But perhaps the reason we should allow people with HIV into this country is that these people have skills, money or talent that benefits the US. Very few people come to the legally as immigrants, and you generally have to prove that you will somehow benefit the US. Considering the fact that HIV is a treatable disease now, and that you can live a very long time, we might very well benefit more than the immigrant.
5.14.2008 11:22pm
Waldo (mail):

For what it's worth, in the late 80s 'Nature' magazine published a study showing that the mere insertion of a sterile glass probe into rabbit rectums caused a major decrease in immune response. From that, I gather that anal sex simply adds an additional risk factor.

You have far more time for research than I.
5.14.2008 11:23pm
Thorley Winston (mail) (www):
Making HIV equivalent to other communicable diseases isn't really accurate either. Unlike TB, measles, etc, HIV isn't transmitted through casual contact. If people with TB were being routinely allowed entry, I'd be worried.


So would I, of course the statute in question doesn't just -- contrary to Sullivan's assertion -- single out HIV. It also specifically requires that a new entrant have proof of vaccination against "mumps, measles, rubella, polio, tetanus and diphtheria toxoids, pertussis, influenza type B and hepatitis B." Perhaps TB should be added to the list of ten diseases specifically enumerated in the statute. Or perhaps they've already been added by the provision which allows the SecHHS to add more through the administratively rule making process.

Either way, it's not a very persuasive argument IMO to say that because there may be a diseases that is more deserving of being added to the list (and it may have been added) in addition to the ones on the list that that means that any of the existing ones should be removed.
5.14.2008 11:39pm
Ricardo (mail):
The ban serves two purposes: to cut down on the spread of HIV (by not enlarging the pool of carriers) and to avoid having to pay the medical expenses of HIV-positive foreigners.

First, for the ban to have any impact on the number of HIV-positive people present in the country, the U.S. would have to terminate its visa waiver program (whereby citizens of certain developed countries can enter the U.S. without applying for a visa in advance) and insist that certified HIV test results be presented at every visa interview. The U.S. currently does not take these steps so the ban is close to symbolic.

Second, if this is purely a public health measure it should be evaluated periodically by public health experts to determine whether it is still an effective way to reduce the risk of HIV transmission. A ban may or may not make sense depending on the existing infection rate (if it is extremely low, the ban might make sense), the effectiveness of other measures to combat HIV (unlike other infectious diseases, it takes two to successfully transmit HIV and we concentrate a lot of resources on helping potential recipients reduce their risk) and the estimated number of newly infected individuals we can expect for every HIV-infected visitor.

Public health measures always involve trade-offs between cost and benefit--HIV shouldn't be any different. If people here are so sure the HIV ban is an effective public health measure, they should show evidence. As it is, since the ban is written into law there is surely legislative inertia behind it.

Finally, I suspect some are trying to have their cake and eat it too. If HIV is a public health threat on the order of other deadly infectious diseases, surely that would justify all-out public health efforts on all fronts to eradicate the disease, including extensive safe-sex education and condom distribution in schools, free distribution of clean syringes to drug addicts, and the like, at least so we can evaluate the relative effectiveness of these measures.
5.14.2008 11:52pm
Gildas (mail):
Second, I would want to know more about if the ban that exists now is in fact so easily evaded by simply not reporting.

All prospective immigrants undergo a medical exam prior to being issued a visa. I don't know whether any of the (many) non-immigrant visas that are available also require a medical - presumably some do. Obviously anyone entering under the Visa Waiver Program would be able to evade detection by lying on the form.

The medical is more than a blood test for HIV. They check for other things, do an overall physical, check your immunizations (I was missing proof of my MMR so had to have that again) and do a chest X-Ray (TB). In fact, you are still required to present your X-Ray to the immigration official on arrival in the USA.

I think the policy is probably overblown given the difference in treatment options available today compared with when it was created (for those worried about costs another of the requirements is that you prove you won't be a charge on the state*). However, Mr Sullivan is being disingenuous (you're all shocked I know) to claim that HIV is singled out. A visa lottery candidate with TB would probably stand as little chance of getting in as one with HIV.

*The requirements for entry on the financial side are pretty stringent too - your sponsor has to provide their tax records to prove they have a sufficient income (based on some income tables) to support you and your family [or else you have to show you have lots of liquid assets].
5.14.2008 11:54pm
Clayton E. Cramer (mail) (www):

Leaving aside Serendipity's point, if *receiving* anal sex is what causes one to contract HIV, then having once done so, one is no more likely to spread HIV no matter how many, er, repetitions. No risk to the population in general.
Except that few men only receive anal sex. They usually end up sodomizing other men as well.
5.15.2008 12:06am
good strategy (mail):

Great. So people who smoke deserve the lung cancer that they get. Afterall, they smoke knowing the risks. And we shouldn't spend any pubic funds on the research of lung cancer which was caused by their personal behavior.

Also, if you are fat and don't exercise, which often leads to diabetes and heart disease, too bad for you! You get the disease you deserve, since you should have refused those big meals and overindulgence in sweets. If you contract any illness that is a result of a personal behavior, then don't expect any expenditure of public funds or help or sympathy. You get what you deserve, right? I don't like smokers or fat people, and my tax dollars shouldn't go to help them in any way.


Bravo Randy.

I would add that when heterosexuals forgo a condom and a woman gets pregnant by mistake, I don't want any of my tax $ going to pay for prenatal care or that kid's education. The parents made their choice, they can pay the cost.

It's pretty shocking to see people claiming heterosexual men can't hardly get HIV. It's like they haven't paid the slightest bit of attention to Africa for the past 15 years.

Rarango, you call yourself a libertarian, but then suggest that the best way to have dealt with AIDS would have been forced government testing and lifelong quarantines. ???

A government with that power and all the information that can be gleaned from DNA is a frightening prospect indeed.

The study cited above that shows a 4% transmission rate did not distinguish between people who knew their HIV status and those that did not. The vast majority of the transmissions are not from people who know they are positive. The immigration ban is silly because people who know their status are unlikely to pass on the virus. A small % of evil people is not a good reason to discriminate against the rest of the population. Those people are likely to lie about their status anyway.

Using public health statistics that show that x% of a given group of people are inevitably going to engage in some undesirable behavior is not just a slippery slope toward tyranny, it's also an example of people's political selectivity. Despite public health statistics that show most people are sexually active by their late teens regardless of context, certain people (not necessarily those above, although I suspect so) argue for 'abstinence only' sex ed anyway. Statistics be damned! If you base public health policy on science, the blanket immigration ban is unnecessary. Don't let the facts get in the way of your prejudices. Remember, people who actually work in public health are a bunch of bleeding hearts, so their recommendations are irrelevant.
5.15.2008 12:08am
good strategy (mail):

I hope they do ad fat epople, aerobically unfit people, and even those who are genetically susceptible to early lingering deaths to the list.


The nation will be stronger if we weed out the weak people.

Godwin's law doesn't apply if people actually come right out and say fascist things.
5.15.2008 12:16am
Anderson (mail):
mere insertion of a sterile glass probe into rabbit rectums caused a major decrease in immune response

(1) Poor bunnies!

(2) Whose immune response -- the inserter, or the insertee?

(3) Except that few men only receive anal sex. They usually end up sodomizing other men as well.

Glad to see you're well and with us, sir. Now -- cite, please?
5.15.2008 12:16am
Waldo (mail):
Thorley Winston:

Well, the statute does single out HIV in that for most diseases it prohibits a person: "who is determined (in accordance with regulations prescribed by the Secretary of Health and Human Services) to have a communicable disease of public health significance". This gives HHS latitute in determining which diseases are significant.

But in the case of HIV the statute reads: "which shall include infection with the etiologic agent for acquired immune deficiency syndrome." This language doesn't give HHS latitude in determining whether HIV is a communicable disease with public health significance.

I don't believe that HIV is a disease similar enough to TB, measles, etc., to justify placing it on the list prohibiting entry to the US. It's not a matter of whether a disease is more or less deserving. It's just about method of transmission. Diseases like TB are transmitted through casual contact; HIV is not. Therefore, HIV is best handled by torts rather than immigration law.
5.15.2008 12:27am
Richard Aubrey (mail):
Not too many years ago, WHO managed to double the number of AIDS cases in Africa by the simple technique of expanding the definition.
Our own CDC did the same thing regarding rates of infection in the Eighties. I called their PA office and got nothing that made sense.
In cases like this, if some is bad, more is better.
In Africa, they call it the wasting sickness and it can be either HIV-related, or...just a wasting sickness. The presumption is that it's a matter of repeated STDs other than AIDS, without treatment and the resulting destruction of the immune system.
Given that--the new and improved definition--there is no surprise that most AIDS cases are hetero. Except they aren't. Not if AIDS is associated with HIV.
Nice excuse, though.
When AIDS first struck, it was politically impossible to shut down the bathhouses where the rate of infection was astronomical. So the idea that hets were responsible for AIDS transmission is nuts.
Gays and libs accused others of being bluenoses and wanting gays to quit having their sinful fun.
Okay. Have your fun.

HIV/AIDS is a big problem socially. For example, on a life insurance application, you sign a form which authorizes all kinds of tests and the release of all kinds of HIPAA-covered information. But you sign a different one, specifically for AIDS, because it's a Big Deal and the companies don't want the applicant to complain the reference to AIDS was buried in the general authorization. Syphillis? No problem? Leprosy? Ditto?

It is silly to insist that HIV/AIDS is just one more disease. In addition to being invariably fatal, it's a kind of Third Rail. Don't go there unless you want somebody accusing you of being a blue-nosed fundie homophobe. Or of blaming the victim.
5.15.2008 12:32am
Brian G (mail) (www):
Like someone else said, AIDS is a politically correct disease. I think the ban should remain in place right where it is. And you can bet there will never be a groundswell of support to lift it until we have a bona fide cure for it, nothing less.
5.15.2008 2:22am
Randy R. (mail):
Clayton: "Except that few men only receive anal sex. They usually end up sodomizing other men as well."

As usual, Clayton demonstrates a complete lack of knowledge of gays.

Richard Aubrey: "When AIDS first struck, it was politically impossible to shut down the bathhouses where the rate of infection was astronomical."

Quite the contrary. The bathhouses were in fact shut down, and some of the leaders in that fight were actual gay men. Please get your fact correct.

"Gays and libs accused others of being bluenoses and wanting gays to quit having their sinful fun."

And there you have it. EVeryone complains about AIDS being a "PC" disease. And yet it people like you who have made it so by claiming this is 'sinful.' By implication, gays get what they deserve, right? At least now people are no longer hiding their true feelings, which I guess is progress....

So what are they doing in the rest of the world, where the vast majority (around 90%) of all AIDS cases are heteros? What is their sin? And should they all die to pay for this sinful behavior? And we are all supposed to die for sinful behavior, then I hope you lead a pretty f******* holier life than the rest of us.
5.15.2008 2:44am
ScottS (mail):
Richard Aubrey, another science-challenged asshat who believes what he wants to believe, meet Thabo Mbeki, thoroughly discredited believer in superstition.

And yes you are an ignorant homophobe for bringing up bathhouses and "sinful fun." No one stated that straights were responsible for anything. It's a VIRUS.
5.15.2008 2:53am
ScottS (mail):
Richard Aubrey, another science-challenged asshat who believes what he wants to believe, meet Thabo Mbeki, thoroughly discredited believer in superstition.

And yes you are an ignorant homophobe for bringing up bathhouses and "sinful fun." No one stated that straights were responsible for anything. It's a VIRUS.
5.15.2008 2:53am
poul (mail) (www):
so mr. Anderson, do you now agree that sullivan posted factually incorrect information?
5.15.2008 2:54am
Randy R. (mail):
Aubrey: "it's a Big Deal and the companies don't want the applicant to complain the reference to AIDS was buried in the general authorization."

Thanks to judgmental types like you, people who are at risk of HIV simply don't get tested for fear of ostracism. Better to not know if you are poz, then to know you are poz and lose your job of whatever. And when people don't know if they are poz, they are much more likely to infect others. So, the CDC and other groups have decided, not because it's PC, but because it is good science to encourage people to get tested and know their status.

" Don't go there unless you want somebody accusing you of being a blue-nosed fundie homophobe. Or of blaming the victim."

Of course, ALL people who are poz are guilty, right? So the person who got infected by blood transfusion is guilty of sinful behavior. So is the fetus who got it from its mother. So is the faithful wife who got it from her cheating husband, who got it from a prostitute.

All these people are guilty of the worst sinful behavior, and must be blamed for their condition, and are deserving of ostracism, all so that you can feel superior to them. Hey, whatever floats your boat, right?

Look, you people tried all that in the 80s. You ignored the disease, because it was just a bunch of gay men who deserve to die anyway. You refused federal funds for research because why waste the money when it can be better spent on cancer research. You blamed the people who got AIDS for their own predicament. Some of you probably didn't care if an HIV person was fired from his job.

And look what a success your policy has wrought! Ballooning AIDs cases in Africa and Asia. Growing numbers in the US. Rocketing rates of infection among blacks and other minorities. And still, after all that, there are more gay men than ever. Really great planning on your part.

Sheesh. Even Jesse Helms, no friend of gay people, reversed himself and supported the removal of this ban. And he also supported research on AIDS when he saw how much progress was being made in crossover research. But it just goes to show you, when it comes to gays, Americans like you always freak out.
5.15.2008 2:56am
Oren:
Somehow I always figured that national health insurance would have an exception for pre-existing conditions, much like health insurance does today. Would that allay the "cost" fears?
5.15.2008 3:12am
Brian K (mail):
I'm curious as to how many of the commenters above are aware that there are 2 main types of HIV divided into several groups and many subtypes? I would guess not that many.

pay particular attention to the section titled "Where are the different subtypes and CRFs found?" and "Are there differences in transmission?"
5.15.2008 6:46am
Richard Aubrey (mail):
Randy.
Wrong again. You missed the memo. Just as bogus accusations of "racism" no longer have any clout, your hysterical accusations of homophobia and whatnot are wasted breath.
Two items: The CDC changed its definitions. The WHO changed its definitions. In both cases the numbers went up--to the benefit of the activists. In Africa, the definition now includes non-HIV presentations known generally as the "wasting disease", and no homophobe has anything to do with that.

Oh, forget it. You're too nuts to talk to.
5.15.2008 9:11am
rarango (mail):
Great Strategy: I did not personally call for a quarantine--what I said was that quarantine was effective in Cuba, and is an appropriate, and probably the best public health response. I also went into considerable detail describing how the political issues trumped public responses. And even though I do consider myself a libertarian, and thought my personal preferences were made quite clear, I also wear a public health hat which has some ethical considerations that trump my personal philosophy. I trust you can see those issues.

You also noted: "Remember, people who actually work in public health are a bunch of bleeding hearts, so their recommendations are irrelevant." I would suggest that it is public health activities (clean water, good sewerage facilities, food handler and establishment inspections and education programs) that are largely responsible for the reasonably good health Americans enjoy.


RandyR: I fully understand that HIV is a major heterosexual epidemic in other parts of the world; but I specifically made my comments with respect to the situation in the United States. I agree with Richard Aubrey's assessment in his 8:11 re your mental facilities. You are a raving lunatic and this will be my last interaction with you.
5.15.2008 9:46am
Anderson (mail):
so mr. Anderson, do you now agree that sullivan posted factually incorrect information?

I'm unclear on it, since this comment above seems to support what Sully wrote:

Well, the statute does single out HIV in that for most diseases it prohibits a person: "who is determined (in accordance with regulations prescribed by the Secretary of Health and Human Services) to have a communicable disease of public health significance". This gives HHS latitude in determining which diseases are significant.

But in the case of HIV the statute reads: "which shall include infection with the etiologic agent for acquired immune deficiency syndrome." This language doesn't give HHS latitude in determining whether HIV is a communicable disease with public health significance.
5.15.2008 10:14am
AnonLawStudent:
Contrary to your assertions, HIV transmission is strongly correlated with homosexual activities. According to the CDC, receiving anal intercourse is 10x as risky as heterosexual intercourse is for a man, and 5x as risky as heterosexual intercourse for a woman. See my 5:55 P.M. post for the exact statistics. Indeed, receiving anal intercourse is almost as risky as sharing an IV drug needle. Regardless of what WHO indicates about worldwide HIV vectors, in the United States, male-to-male sexual contact accounts for 61% to 66% of HIV transmissions, as compared to 17% by heterosexual contact. Source: CDC. For this reason, even homosexual advocates admit that HIV is largely a "gay disease."

But never let the science get in the way of calling someone else a homophobe.
5.15.2008 10:30am
AnonLawStudent:
[The 9:30 A.M. post was directed to Randy R.]
5.15.2008 10:32am
AnonLawStudent:
Further clarification: transmission rates (61-66% vs 17%) cited in my 9:30AM post are for men only.
5.15.2008 11:09am
Richard Aubrey (mail):
It appears that much of the HIV transmission in other parts of the world is due to re-use of medical equipment.
Not too long ago, a Russian athlete was considered to have made a particularly generous gesture. An American athlete traveling in Russia was seriously hurt in an auto accident.
The Russian offered his private stash of foreign-acquired medical and surgical supplies to the American. The reason was to prevent the possibility of infection resulting from re-use of medical supplies in Russia. Apparently those who can afford to acquire their private stock, just in case, abroad.
When AIDS was new on the scene, NPR reported that Russia manufactured as much as ten percent of their need for needles. The other 90%....
5.15.2008 11:54am
ParatrooperJJ (mail):
It is a good law. Do we really want the taxpayers to pay for a lifetime of care for an AIDS patient?
5.15.2008 11:55am
Cold Warrior:
I hope some rational people are still reading, because I want to correct a few misconceptions here.

1. As many have noted, HIV is not "singled out" as a public health/communicable disease ground of inadmissibility.

2. Current HIV law and policy was greatly influenced by the misinformation surrounding the feared ease with which HIV could be spread. (Remember the Ryan White age?) As a result, the former INS and CDC were unable to come up with a rational policy for dealing with would-be immigrants who are infected with HIV. Regulations were drafted and then killed as no one wanted to touch what was (at the time, and still apparently to some posters on this blog) a political hot potato.

3. As a result, HIV waivers were treated by analogy to established waivers for other conditions. The fullest body of law and procedure applied to TB waivers, so TB provided a very imperfect model.

4. Sullivan is wrong -- very wrong -- on one very key point:


Nonetheless, because I am HIV-positive, I am not eligible to become a permanent resident.


HIV waivers exist under the authority of Immigration and Nationality Act section 212(g). The process is long and cumbersome, but hardly out of the reach of a man of means such as Sullivan. In fact, I'd find it hard to believe that Sullivan doesn't know this. There is a lenghty 4-part process that the HIV+ applicant must go through, requiring CDC certification and the commitment of a clinic to provide treatment for the condition and to assume responsibility for any costs of treatment that the applicant cannot cover. The bureaucratic process is far from ideal. However, the core principle is solid, and is based in at least half a century of policy and law: we should have some assurances that that person carrying the communicable disease does not present a risk to public health, and we need assurances that his treatment regimen also doesn't present a risk to the public purse.

I have seen many HIV waivers granted, and many of those were to persons of extremely limited means (example: Haitian immigrants who fled with little or nothing). So Sullivan is right to raise the public policy question, but wrong (and although I generally enjoy his commentaries, I cannot help but say "deliberately wrong") on this key point. It does not have the same impact to say, "The U.S. Government won't allow me to become a permanent resident without going through a long and expensive waiver process" as to say "I cannot ever be a permanent resident." Unfortunately, the former is true; the latter is not.
5.15.2008 12:02pm
rarango (mail):
Cold Warrior--thanks for your information; much of the discussion on this thread highlights what happens at the intersection of public health and politics. As such this thread would be a great addition to course syllabus in a public health course.
5.15.2008 12:15pm
Randy R. (mail):
Aubrey: " Just as bogus accusations of "racism" no longer have any clout, your hysterical accusations of homophobia and whatnot are wasted breath. "

Then why did you state that gay men engage in 'sinful behavior" Are you going to say that isn't a tad judgmental? And you refuse to admit that it was gay men who lead the fight to close down the bathhouses. But then, it easier to claim I'm a 'raving lunatic' that deal with actual facts, isn't it?
5.15.2008 12:50pm
ejo:
on the pro-side, I see a bunch of ignorant political posturing. on the anti-side, people actually cite to facts, costs and things that might actually impact us. emoting isn't going to pay the costs for medical treatment or the people infected.
5.15.2008 1:02pm
ejo:
sinful behavior? judgmental? are we not allowed to point out the anonymous partnering that led to the spread of the disease? how about, to avoid being "judgmental", stupid?
5.15.2008 1:08pm
Richard Aubrey (mail):
randy. Just to prove you're nuts, I'm going to respond.
I did not say that gay behavior is sinful.
I said that gays accused conservatives and Christians of believing gays were getting what they deserved for their sinful behavior.
Some conservatives believe that. Some don't. But it was the gays' accusation I was referring to. One gay said Falwell must be gloating.
See? You got it 'way wrong. Again and again and again. See your shrink.

BTW. A long time ago, Calfornia magazine had a lengthy article on the Air France steward who was probably Patient Zero for North America. Among other things, they had him deciding that, once (again) infected with syphilis, it was okay to go cruising before he was sure his last penicillin shot had kicked in. Think he's the last one to think like that?
5.15.2008 1:45pm
ejo:
who are you to judge the behavior or "Patient Zero"? It is your moralizing, not his behavior, that is the real problem, right? If not "immoral" or "sinful" or "scummy" or "sleazy", what is the proper term to apply to this type of conduct?
5.15.2008 1:49pm
Richard Aubrey (mail):
ejo.
Consider me abashed.

Patient Zero...? Free. Liberated. Stuff like that. The newly infected...? I suppose we can call them kulaks and insist they deserved to be starved. Or like Vietnamese boat people, that they came from the oppressor class and deserved to be eaten by sharks.
The newly infected were probably self-loathers and were planning on joining a club for those trying to escape the life. They deserved to die!!!

How'm I doing?
5.15.2008 2:01pm
rarango (mail):
Caveat: the index case (the steward) is most certainly not reflective of the gay community as a whole.
It is, however, instructive to realize his sexual activity led to infecting some 8000 people and caused the death of 3000. (figures are rounded off and are not meant to suggest that the index case had sex with 8000 people--these figures include all cases than can be traced back to the Index case) Probably would have been a good move to keep this dude out of the country--would have saved 3K lives.
5.15.2008 2:03pm
Randy R. (mail):
Aubrey: Here is what you said: "Gays and libs accused others of being bluenoses and wanting gays to quit having their sinful fun."

Now, I interpreted that as you accusing us of having "sinful fun" because gays do not actually believe that gay sex is sinful. If I interepreted incorrectly, then I apologize.

However, I never accused anyone here of being homophobic.

As regards my 'raving lunatic' I do admit that for me this an emotional topic. When you have friends who have died of the disease, and being told contantly that they 'deserved' it, and seeing that repeated here, I kind of go off the deep end. However, there are other people here who have deeply held prejudices about gays and AIDS, and when you bring up facts that contradict those beliefs, ie., not all people with AIDS are gay, many people get AIDS through means other than gay sex, that the political establishment did nothing to stop AIDS thoroughout the 70s and mostly 80s, it's precisely because the authorities refused to deal with the situation that forced gay men to take the lead in closing down bathhouses and start and educational program, that it's gays and lesbians who pressured the FDA and NIH to streamline their drug approval process, and that AIDS research has resulted in numerous advances in many other sciences, people would prefer not to deal with that and just label me a lunatic.

Rarango raised the issue of personal behavior, but it only cuts one way -- against gay men. I suggested that if you want to fund research based on personal behavior, by all means, let's do it, so that means no funding for lung cancer, obesity, diabetes, alcoholics and other diseases that are a result of lifestyle choices. For taking his logic at its face, I'm labeled a lunatic. Rarango, which is it? Do we blame all people for their personal choices that result in disease, or just gays? If these questions make you uncomforable, then don't answer them -- but don't call me a lunatic for raising them.
5.15.2008 2:15pm
rarango (mail):
Since no one is completely sure of when AIDS entered the US, I am using the epidemilogical term "index case" very loosely and incorrectly. In epidemiology, the index case is the very first case the leads to the outbreak. The Flight Steward, was one of the more startling cases.
5.15.2008 2:16pm
shawn-non-anonymous:
If cost of future medical is a real issue, then other illnesses like cancer ought to be on that list as well. I'm reminded of the number of surgeries John Wayne went through to battle his cancer.

The other list of illnesses, in my limited medical understanding, are highly communicable through casual touch or even proximity. I just don't see the correlation.
5.15.2008 2:47pm
rarango (mail):
Like Richard Aubrey I am going to respond to Randy--Understand this please--I am philosophically opposed to having the public treasury pay for people who acquire disease or conditions due to life style choice--and that most certainly includes smoking and,in some cases, obesity and diabetes along with many others including AIDS resulting from unsafe sex. I am sure you understand, you can lead a perfectly healthy life and still contract lung cancer, become obese, contract AIDS or succumb to diabetes.

What I would LIKE to do, however, isnt relevant to what we have to do, so we bleeding heart type public health folks, and researchers and practitioners have to deal with the diseases as they exist. And unfortunately we do end up with people who have made very bad personal choices as free riders in the system. If you think I am homophobic, or singling out gay men, that was most certainly not my intention. The thread revolved around AIDS; had it revolved around smoking or obesity I would have made precisely the point.
5.15.2008 2:52pm
The Unbeliever:
But perhaps the reason we should allow people with HIV into this country is that these people have skills, money or talent that benefits the US.

Objection! Andrew Sullivan lacks both #1 and #3 in any quality beneficial to the US. He is, however, free to spend his money here... so long as he doesn't overstay his visa.
5.15.2008 2:53pm
Richard Aubrey (mail):
Randy.
If you quit using your vicarious experiences to excuse irrationality, you'd be more rational.
You want to compare per-patient research dollars on various diseases with that for AIDS?
Didn't think so.

Would you like people to give AIDS patients the same lack of sympathy that smokers get?
One church said we need to confront lovingly people who are living an unhealthy lifestyle. 'cause busybodying is so much fun. But promiscuous gay life? Nope. Off limits.
Everybody in this country, gay or not, knows how to avoid AIDS. We also know not to stand in an open field during a thunderstorm with a long copper rod in our hands pointing straight up.
While neither the AIDS sufferer nor the lightning struck can be said in a moral sense to have deserved their fates, it's certainly legitimate to point out that they could have avoided all this. Or, to warn them in advance.
If they fail to take the warning...on to the next subject. You're on your own, sport.
Medical mischance is a matter, in part, of having AIDS positive people in the population and that means a certain percentage got out in the thunderstorm while telling those warning them not to be so judgmental. And then it means money into health care, which we have and others don't. Of course, even without money in healtcare, if AIDS were not in the population--where it got going voluntarily by people who knew better--we'd be in better shape.
Years ago, I helped out at a messy accident.
It is probably a coincidence that the Red Cross no longer wants my blood and my doctor says my liver enzyme blip puzzles him. It's called "NAST" which stands for Non Alcoholic Something Terrible. Or maybe something else.
Nobody at the hospital would tell me what this moron had--thanks privacy folks--and the HIV tests came back negative.
I was not thinking of all this, but I recall being relieved when a bystander got a bag of hamburger rolls out of his car, pitched them onto the street and gave me the bag to use as a crude glove.

See? I have adventures, too. You want I should get irrational and stupid? Would I have an excuse?
5.15.2008 2:54pm
Leopold Stotch:
Comment threads here rarely fail to depress me. I really should stick with the main page.
5.15.2008 3:46pm
shawn-non-anonymous:
Richard Aubrey said:

...where [AIDS] got going voluntarily by people who knew better...


Please excuse me if I'm misreading your intent here, but this strikes me as not only untrue, but willfully skewed.

There is a long period, often over five years, between getting infected with HIV and having your first obvious symptoms. AIDS "got going" before a test was invented and back before any connection to sexual transmission amongst gay men was discovered. Large numbers of gay men contracted the illness and passed it on long before anyone "knew better" or even knew at all. The cost of promiscuity amongst gay men, at that time, was less than that for straight men; same STDs but no children. The political establishment, at the time, was slow to respond because those getting sick were unpopular, which only made things worse.

I am responding to the "got going" aspect of what I think was intended as a throw-away comment. Several people, such as yourself, are using moral arguments as to why immigrants and tourists should be denied entry and I think it's important to note that those arguments have more weight when applied to people who should know better today and not to those who couldn't have known better over three decades ago.

Similar, in a way, to people who started smoking in the 50s when there was a belief that it wasn't harmful versus those who start today knowing in great detail just what sort of harm it can do.
5.15.2008 4:42pm
Richard Aubrey (mail):
shawn.
The Patient Zero knew he had what he called "gay cancer". Sure, he didn't know it was AIDS, but he knew it was communicable. Didn't care.

Cigarettes were called "coffin nails" and "cancer sticks" long before the Fifties.
During WW II, the doctors tried to convince even the Infantrymen to stop smoking. It would shorten their lives (and increase chances of trenchfoot).
That didn't fly, as you will recall.
What I do recall is the growing connection between gays and AIDS even before anything scientifically reputable--or politically allowable--came from officialdom.
5.15.2008 6:04pm
Dilan Esper (mail) (www):
I get the feeling that a lot of the support for this is not based on whether HIV is treated the same as other diseases, or comparative public health threats, or sensible immigration policy. Rather, there's a lot of resentment about the fact that HIV was treated differently than other public health threats when it came on the scene in the 1980's, a decision a lot of conservatives seemingly believe was based on the political touchiness of going after gay men rather than valid scientific and public policy reasons.

Whatever one says about that debate (and in fact, a lot of the reason HIV was treated the way it was actually had to do with judgments by experts about how to best reduce risky conduct), it was 20 years ago, HIV is now a very manageable issue in the United States (though not in Africa!), and we shouldn't be making policy based on conservative resentment about alleged political correctness from 20 years ago.
5.15.2008 6:42pm
Richard Aubrey (mail):
Dilan.
Conservative resentment? Hell, I recall one of the most vociferously self-promoted Professionally Incredibly Wonderful clergyman it was ever my misfortune to meet who wouldn't go into the hospital room to counsel with an AIDS patient. Did it from the hallway.
Nobody knew enough about AIDS at the time, some of what they knew was wrong--see Fumento and the confession of the CDC docs--and what I see now is the guilt of the liberals who were scared out of their pink undies at the thought of inadvertently using the same toilet seat as an AIDS sufferer.
So they're overcorrecting.

Damn. I shouldn't be channeling/reversing Dilan. I might get to like it.
5.15.2008 8:07pm
Dilan Esper (mail) (www):
Richard:

Congratulations. You posted a comment so dripping in snark, sarcasm, and irony that it became completely impossible to understand, like something out of "Being There".

Perhaps you might post a response that contains an actual point?
5.15.2008 8:37pm
Richard Aubrey (mail):
Dilan. I already gave you a HINT. I was channeling/reversing you.
I was blaming the liberals for the current confusion with considerably more to back me up than you have.
Fun, too.
But let me be clearer: You're wrong.

Old conservative resentment about the PC treatment of AIDS sufferers compared to, say, TB sufferers, while justified, is not behind, say, the concern about costs of taking care of these people. Is it?

You saw Randy have a gigantic brain fart when the subject was only distantly referred to. That was how it was in those days.

But that's not today's problem.

The presumption is that every AIDS sufferer who comes here is going to take his meds and be a good boy and not take chances which would infect others, including bug catchers.

I reread some stuff about Kimberly Bergalis and Doc Acer. One guy claimed that all these folks died of something else: Bergalis of the treatment, others of unspecified diseases. Ryan White, infected differently, died of hemophilia--the guy said. Nice distraction from the fact that these folks did indeed have AIDS. Whether they died of something else or not, they did, in fact, have AIDS. This guy sounded like Bomber Bill Ayers. AIDS? So?
It's one thing to let nutcases into the country, but to have them infected with something which does not present for years is a whole 'nother thing.

I take the position that Typhoid Mary, who would not stop looking for work as a cook, should have been locked up. Most people, except those who think whole families dying of typhoid is no biggie, think so, too.
Those with certain strains of TB are criminals if they fail to take their meds. There's a reason for that.
The idea of quarantining is not so very long gone. Ships--Mark Twain told of it--coming into the harbor of a foreign country might be required to wait several days before being inspected by a harbor official and allowed to land their people or stuff. Just in case they had something about to pop.
IMO, gays got their accredited victim status about six months before they were connected with AIDS. Lucky for them.
So here's my point: It would be a good idea to claim that the vast, vast majority of AIDS communication comes from gay sex and needle-sharing. If you start up again on the threat to the rest of us, the rest of us might take you seriously. Then what?
5.15.2008 9:38pm
Dilan Esper (mail) (www):
Richard:

I am going to shock you by saying that I don't really know enough about this issue to take an actual position. I do think that any policy needs to be consistent with the following principles:

1. In general, we should welcome immigrants and visitors.
2. On the other hand, we have the right to exclude people who are truly public health threats.
3. HIV/AIDS should not be treated discriminatorily as opposed to other diseases; it should also not be treated with favoritism.
4. Point 3 does not mean, however, that if experts believe that HIV/AIDS should be treated differently for some persuasive reason, that such advice should not be followed.
5. Any policy that involves per se treatment with respect to any disease should be subject to liberal and straightforwardly obtained waivers for people who do not pose a threat.

But beyond that, I can't venture.

What my point was, though, is that if you read this thread, you see quite a lot of people who are pissed off about the way we treated HIV in the 1980's. I remember that debate-- a lot of consrvatives called for contact tracing and even quarantines, and public health experts indicated that this was different from other diseases and that such measures weren't necessary. In fact, I think the record proved the experts right and the conservatives wrong-- the dire predictions of an AIDS epidemic in this country in fact did not come to pass, and there was thus no need for the grave impositions on freedom that many conservatives were calling for. (And I would be remiss to mention that at least some of the conservatives who were calling for these measures were homophobes who were clearly looking for an excuse to impose restrictions and impositions on gay men.)

The point though is that even if we assume the conservatives were in fact right on this issue in the 1980's, that's not really germane to the issue of what to do about immigration policy in the 21st century. The current issue should be decided based on the factors I enumerate above, not bad blood over the decisions to treat HIV different from other public health threats 20 years ago.
5.16.2008 4:07pm
Richard Aubrey (mail):
When you figure that malaria is spread by mosquitos, as is breakbone fever and other nasties, it is not lunacy to worry about HIV until proven otherwise.
Nobody knew at the time. Nobody knew much at all.
But it was the gay community and their allies who promoted the fear that we are all at risk.
Would they lie?
Hell, yes. They figured that this way the rest of us would pony up some big bucks. Not if we thought it was gays and druggies who were at risk.
So they lied and lied and lied. Fumento didn't write against the conservatives' views. He wrote against the liberal views on the Myth of Heterosexual AIDS. I talked to an AIDS hospice director who, several years after Fumento's book came out, was still trying to convince me i was at risk.
A BSing Presbyterian clergyman--an activist because nobody wanted him to have a congregation--tried to convince me that, despite being faithful, my wife and I were at risk.
That was the gays, Dilan. I may be getting old, but my memory isn't that bad.
So trusting that crowd turned out to be a bad idea.
I'll believe anything they say, after it's been proven by other means.
5.17.2008 3:03pm
Sarah Wells (mail):
If this has not been previously mentioned, the reason the "etiologic agent" of aquired immune deficiency syndromw was called out specifically in the statute, is that a person may carry it and seem perfectly healthy, and it was thought existing law might not be adequate to cover cases of infected individuals until they became demonstably ill, actually had DEVELOPED aids.

I don't see cause to revisit the statute. HIV untreated and allowed to progress is still fatal, with a long period of significant morbidity which can include changes in mental status, HIV positive individuals are a vector. Immigration should have discretion to prevent entry into the country on the basis of infection status and the applicants ability and willingness to comply with a preventative regimen and to refrain from activities that will spread the virus.

Permanent residency can not be granted because all of the above may change, the infected individual can not be cured or made "safe", and may choose not to comply with his regimen of treatment or to limit disease spreading activities within his control.

Admission to the country tentative on review seems a prudent measure, it allows deportation when a visitor is revealed not to have disclosed his HIV statues deliberately.
5.20.2008 2:22am