The Immigrants

The Immigrants

I saw a recent news story that the United States had removed three communicable infectious diseases from the list of diseases that potentially bar immigration into the United States. All potential immigrants have to undergo a medical exam. The law states that certain diseases which if found in the potential immigrant, will make them ineligible for immigration to the United States. The list still includes Leprosy, Syphilis and active Tuberculosis.

HIV infection was taken off the list in 2010. I have seen two patients who were impacted by this change. Here are their stories.

The first story started by my getting a call from another physician. He asked me if I would be willing to see a new patient with HIV. I replied in the affirmative. The patient that came to see me was a recent immigrant from Ethiopia. She was about 30 years old and was accompanied by her husband and a two-year-old daughter.

The husband had applied for immigration to the United States and been approved with his family. During their physical exam, his wife came back positive for HIV. At that time her immigration was halted. The husband tested negative, and came here on his own. He got a job, and the wife remained in Ethiopia with their daughter. A year later the law was changed and the wife was able to join her husband.

When I saw her, she spoke no English and her husband translated for her. Despite her diagnosis, her husband was very devoted to her. As with a lot of immigrants, she had no health insurance. Her tests confirmed HIV infection. She had not progressed to develop AIDS, but needed to start treatment. Unfortunately, the medications would cost thousands of dollars a month. This was money that they did not have.

I was able to arrange for her treatment at the local health department which provided free care for HIV infected patients. They provided this care with a grant from the federal government. The funding for this came from the Ryan White program.

Ryan White was a teenager from Indiana who contracted HIV from a blood transfusion which he required as a hemophiliac. He was expelled from middle school because of his infection. In 1988 he gave testimony to a presidential commission created by president Ronald Reagan. He became the face of the HIV epidemic.

Congress subsequently created the Ryan White program. All HIV infected patients can receive free care through this program. By 1996, we had effective treatment for HIV. Unfortunately, Ryan White died in 1990 at age 19 due to complications from his HIV infection. I have met his mother, who still campaigns for HIV patients.

After arranging for her to go to the Ryan White funded clinic, I never did see my Ethiopian patient again. I hope that she is doing well today.

My second patient was a young man in his early thirties. He also came to see me for HIV infection. He was an immigrant from Myanmar. He had obtained a green card through a lottery program that is run to promote diversity amongst immigrants to the United States. However, his HIV test came back as positive and his immigration was put on hold

This was how he found out that he had HIV. Luckily he was able to get started on treatment in Myanmar. After the law was changed in 2010, he was able to come to the United States and has continued to do well on treatment. His wife was negative and remains devoted to him.

The laws regarding communicable diseases and immigration are not always effective. In 2001, the United States allowed the immigration of 3800 young orphans from South Sudan. These were known as the lost boys of Sudan. I don't know if any of these boys had an immigration physical or not.

During my fellowship training, I once took care of one of these lost boys. He was from the Nuer tribe of Southern Sudan. This patient was unfortunately found to be positive for both HIV and Leprosy after he got to the United States. He had to be sent to the last remaining Leprosy treatment center in Louisiana for further treatment.

I still remember my professor of Infectious Disease telling me that it was challenging for him to write a letter to the airline asking them to allow an active leprosy patient to fly on a commercial flight and convincing them that he would not be a risk to the other passengers.

Communicable infectious diseases will always be able to cross borders, despite the best attempts to control them.

Health screening of immigrants, Ellis Island early 1900's.