General Questions and Answers

Final Rule Removing HIV Infection from U.S. Immigration Screening:

Immigrants and refugees must undergo a medical exam as part of the immigration process for entry into the United States. The exam includes screening for any illness defined as a communicable disease of public health significance. All of these diseases can be easily spread between people. Those immigrants and refugees found to have these diseases may not enter the United States.

The screening process, along with this list of diseases which can prevent entry into the United States, are outlined in federal regulations written by the Centers for Disease Control and Prevention (CDC). If new diseases emerge or as more is learned about diseases already on this list, regulatory changes can be made to alter the disease list.

The Department of Health and Human Services (HHS) and CDC are removing HIV infection from the list of diseases that keep non-U.S. citizens from entering the United States. General information about the change is provided below:

What was the process for removing HIV from the list and when will the change take effect?

HHS published a Notice of Proposed Rulemaking (NPRM) on July 2, 2009 explaining the proposed changes in the Federal Register and seeking public comment on those changes.  The proposed rule was based on the science that HIV is not spread through casual contact. A public comment period was open until August 17, 2009. These public comments were considered in making the final policy decision. After the comment period closed, CDC carefully reviewed over 20,000 public comments. Most comments supported the rule as proposed.

The final rule was published on November 2, 2009 in the Federal Register. After the 60-day waiting period required by federal guidelines, the final rule will go into effect on January 4, 2010.

Before the effective date of January 4, 2010, what changes will take place for non-U.S. citizens with HIV infection who wish to enter the United States?

Until the final rule is in effect on January 4, 2010, non-U.S. citizens who have HIV cannot come to the United States unless granted a waiver by the Department of Homeland Security. Also, all those applying for an immigrant visa will have to be tested for HIV infection during the immigrant medical exam until January 4, 2010.

Under the new rule, effective on January 4, 2010, HIV testing will no longer be required as part of the immigrant medical exam. In addition, waivers will no longer be needed for HIV infection.

What diseases prevent non-U.S. citizens from coming to the United States?

Diseases that can prevent entry to the U.S. fall into three categories:

• Any of the following diseases: active tuberculosis, infectious syphilis, gonorrhea, infectious leprosy, chancroid, lymphogranuloma venereum, granuloma inguinale, and HIV infection. (HIV infection will be removed on January 4, 2010)
• Quarantinable diseases designated by any Presidential Executive Order.  The current list of diseases includes cholera, diphtheria, infectious tuberculosis, plague, smallpox, yellow fever, viral hemorrhagic fevers, severe acute respiratory syndrome (SARS), and influenza caused by novel or re-emergent influenza (pandemic flu).
• Diseases reportable as a public health emergency of international concern to the World Health Organization under the International Health Regulations of 2005. These diseases currently include: polio, smallpox, SARS, pandemic flu and other public health emergencies of international concern.

HIV infection will be removed as a communicable disease of public health significance effective January 4, 2010. At that time, HIV infection will not be used to keep people from entering the United States.

Who is affected by the rule change?

Those who are not U.S. citizens will no longer be denied entry to the United States based on their HIV status. This would include: immigrants (including those in the United States applying for change of status to lawful permanent resident), refugees, and those seeking asylum. This also includes temporary visitors for school, work or pleasure.

Why did CDC remove HIV infection from the list of diseases that can prevent non-U.S. citizens from entering the United States?

When the regulation preventing non-U.S. citizens from entering the country was created in 1987, far less was known about how HIV infection is spread and what puts people at risk for HIV. Health experts now know that HIV is not spread through casual contact like hugging or shaking hands. Nor is HIV spread through the air, food or water. In the United States, HIV infection is passed between adults almost solely through unprotected sex with someone who has HIV or by sharing needles or syringes used by someone with HIV. Removing HIV infection from the list of illnesses that prevent entry to the United States is based on this improved knowledge of the risk of spreading the disease.

Will the rule change increase the risk that average Americans will contract HIV?

Allowing non-U.S. citizens with HIV infection into the United States will not pose a risk to the public’s health through casual contact. HIV infection is preventable and is not spread through casual contact or day-to-day activities. It is mainly spread through behaviors which involve the exchange of bodily fluids during sex or sharing of needles.

HIV is not a new virus in the United States. Currently, it’s estimated that more than 1 million Americans are living with HIV. It is important to remember that any risk posed by people with HIV is not a result of their nationality. The risk of spreading HIV is only increased when a person engages in specific behaviors, such as having unprotected sex or sharing needles.

Why are HHS and CDC removing only HIV infection when other sexually transmitted diseases (STDs) are still on the list of diseases that prevent entry?

Legislation passed in July 2008 removed language from the Immigration and Nationality Act (INA) related to HIV. This original text had mandated that HIV infection be on the list of diseases that can keep people from coming to the United States. The decision to remove HIV infection from the regulations is because of this change in law and the science of how HIV is spread. In the United States, HIV infection is passed between adults almost solely through unprotected sex with someone who has HIV or by sharing needles or syringes used by someone with HIV. HIV is not spread through casual contact.

CDC continues to review the list of diseases in the regulations. If CDC seeks to remove other STDs in the future, it will do so through the federal rulemaking process.

Why does the law require 60 days before the final rule can go into effect?

The U.S. Office of Management and Budget (OMB) requires a 60-day waiting period for any rule that has a major economic impact. An economic analysis has shown that this rule will have a major national economic impact.  Thus, this rule meets the OMB guidelines for the 60-day waiting period.

The 60-day waiting period will begin on November 2, 2009. Thus, the final rule will go into effect on January 4, 2010.

Where can I find out more about the new rule?

For more information about the new rule, or to view the rule in its entirety, please visit the Final Rule Removing HIV Infection from U.S. Immigration Screening page.

For more information on HIV, please see http://www.cdc.gov/hiv.