General Questions and Answers, Proposed Removal of HIV Entry Ban

Immigrants and refugees undergo a medical exam for certain communicable diseases as part of the immigration process. The process includes a medical exam for certain diseases like HIV (human immunodeficiency virus) infection and tuberculosis. People who have certain diseases may not come to the United States. The screening process, along with the list of diseases which can prevent entry into the United States, is outlined in federal regulations administered by Centers for Disease Control and Prevention (CDC). If new diseases emerge or 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 proposing the removal of HIV from the list of diseases that keep people who are not U.S. citizens from entering the United States. General information about the proposed change is provided below:

What are the current rules for non-U.S. citizens?

Under current regulations, non-U.S. citizens who have HIV can’t come to the United States unless granted a waiver by the Department of Homeland Security. Immigrants and refugees must also be tested for HIV. If the proposed change is made, HIV screening would no longer be required for immigration purposes and waivers would not be needed because the regulations would no longer prevent people with HIV from entering the country.

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

As of January 2009, 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.
• 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 that are 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.

CDC is proposing to remove HIV from the list of communicable diseases of public health significance so that HIV infection would not keep people from entering the United States.

Who would be affected by the proposed changes?

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

Why does CDC want to remove HIV from the list and screening process now?

When the regulation was created in 1987, far less was known about how HIV is spread and what put people at risk for HIV. Health experts now know that HIV is not spread through casual contact like hugging or shaking hands, through the air, food or water. In the United States, HIV infection is passed between adults almost exclusively by unprotected sex with someone who has HIV or by sharing needles or syringes contaminated with HIV. CDC’s proposal to remove HIV infection from the list of illnesses that prevent entry to the United States is based on this improved understanding of the risks.

Will the proposed 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 because HIV infection is preventable and is not spread through casual contact or day-to-day activities. It is mainly spread through behaviors which involve exchange of bodily fluids during sex or through sharing HIV-contaminated needles.

It’s important to remember that any risk posed by people with HIV is not a result of their nationality but is based on whether the person engages in specific behaviors that increase the risk of getting HIV, such as unprotected sex or sharing HIV-contaminated 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.

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 which had previously mandated that HIV be on the list of diseases that can keep people from coming to the United States. This legislative change allowed HHS and CDC to reassess whether HIV infection should be removed from our regulations. CDC constantly reviews the list of diseases in the regulations. If CDC seeks to remove additional STDs in the future, it will do so through changes in these regulations.

What is the process for removing HIV from the list and when would 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.  HHS and CDC will carefully review all public comments it receives and decide whether to make any changes based upon those comments.  HHS and CDC will then publish a final rule in the Federal Register containing the final changes. Any change would become effective at the time described in the final rule.

Where can I find out more about the proposed change?

The regulation is part of the Code of Federal Regulations (CFR) and is published at 42 CFR Part 34. For more information about the revisions, to view the proposed rule in its entirety, or to find out how to provide comments, please click here.  For more information on HIV, please see www.cdc.gov/hiv.