Quiet reprieve for HIV refugees

After speaking at a political rally back in 1996, Mohammed Ali was tortured and spent more than a year in prison in his native Ethiopia - without being charged. Two years ago, the ethnic Somali father of nine managed to flee to Kenya.

But he has faced frequent police harassment in his adopted homeland, and can't afford the fees to send his children to school. And he is grappling with the gritty challenge of being diagnosed as HIV-positive. All he wants now is to move to America.

"I had no life and no future here," says Mr. Ali in the relative luxury of a Nairobi coffee shop. "What I wanted is to bring up my children in a free society and get education for them. Most of them are under 10."

But coming to the United States was a more prickly process than he'd envisioned. Although he and his family were approved for resettlement to the US in 1998, they were later rejected when medical tests found Ali to be HIV-positive. Under longstanding regulations at the Immigration and Naturalization Service, refugees living overseas had to prove they could cover their own medical costs before being naturalized.

This effectively barred those carrying the virus associated with AIDS from any hope of resettlement. But that all changed last June.

In a quiet, but major, shift in US policy, the INS has lowered the economic barriers for refugees diagnosed with the human immunodeficiency virus (HIV). Now Ali is one of an estimated 70 people now able to emigrate to the United States in an initial test program.

Six US cities, known for their advanced HIV health and hospice networks, have been selected to host a limited number of HIV refugees in the trial: Boston, New York City, Chicago, San Diego, Minneapolis, and San Francisco.

"From [the day the initiative passed], I was happy, and now it's almost a reality," Ali beams .

And observers echo his enthusiasm. They are particularly impressed by the humanity shown by the US. "We think it's a compassionate move on the part of the US government to assist refugees," says Bob Carey, vice-president in charge of resettlement at the New York-based International Rescue Committee. "It's a humanitarian response to a particularly vulnerable group of refugees."

Under the Immigration and Naturalization Act, HIV-positive foreigners are still deemed "inadmissible" to the US. The refugees still need to apply to the attorney general for a waiver to this clause. However, "many more" refugees are expected to receive the waiver, according to the State Department.

"HIV-positive persons determined by INS to meet the refugee definition now face a simpler waiver process and a greater likelihood of being admitted to the US," says a State Department cable, signed by US Secretary of State Madeleine Albright.

Refugees who were selected for resettlement and then left behind after testing positive for HIV were facing an even greater risk of persecution because they were being singled out, according to a State Department official.

"In an ironic way, our attempt to provide protection to them greatly increased the risks they suffered in their country of asylum," admits the official. "The thing that prompted this change in policy was our concern that many of these people were not safe where they were, languishing in refugee camps, and were at risk of being returned to their country of origin."

The Department of Health and Human Services now says it can cover the medical costs of HIV-positive refugees until they obtain private insurance. "We don't expect it to be a significant cost to the taxpayer," says an anonymous spokesman.

Currently, refugees can come to the US in two ways: Some arrive at borders and airports and claim asylum, while others are selected overseas for resettlement. The government has dramatically increased its annual quota for resettlement from Africa in recent years. This year's ceiling is 18,000 individuals, up from 2,000 in 1999 and 7,000 in 1998. But this is still less than a third of one percent of the continent's refugees, which currently number 6 million.

Africa is also home to 23 million people infected with HIV. In some countries, one out of every five adults is HIV positive.

A "small minority" of resettlement cases will be HIV positive, says the State Department official, but he couldn't specify a percentage. He estimates about 35 cases have already come to the US under the policy change and another 50 to 70 cases are in the process.

"We all feel we're doing the right thing for refugee protection and it's something we've been urged to look at for years by the UN High Commissioner for Refugees," says an INS official.

The policy change brings the U.S. in line with the Nordic countries, which have long accepted HIV-positive refugees for resettlement. It's being warmly welcomed by refugee advocates.

"I'm really happy about this," says an American refugee worker based in Nairobi, a central location for processing resettlement cases.

He says the change in policy simply rectifies an unfair ban against refugees diagnosed with HIV. "We take stretcher cases, people at the final stages of cancer: None of these were medical exclusions except HIV."

However, he's concerned that opposition to the policy change will generate anti-African sentiment - especially in the US cities designated as safe havens for the ill refugees.

"This is the place with AIDS," he says, referring to the some 23 million cases of AIDS in Africa, compared with about 34 million worldwide. "I would hate for there to be a backlash against all Africans."

However, Mr. Carey of the International Rescue Committee downplays such worries. "The American public tends to be sympathetic and very compassionate when faced with refugees in their communities," he says, citing the Kosovo crisis as an example. He says most resettled refugees get jobs and become contributing taxpayers.

"We would be concerned about any efforts to prevent these people from coming to the United States," added the State Department official.

Meanwhile, Ali has a message for people who might object to HIV-positive refugees coming to the U.S. "No one chooses this thing," he says. "To hate someone for [having HIV] is a crime."

"If America doesn't accept people, who will? If people are not going to be free there, where can they be free?"

(c) Copyright 2000. The Christian Science Publishing Society