Because of the disease, Kremer — a native of Germany — has been barred from becoming a legal resident of the United States. She and her two children are fighting possible deportation, and their plans for the future are on hold.

But that soon may change.

This month, the federal government cleared the way for HIV-positive foreigners to visit the country and apply for green card visas, lifting a bar that has been in place for more than two decades.

Kremer, 46, a trained physician and HIV researcher who lives in Miami, said she was relieved that her case might be resolved when she returned to court in February. But she said she also felt a sense of responsibility.

“This is not the end of the story,” she said. “What about all the lives that the HIV travel and immigration ban ruined?”

Immigration lawyers in California and around the nation said the ban had caused families to be separated; foreigners to avoid being tested or to go without medication; and highly skilled workers to return to their home countries.

Since the announcement, Los Angeles immigration lawyer J Craig Fong and other lawyers said they had received a flurry of calls and e-mails from HIV-positive foreigners who now had renewed hope. The new rules, including the elimination of HIV testing for green-card visa applicants, take effect Jan. 4.

“To finally be in a position where I can tell people that they can come to the United States to visit their family or that they can get a green card visa and stay here with their partner is just incredible,” said Victoria Neilson, legal director for Immigration Equality, a national organization that advocated for lifting the ban.

But Mark Krikorian, executive director for the Center for Immigration Studies, said the decision to remove HIV as a bar was based on politics, not science. “It was clearly a politically motivated move,” Krikorian said, adding that the decision could have real consequences — more HIV cases and more costs. “It is extra healthcare spending that we wouldn’t have otherwise.”

An analysis by the Centers for Disease Control and Prevention showed that in the first year, an estimated 4,275 people infected with HIV could come into the U.S. at a cost of about $25,000 each.

The ban on infected foreigners began in 1987, when federal health officials added HIV to the list of communicable diseases that prevented people from entering the country. In 1993, Congress made it law.

“At the time, much less was known about HIV,” Neilson said. “People were really scared that HIV status was a death sentence.”

People could apply for waivers, but for most applicants that required proof that the foreigner had a family member in the U.S. legally. Because same-sex partners don’t qualify as family members under the law, the requirement was difficult for many to meet.

Last year, Congress changed the law, and this month, the CDC removed HIV from the list of diseases restricting foreigners’ entry.

Kremer was infected as a medical student in Germany. In 2001, she received a visa to come to the U.S. on an educational exchange program and later qualified for a visa for highly skilled workers. Her original waiver — granted by a sympathetic consular officer in Berlin — was automatically renewed.

But when Kremer applied last year for a green card visa, she was denied based on her HIV status, and she and her family were placed in removal proceedings. “I was fuming,” she said. “My whole future was built up to stay in the United States.”

Knowing the change in policy was coming, her lawyers pushed to get her case postponed until after the new year. Kremer, whose treatment is paid for by the German government, said she was thankful to have both medical coverage and immigration lawyers.

“I am concerned about other people who have been affected who aren’t fortunate enough to have attorneys who know how to navigate the system and keep people from being deported,” she said.

Another HIV-positive visa holder, who lives in Southern California, has also had access to an immigration lawyer but hasn’t been able to apply for legal residency.

Dave, who did not want his full name or occupation used because his HIV status is unknown to his employer, arrived from Canada a decade ago as a visitor. He soon found a job and was able to get an H1B visa for high-skilled workers. Now, he earns six figures and manages million-dollar projects.

Dave’s employer offered to sponsor him for a green card visa, but Dave couldn’t move forward because he knew how it would end — with a denial. His visa expires next year, and he had started looking for new job opportunities.

“Everything had a finite end to it,” he said. “You were working within certain boundaries. Now those boundaries have been removed.”

[Source: LA Times]

Lifting the ban, he said, is “a step that will encourage people to get tested and get treatment, it’s a step that will keep families together, and it’s a step that will save lives.”

History of the ban

The travel ban, in place since 1987, barred HIV-positive foreigners from obtaining permanent immigration status or entering the United States without special waivers. The United States is one of 12 nations, including Armenia, Iraq, Libya, Saudi Arabia and Sudan, that still deny entry to HIV-infected people.

The ban’s longevity has been the result of “misinformation and AIDS-phobia,” says Rachel Tiven, executive director of Immigration Equality, a legal advocacy organization based in New York.

Public health experts have similarly argued that the ban was outdated, reflecting an era when the threat of AIDS was poorly understood. A July CDC report argued that advances in epidemiology, as well as treatment, rendered the ban unnecessary.

“We’ve learned a lot since 1987,” said CDC spokeswoman Christine Pearson.

The move to lift the restriction was initiated last year, when Congress voted to remove language from the original 1987 law singling out HIV as a threat to public health. Presidents George H.W. Bush and Bill Clinton had earlier lobbied against the language to little effect.

That change opened the door for the Centers for Disease Control and Prevention to propose lifting the ban this past July. The move elicited more than 20,000 responses from the public, many of them positive, during a mandatory 45-day comment period.

Effects on travel and immigration

Over the course of the 20-year ban, some HIV-positive visitors were allowed to enter the United States, but only after demonstrating they had medication and health coverage, and successfully petitioning for the special waiver.

“All this was unevenly applied and often resulted in last-minute rejections,” Tiven says. “That’s why no major scientific conferences on AIDS have been held in the U.S. since 1987. It’s an embarrassment.”

Heidemarie Kremer, a trained physician and researcher who contracted HIV in 1988 while working as a medical student in Germany, has been in the United States since 2001 under a temporary visa for immigrants of “extraordinary ability.” Because of her infection, however, she had to continually reapply for special waivers.

Last March, when Kremer finally applied for a green card, a U.S. Citizenship and Immigration Services official told her that, though HIV rules would likely change by the end of the year, her waiver application would still be denied under the existing rules.

“That day, my whole life changed,” she said. “I kept thinking, what will happen to my kids?” she said. “What about my home and my friends?”

For now, Kremer can remain in the country until her court date later this fall, though her pro-bono legal team worries that she could still be deported, along with her children, back to Germany, despite Mr. Obama’s announcement.

“For Dr. Kremer and others like her, there is still much work to be done,” said Cristina Velez, a staff attorney with the HIV Law Project, which recruited Kremer’s legal team.

Kremer believes that the ban has stifled medical innovation, remarking that the reputation of the United States as a medical research powerhouse suffers when highly skilled, but HIV-positive, researchers cannot obtain short-term visas.

Some support for ban remains

While fear of an AIDS epidemic has subsided over the years, proponents of the ban continue to warn that allowing HIV-positive immigrants to settle in the United States could saddle public health agencies with excessive costs. The CDC estimates that lifting the ban would likely increase immigration by 4,300 people annually.

“With rising costs of health care being a heated political issue this year, a discussion of how this policy change may increase the burden on our health care system seems necessary,” according to a statement released in July by the Washington-based Center for Immigration Studies.

Last year, the Congressional Budget Office estimated that lifting the ban might cost the federal government $83 million over the next eight years, primarily in public health expenditures.

Tiven counters that these figures do not take into account the added revenue that HIV-positive immigrants would contribute as fully employed taxpayers.

Ban’s human cost

For those personally affected by the ban, however, bureaucratic wrangling over budgets and visas elide the human impact of twenty years of uncertainty, fear and frustration.

British-born Andrew Sullivan, a prominent political blogger for The Atlantic, is both openly gay and HIV-positive. He has lived in Washington, D.C. since the mid-1980s.

Despite being legally married in Massachusetts, his American-born husband cannot sponsor him for a green card visa because of the Federal Defense of Marriage Act. With today’s announcement, he will finally be able to apply for papers on his own.

An outspoken critic of the president’s delay on the ban, Sullivan reacted to this morning’s announcement on his blog with enthusiasm and relief: “For me, it is the end of 16 years of profound insecurity. I will be able to see my family again in England and know that my HIV will not force me to choose between my husband and the country I have come to call my home. There is no price to be put on that.”

[source: PBS]