Opening The Border to AIDS

By Christine Gorman

Somewhere between the heavenly promise of America and the hellish reality of Haiti lies a way station on the Cuban coast called Guantanamo Bay. There, at a U.S. naval base, more than 200 Haitians have languished in tin-roofed barracks for up to 17 months, surrounded by wire fences and plagued by banana rats. Last year the Bush Administration ruled that they had plausible claims for political asylum. But because most of them tested positive for the AIDS virus, they are barred from the U.S. Suspicious of their captors and even their doctors, many have staged a hunger strike, and their situation has now become critical. "The next few days will determine whether or not the Haitians live or die," says attorney Michael Ratner.

The Haitian refugees are the most visible symbol of what may be the next unnecessary controversy to distract the Clinton Administration from its attempt to focus on economic issues. Last week the President announced plans to lift the ban that prevents foreigners with the AIDS virus from immigrating to -- or even visiting -- the U.S. Most medical experts support the change on the grounds that the virus is not easily transmitted. "This shouldn't be a hot-button issue, especially when you consider the lack of a public health threat," says Dr. June Osborn, chairman of the National Commission on AIDS. But opponents believe the plan could be both dangerous and costly. "Unless you believe we have the AIDS crisis under control, I would advise you to resist this potentially explosive policy change," Senate Republican leader Robert Dole wrote last week to Health and Human Services Secretary Donna Shalala.

Under current regulations, there is a list of communicable diseases -- including AIDS, syphilis, gonorrhea, leprosy and tuberculosis -- that are grounds for barring entry into the U.S. The Clinton proposal is to remove all of them except active tuberculosis, which unlike the others can spread through the air. The National Commission on AIDS estimates that as a result between 300 and 600 people with AIDS or infected with HIV might immigrate into the country every year.

"You don't open your gates when you're trying to control a disease within your borders," insists Republican Representative Tom DeLay of Texas. He is worried that the tab for infected Haitian refugees and other immigrants could land in the taxpayers' lap. According to the government's own estimate, the cost of treating the average AIDS patient from diagnosis to death is $100,000. "Our medical care, social-services net and free public education are a magnet for immigrants," argues Dan Stein, executive director of the Federation for American Immigration Reform, a conservative lobbying group in Washington. "We can't bring people here en masse for medical treatment."

Refugees and immigrants aren't the only groups that would be affected. In 1990 many non-American members of the World Federation of Hemophilia could not attend their annual convention, which was held in Washington, because they carry the AIDS virus. Ironically, most of them had been infected by American blood products exported to their countries. Under current rules, even a child dying of AIDS could be barred from crossing the border to visit Disneyland. "Let them go to Disneyland in France," DeLay says. "You've got to be hard in situations like this."

Clinton's plan to lift the current ban is supported by most of the medical community, including officials at the Public Health Service, the Centers for Disease Control and Prevention, and the National Academy of Sciences. "AIDS is not transmitted by casual contact, so we don't have a public health concern with Clinton's proposal," says Dr. Charles Mahan, Florida's state health officer. "The argument has been that it's expensive to take care of these patients, but we let in chronic kidney and cancer patients, whose treatment can be even more costly."

Foreigners are actually at higher risk of being infected by Americans than vice versa. With 1 out of 200 Americans carrying the virus, the U.S. is a net exporter of AIDS. "It was tempting early in the epidemic to blame AIDS on strangers from other countries," says Mahan. "But you can go down the street and get AIDS from someone whose ancestors came over on the Mayflower too." Some doctors also argue that the AIDS ban actually contributes to health problems in the U.S. by discouraging resident aliens, who fear deportation, from seeking treatment.

Opponents of the ban deny that an open-door policy will cost the taxpayer money. According to a 1991 report by the National Commission on AIDS, HIV carriers typically remain employed and self-sufficient for 10 years or more from the time of infection to development of clinical disease. "Their economic contribution to our society," concluded the report, "will far outweigh the estimated lifetime cost of treating HIV-infected individuals."

Clinton is unlikely to be able to lift the ban without congressional approval. Senator Jesse Helms helped establish the restriction in 1987 by introducing it as an amendment that, after some compromising, passed unanimously. Although the Helms legislation is not still in effect, Dole and other Republicans say they plan to introduce a similar measure if Clinton tries to open the borders by executive fiat.

CHART: NOT AVAILABLE

CREDIT: From a telephone poll of 1,000 American adults taken for TIME/CNN on Feb. 10-11 by Yankelovich Inc. Sampling error is plus or minus 3%.

CAPTION: Should the U.S. allow foreigners who have the AIDS virus to enter?

With reporting by Cathy Booth/Miami and Bernard Diederich/Guantanamo Bay