America Living With AIDS

National Commission, as well as other concerned constituencies, Congress passed an
immigration law that directed HHS to evaluate the list of "dangerous contagious diseases," renamed as the list of "communicable diseases of public health significance" as it
relates to those entering the United States in late 1990.15 In congressional testimony in
1990, Dr. William Roper, Director of the Centers for Disease Control, testified concerning the removal of HIV/AIDS and other sexually transmitted diseases (STDs) from the
list of dangerous contagious diseases, and stated that
"[a]liens with these diseases can no longer be considered a significant public health
threat to the United States. The sexually transmitted diseases proposed for deletion, as
well as HIV infection, are not transmitted by casual contact, through the air, or from
common vehicles-such as fomites, food, or water. Therefore an infected person in a
common or public setting does not place another individual inadvertently or unwillingly at risk. Rather these diseases are primarily spread through voluntary exposure."16
In January of 1991, HHS revised the list, deleting a number of STDs, including HIV
infection, leaving "infectious tuberculosis" as the only "communicable disease of public
health significance" for which aliens, including refugees, can be excluded from the United States.
As the June 1, 1991 deadline neared for decision about what list of diseases constituted
grounds for exclusion, a new debate apparently arose within the Administration around
the proposition that travelers should be dealt with separately from immigrants. One view
in this discussion was that the costs of medical care for people with HIV infection or
AIDS made this disease a communicable disease of public health significance that should
result in exclusion of immigrants. The Commission has reviewed that issue and found
that present immigration law deals extensively and in detail with such economic concerns in the exclusion of persons who wish to immigrate if they are likely at any time to
become a public charge. To single out HIV disease in this economic context seems irrelevant and highly discriminatory.
The issuance on May 31, 1991 of an interim rule that extends the same travel and
immigration restrictions as "communicable diseases of public health significance" that
previously were classified as "dangerous contagious diseases" defies public health knowledge. This action perpetuates the misleading and discriminatory effects of prior HIV
inclusion on an outdated list of diseases. This has had the additional, serious side effect of
jeopardizing further important scientific meetings that are crucial to the efficient exchange
of scientific information and progress in the midst of this accelerating pandemic.
Conclusions
Over the course of the past two years, the National Commission on AIDS has submitted a series of recommendations to the President and Congress in addition to those
included in this comprehensive report. Given the lack of federal response to the Presidential Commission recommendations, the National Commission has had to re-recommend a number of initiatives that were highlighted by the Presidential Commission.
National Commission recommendations that overlap with the Presidential Commission
recommendations include: (1) passage of antidiscrimination legislation, (2) intravenous
drug use treatment on demand, (3) expansion of health care provider recruitment initiatives including the National Health Service Corps, (4) expansion of clinical trials to
include underrepresented groups traditionally excluded from clinical research, such as
people of color, (5) development of comprehensive care programs, (6) creation of a federal interagency mechanism to coordinate a national plan, and (7) funds for housing
projects for people with HIV. The Congress and/or the President have taken some action