The Clinical Guide to Supportive and Palliative Care for HIV/AIDS

A Clinical Guide to Supportive and Palliative Care for HIV/AIDS • Chapter 15: Special PopulationsLegal StatusPeople who are not citizens may have various types of legal status or no legal status at all. TheU.S. Illegal26 picasImmigration Reform and Immigrant Responsibility Act of 1996 (also called the illegalimmigration reform bill) established procedures for determining the admissibility of immigrants.Even non-citizens who are legally in the U.S. may risk being deported by the Immigrationand Naturalization Service (INS) because of their positive HIV status. It is essential that noncitizenstalk to an immigration law expert before speaking to the INS. In addition, it is essentialthat health care providers be able to assure their clients that everything they say, as well aseverything in their medical records, will be kept confidential and not reported to the INS.Public BenefitsThe U.S. Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (whichcreated the welfare-to-work program, TANF, described in Chapter 18: Legal and Financial Issues)established new and complex eligibility rules for public benefits for legal immigrants. Thislaw also made several categories of previously eligible legal immigrants ineligible for most federalpublic benefits. The illegal immigration reform bill established certain procedures for determiningthe admissibility of immigrants and heightened immigrants’ fears that using publicbenefits, even legitimately using Medicaid, could jeopardize their ability to become legal permanentresidents or U.S. citizens. A recent study determined that immigrants are less willing toapply for Medicaid, even if they are eligible, or to access primary care as a result of these laws.Barriers such as poverty, language differences, and lack of transportation compound the difficultiesfor immigrants in accessing public benefits. 4Legal ResourcesAlthough local resources are absolutely necessary for individuals needing legal counsel, thefollowing national resources may be useful for clients in the U.S., as well as for providers attemptingto understand their clients’ problems:• The National Immigration Project of the National Lawyers Guild published anupdated version of HIV and Immigrants: A Manual for AIDS ServiceProviders, funded and distributed by the San Francisco AIDS Foundation. 3 Themanual provides a comprehensive and detailed presentation of issues and isavailable free of charge from the San Francisco AIDS Foundation, P.O. Box426182, San Francisco, CA 94142; phone (415) 487-3080, fax (415) 487-3089,www.sfaf.org/policy/immigration/appendix_c.html.• For referrals to local immigration advocates or for a legal training packetdesigned for immigration practitioners, contact The National ImmigrationProject of the National Lawyers Guild at (617) 227-9727 or nip@igc.apc.org.The project lacks the resources to assist individual clients but will provideadvice and information to AIDS service providers.• To receive an update on public benefits and the rights of non-citizens arrestedby the INS, you can e-mail the above-mentioned National Immigration Projectat nip@igc.apc.org. Include the following information: name, organization,address, city, state, zip code, telephone, fax and e-mail address.322U.S. Department of Health and Human Services • Health Resources and Services Administration • HIV/AIDS Bureau