38 Pages Posted: 4 Aug 2013 Last revised: 1 Sep 2013
Date Written: August 2, 2013
The administration of HIV treatment in immigration detention centers presents numerous challenges for both residents of the facilities suffering from the illness and the government agencies tasked with providing medical services for detainees. For detainees, failure to obtain access to a suitable HIV treatment regimen, and continuous monitoring by an HIV specialist, for even short periods of time, can make that regimen ineffective. Moreover, inadequate access to antiretroviral therapy increases the risk of spreading the illness, as HIV-positive individuals that do not undergo treatment are more likely to pass on the virus to others during unprotected sex. Incidents of sexual violence and a lack of access to condoms and prevention education in many detainment facilities, presents a serious public health threat. In addition, the lack of uniform guidelines for HIV treatment across detention facilities nationally results in unequal treatment of HIV-positive detainees. Non-citizens fearful of the health consequences of being housed in a detention center that does not have adequate medical provisions may opt to transfer to another facility, away from their families and legal counsel or to a jurisdiction that is less-likely to produce a favorable outcome in their immigration proceeding.
From the government’s perspective, administering HIV treatment in detention facilities does not come without its challenges. The costs of antiretroviral therapy are exorbitant – the most effective antiretroviral drugs are also the most expensive. Additionally, providing the range of services available in many privately funded HIV clinics, including quarterly doctor visits, blood tests, and mental health services, can prove burdensome on detention facilities. It would be difficult for the federal government to justify placing this burden on taxpayers, especially when treatment for poor HIV-positive U.S. citizens is deficient.
Issues concerning the distribution of HIV medication also present challenges. On the one hand, training and establishing protocols for nurses or guards to administer treatment may prove cumbersome, but leaving medicine in the care of detainees presents its own risks. Recent news reports note an emerging underground drug market for HIV medications. Further, the appropriate standard of care for HIV patients is highly debated. Specialists particularly disagree on when a patient should begin treatment. While some providers recommend beginning treatment as early as possible after diagnosis, others recommend treating the illness when it shows signs of maturity.
This Note will explore legal and public policy strategies to address inadequate access to medical treatment for HIV in immigration centers.
Keywords: detention, ICE, Immigration and Customs Enforcement, HIV, AIDS, antiretroviral drugs, treatment, Performance Based National Detention Standards
Suggested Citation: Suggested Citation
Lipscombe, Carl, Tylenol and an Ice Pack: An Inadequate Prescription for HIV/AIDS in Immigration Detention Centers (August 2, 2013). 11 Cardozo Public Law, Policy and Ethics Journal 529. Available at SSRN: https://ssrn.com/abstract=2305110