AIDS-Aliens Policy Review Stirs Criticism

Top health officials in the Bush Administration are expected to strongly oppose the Administration’s apparent attempt to reverse itself on controversial AIDS immigration policy, knowledgeable sources said Sunday.

“(We) will weigh in heavily against this,” said a source in the Department of Health and Human Services close to Assistant Secretary for Health James O. Mason, the highest-ranking federal health official after Secretary Louis W. Sullivan. “It sends the wrong message to people outside the country--and to people inside the country.”

The Administration, under pressure from conservatives, is reportedly considering dropping its plan to allow individuals infected with the AIDS virus to enter the United States. The proposed regulation, scheduled to go into effect June 1, would have reversed a 1987 law that barred foreigners who are ill or infected with the human immunodeficiency virus from visiting or establishing permanent residence in this country.

The existing law has been attacked as discriminatory and medically unnecessary by many members of the world health community, by Congress and by civil rights and AIDS advocacy groups. Both Sullivan and Mason have long advocated lifting the restriction, and the Administration proposed doing so last January.

But conservatives argue that traditional public health measures have always excluded immigrants with communicable diseases and that policy should be maintained.

An outpouring of conservative sentiment against the plan, coupled with concerns raised by the Justice Department over the difficulties of enforcing the proposed change, have prompted the Administration to consider changing its mind, sources said. Mason was ordered last week “by conservative elements in the department” to draft a new regulation that would maintain the status quo, they said. He did so, but refused to sign his name to it, they said.

“He did the paperwork because he had to, but there’s no way he wants to be tied to it,” a source said. “He is hoping that the Administration simply wanted another ‘option’ to consider, and that this is not the final regulation they intend to issue.”

Sources said that Mason and Sullivan were angry that Administration officials who were not experts in public health matters “were making public health decisions.”

“It’s not their role, it’s the secretary’s role,” one high-ranking HHS source said, adding: “In this country, 4 out of every 1,000 people are infected. Outside this country, only 1 out of every 1,000 people are infected. The truth is, it’s safer to get involved with an alien.

“This will send the wrong message, especially to people in this country. They will think that AIDS has been taken care of because we’re excluding foreigners. We shouldn’t be avoiding foreigners, we should be avoiding risky behaviors.”

In legislation passed during the final days of its last session, Congress gave the secretary of HHS authority to determine which diseases should prevent an individual from entering the country. Sullivan had said repeatedly that he would remove AIDS from the list as soon as he received the power to do so. AIDS had been added to the list in 1987 when Congress approved an amendment sponsored by Sen. Jesse Helms (R-N.C.).

In January, HHS proposed that only tuberculosis remain on the list, thereby eliminating not only HIV, but syphilis, gonorrhea and leprosy, among others. Tuberculosis is the only disease on the list that is transmitted through the air.

Conservatives inside and outside government, however, launched an intensive campaign against the proposal. “One religious broadcaster urged all his listeners to call and I was getting 600 calls a day,” said another HHS official, who requested anonymity.

Rep. Robert K. Dornan (R-Garden Grove) said he and about five dozen other House members sent a letter to the White House urging that the current restriction be maintained.

“It simply said: ‘Don’t reverse the original policy,’ ” Dornan said. “We told the White House that the legislative intent was to be merciful--that a person could come in for treatment, or to attend a health seminar, or for another compelling reason, but for tourism or to live here--no go.

“Our health systems are already taxed, and will be taxed to the breaking point,” Dornan added. “It is simply not good health policy to allow people to come into the country who are infected with an always fatal venereal disease.”

HHS officials said that additional concerns had been raised by some medical groups and by the Justice Department regarding the potential economic burden that might be imposed on the health-care system by allowing AIDS-infected individuals to enter the country. AIDS is one of the most expensive diseases to treat.

But advocates of changing the rule argued that existing immigration law already provides that those applying for a long-term visa or permanent residency must prove they have sufficient financial resources not to become a “public charge.” Further, they said, the United States currently allows other immigrants with financially draining conditions--such as heart disease and cancer--to enter without restriction.

The Justice Department, however, indicated it was reluctant to enforce the “public charge” provision, according to one HHS source. “We told them that the Public Health Service would work with them--we offered to work with them--and they still just didn’t want to play that role,” he said.

A Justice Department official said the Immigration and Naturalization Service, an arm of the department, contended the public charge provision could not be fairly administered by its inspectors.

“They felt it was a projection into the future they could not make,” the official said of INS’s position. “Suppose someone showed up (for entry into the country) with AIDS and health insurance. How could you project five to 10 years when the person might no longer have the insurance” but need the expensive treatment, he said.

“It was not a question of not wanting to enforce it (the public charge provision), but rather its unenforceability,” the official said.

It is as yet unclear what impact the Administration’s refusal to drop the restriction will have on the fate of the annual international AIDS conference, the world’s largest and most prestigious AIDS scientific meeting. Harvard University in Cambridge, Mass., near Boston, which is scheduled to host the 1992 meeting, threatened last year to drop its sponsorship if the immigration rule were not changed. The 1991 conference is slated next month for Florence, Italy.

“My guess is that if the United States is once again humiliated in front of the international AIDS community, the conference next month will vote to move next year’s meeting out of Boston,” predicted Jeff Levi, of the AIDS Action Council.

Supporters of ending the current policy reacted angrily Sunday.

“The law told the Administration to make a public health decision on immigration--not just another political decision,” said Rep. Henry A. Waxman (D-Los Angeles). “Health officials say there is no reason for discrimination and they oppose it. The President should back them up.”

Levi agreed. “It is our hope that Dr. Sullivan will stick to the spirit and letter of the congressional mandate,” he said.

Times staff writer Ronald J. Ostrow contributed to this story.