Public Health Threat Cited in Isolation of Ill Haitians

Federal health officials have warned privately that an estimated 300 Haitians infected with the AIDS virus quarantined in a tent city at the U.S. Navy base at Guantanamo Bay pose “a potential public health disaster” and have urged immigration and military officials to take action to avert a serious outbreak of disease.

“An outbreak in this population . . . could have devastating repercussions,” according to an internal memo written by an official with the federal Centers for Disease Control. “With what is at stake, I don’t think we can afford to take chances.”

The memo, a copy of which was obtained by The Times, was written March 1 by Dr. Paul V. Effler to Charles McCance, director of the CDC’s division of quarantine. Effler is a physician with the division of CDC that is responsible for tracking efforts to prevent the spread of the AIDS virus and other sexually-transmitted ailments.

Effler warned that the practice of housing migrants infected with the AIDS virus together under quarantine could result in the uncontrollable spread of disease among them, adding that Haitians carrying the AIDS virus would be especially vulnerable because of their weakened immune systems.

It defies “common sense” to cluster such people together in such close quarters and with such crude sanitation, Effler wrote.

Assistant Secretary for Health Dr. James O. Mason, the nation’s highest-ranking public health official, wrote a letter to Immigration and Naturalization Service Commissioner Gene McNary in March, expressing his concerns about the looming health problems among the infected Haitians, according to a source who asked not to be identified and who added: “I’m not aware that there was any response.”

Sources in the Public Health Service said they remain “frustrated” and “outraged” that no steps have been taken to alleviate the concerns they raised nearly two months ago.

Navy spokesman Lt. Rob Newell insisted, however, that “Navy medicine is doing everything possible to ensure that (a serious outbreak) doesn’t happen.”

“There have not been any outbreaks of serious illness or disease during the entire period the Haitians have been in Guantanamo Bay,” Newell said in response to queries by The Times.

The AIDS-infected Haitians and their families--who arrived by boat with thousands of their countrymen earlier this year after the regime of democratically elected President Jean-Bertrand Aristide was overthrown--have been separated from the healthier population at Camp Bulkeley, in a remote corner of the base.

All of the Haitian migrants in residence at Guantanamo Bay are being housed roughly 20 to a tent that measures about 30 by 30 feet. Limited laundry facilities mean that they do most of their own washing by hand.

Meals are eaten in mess halls. Toilets are either commercially available portable units leased by the Navy or facilities housed in cinder-block buildings erected for soldiers on maneuver there.

The tents are without air-conditioning, an increasingly serious problem, military officials noted, as the heat and humidity of a Cuban summer approaches.

Effler noted that one danger already was present among the Haitians at Camp Bulkeley: In early March, 22 Haitians with infectious tuberculosis were in residence.

About 4,700 Haitians remain at Guantanamo, awaiting a determination of their immigration status. Thousands have been forcibly returned after being denied asylum.

Their presence has presented a thorny problem for the Bush Administration, which generally has favored repatriation. Lawyers for the Haitians, meanwhile, have taken their fight all the way to the Supreme Court, largely unsuccessfully.

Military officials said privately they were aware of the increased dangers of disease among the quarantined Haitians and have urged the Administration to find ways to move them off the island before summer. But Pentagon officials, who are responsible for administering the migrants’ camp at Guantanamo Bay, say their warnings--like those of the Public Health Service--have not been heeded.

The Haitians, meanwhile, are caught in a legal Catch-22 because of apparently conflicting provisions of immigration law.

Initial screenings have determined that all of those who remain have plausible grounds for political asylum in the United States, and would probably face serious consequences if they were forced to return to Haiti because of their political opposition to the regime in power there.

If they ultimately are deemed political refugees, they would be entitled to enter the United States. But immigration law forbids admittance to anyone known to be infected with the human immunodeficiency virus that causes AIDS.

Furthermore, as political refugees they would be entitled to receive government-paid medical care for eight months after they enter the United States.

Should they be returned home, they will face not only the consequences of their political activities, but the stigma of being HIV-positive, the memo noted.

Effler’s memo described the possibility of a horrifying health scenario if the situation at the U.S. base in Cuba is allowed to continue: Hundreds of individuals with damaged immune systems grouped together and exposed to “infections spread by inhalation,” such as tuberculosis, “and by fecal-oral contamination,” such as cryptosporidiosis, a sometimes life-threatening parasitic infection that causes intractable diarrhea.

Effler said that even when people whose immune systems are healthy are crowded together in poor sanitary conditions, “the opportunities for disease transmission are enhanced.”

He also pointed out that the quarantining of HIV-infected individuals was against U.S. Public Health Service policy and that of the World Health Organization.

When asked about the conditions, immigration and military officials blamed each other.

“We’re not the inn-keepers in that role; we’re the screeners,” said Duke Austin, a spokesman for the Immigration and Naturalization Service. “If you want to discuss their care . . . you have to talk to the Navy. We do not run that facility. We are not the guards or the feeders or the caretakers of that facility.”

But Navy officials said they cannot resolve the situation until the Administration decides what to do with those Haitians who test positive for HIV.

Navy sources said Adm. Leon Edney, who heads the U.S. Atlantic Command and is responsible for the camp at Guantanamo, has sent urgent messages to the staff of Gen. Colin L. Powell, the nation’s chief military officer. But neither his warnings nor the CDC’s has received much attention from the Bush Administration, sources said.

One Bush Administration official acknowledged an “ongoing debate” over the broader issue of what to do with HIV-infected Haitians who cannot return to Haiti.

“But I’ve never heard it said that we should just mix them (in with the uninfected) and accept the consequences, whatever they may be,” the official said.

The CDC memo urged the United States to provide medical treatment, including such drugs as AZT and aerosol pentamidine, and to counsel those infected about ways to prevent transmission.

Navy spokesman Newell said that the Navy has immunized all of the Haitians against measles, mumps, flu and tetanus, but made no mention of any therapy to stave off AIDS-related conditions.

“We’re doing everything we can from the preventive medicine standpoint,” Newell said.

Capt. Kendall Pease, a spokesman for the U.S. Atlantic Command, agreed, saying that, among other things, the military plans to construct more permanent housing for the Haitians in an attempt to reduce overcrowding and increase the quality of their care.

“We’re down there providing human care the best we can,” he said.