HIV Policy Watch

Former Florida Governor Rick Scott rejected millions of dollars for HIV as epidemic grew

This month the Guardian reported that Rick Scott rejected $70 million in federal funds to fight the state’s HIV epidemic when he was governor. Between 2015 and 2017 Scott’s administration directly blocked or rejected desperately needed funds that could have had a profound impact on the lives of Floridians living with HIV. His intransigence appears to have helped fuel – rather than end – the HIV epidemic in Florida. By 2017, the state had the highest number of new HIV diagnoses in the U.S. and of the 10 states that have the most annual HIV diagnoses, Florida was the only one to have an increase from 2013-2017. Advocates are calling on current Governor Ron DeSantis to right Scott’s wrong by funding care and services and by modernizing the state’s HIV criminalization laws.

Customs and Border Patrol using HIV status as factor to justify family separation

In July, U.S. Customs and Border Protection (CBP) Chief of Law Enforcement, Brian Hastings, said that an immigrant’s HIV-positive status could be used as grounds for family separation at the border. Using HIV status to justify tearing families apart increases HIV stigma, ignores modern science, and goes against long-standing U.S. policy. HIV and immigrant advocates mobilized quickly to demand an immediate end to family separation and respect for the human rights of all, regardless of HIV status.

This month, we learned more troubling information about the U.S. government’s official policy. In response to a question about whether HIV status is used on a “case by case” basis to justify family separation, CBP Acting Commissioner Mark Morgan said,

“Yeah, so what the policy is, is that we’re going to look at, first and foremost, the health, safety, and wellbeing of the child. And we will use a totality of circumstances to make that decision to determine any type of separation. And that’s our policy. It has been and it continues to be.”

The Commissioner did not acknowledge that HIV status cannot be used as a reason to exclude or remove immigrants from the U.S. and implies that HIV status could explicitly be a part of the “totality of circumstances” test. Public charge determinations rest on a totality of circumstances test, raising concerns that immigration officials could be using HIV-status to deny immigrants admission to the U.S. or lawful permanent resident status (green cards).

Health Care Access

Democratic Senators introduce bill to block Trump Administration’s public charge rule

A group of U.S. Senators introduced the Protect American Values Act (Senate Bill 2482) which would stop the Trump Administration from using federal funds to implement its “public charge” regulations. The Department of Homeland Security’s public charge rule seeks to further intimidate and punish some immigrants just because they use public programs that are supposed to help us meet our everyday needs, like health care, housing and nutrition programs – even if they are legally eligible for these programs. The rule could also bar people living with HIV, other chronic health conditions, and people with low incomes from becoming U.S. citizens. You can read more about the rule here and here. Unless it is held up in the courts, it is slated to go into effect October 15, 2019. There is a similar version of the Protect American Values Act in the U.S. House of Representatives, the No Federal Funds for Public Charge Act, H.R. 3222.

Sexual & Reproductive Rights, Health & Justice

The Title X Domestic Gag Rule has gone into effect

The nation’s only federally funded family planning program serving primarily poor and low-income women–the Title X program–has taken a major blow. Many health care providers, including Planned Parenthood, and at least seven states were forced to leave the program because of the Trump Administration’s Title X Domestic Gag Rule — an administrative rule that bans federal family planning dollars from going to health care providers who perform or refer patients for abortion services.

The fallout from the Domestic Gag Rule has been chaotic and damaging for Title X patients and the health care centers alike. Planned Parenthood of Southwest Ohio, for example, announced that they have to close two of their four centers in Cincinnati, impacting more than 6,000 patients. Another former Title X clinic in rural Minnesota was forced to reduce staffing by 50 percent and might have to raise the costs on their already low-income patients.  According to the Guttmacher Institute, in order to serve every Title X patient without Planned Parenthood in the program, other Title X providers would have to increase their client caseload by 70% on average. In some states, federally qualified health centers (FQHCs) would have to double or triple their capacity to fill the gap.

Trump Admiration restricts U.S. citizenship, impacting some children born to same-sex couples and troops stationed overseas

The Trump Administration continues to attack citizenship rights for children born outside of the U.S. through two separate policy updates. Traditionally, children with a parent who is a U.S. citizen automatically become U.S. citizens, even if they’re born outside of the U.S. or adopted, so long as certain residency requirements are met. Children of U.S. government employees and service members born abroad are treated as though they are born in the U.S. and also receive automatic U.S. citizenship.

The U.S. State Department, however, has reportedly refused to grant citizenship to children born abroad to same sex couples through surrogacy. This policy is a clear attack on same sex families, treating their children born abroad as though they are born “out of wedlock” – even if the couple is legally married – because of the involvement of a surrogate. There have been at least four lawsuits filed against the State Department for discrimination.

Additionally, U.S. Citizenship and Immigration Services (USCIS) released new guidelines to change U.S. naturalization policy. Under the guidance, children born abroad to U.S. government workers or servicemembers living and working abroad will no longer automatically have U.S. citizenship. The new policy does not make them ineligible for citizenship, but it does force them to go through a “bureaucratic maze” to attain U.S. citizenship, making the process far more difficult and raising the possibility that some applications will be denied.

California bill would require public universities to provide medication abortion on campus

California could become the first state in the U.S. to require public universities to provide medication abortion on campus. The bill, SB 24, would go a long way to ensuring that college students have access to abortion without unnecessary travel or delay. State law already required insurers to cover abortion and the bill would use private donations to train staff and equip health care centers. $10.3 million has already been raised. It has passed the legislature and is awaiting a signature from Governor Newsom.

Eight-week abortion ban in Missouri blocked

The state’s eight-week abortion ban was temporarily blocked by a federal judge just one day before it was to go into effect. The court blocked portions of the law that would have banned abortion at 8, 14, 18, and 20 weeks as the legal challenge proceeds through the courts. The ruling took aim at lawmakers’ “hostility” to Supreme Court precedent that protects the right to an abortion, criticizing them for using the law to protest Supreme Court decisions. This is only a partial victory for people in the state who need abortions. The selective abortion ban, which purports to ban abortions sought on the basis of race, sex, or genetic anomaly, was not blocked. Such bans function as a smokescreen, perpetuating the trap of “justified abortion” and incorporating racist and sexist presumptions about why people get abortions.

North Dakota law requiring doctors lie to patients blocked temporarily

A federal court temporarily blocked a North Dakota law that would have required doctors to lie to their patients about abortion care. HB 1336 would have required doctors to tell people seeking abortion care that it may be possible to reverse medication abortions – something which is, in fact, not scientifically possible. That law will not go into effect while its legality is challenged through the courts. In the opinion, the court notes that the abortion reversal theory is “devoid of credible scientific evidence; misinforms and misleads the patient” and that the law “clearly interfered with the doctor-patient relationship.”

Austin, Texas, to fund abortion support services for low-income people

Austin, Texas, will be the first city in the U.S. to fund “abortion support services” that can help low-income people access abortion care. The Austin city council voted to allocate $150,000 to cover common barriers to care like travel, lodging, and childcare costs. This comes amidst escalating attacks on abortion rights in Texas, including a new state law, SB 22, that prohibits local and state government from using tax dollars to fund abortion providers or affiliates.

LGBTQ Rights, Safety, and Justice

Trump Administration cancels protections for LGBTQ people in hospitals

The Department of Health and Human Services (HHS) is removing regulations that would have protected against discrimination based on sexual orientation and gender identity in hospitals. In 2016, HHS issued a proposed rule to add explicit non-discrimination protections for LGBTQ people as a condition for hospitals accepting Medicaid or Medicare funding. This month, HHS released the final rule but removed those protections from the text of the rule. This is the latest in this administration’s attempt to greenlight discrimination against LGBTQ people.

Federal and state actors fail to act in the face of rising violence against people of trans experience

So far this year, at least 18 people of trans experience have been killed through violent means, including two Black transgender women this month alone. Violence against the trans community, and against Black trans women in particular, has reached shocking levels the U.S., and yet state and federal government actors have consistently failed to act. Cuts to housing, employment, health care, and nutrition programs create barriers that disproportionately put people of trans experience at risk of harm. Too few states have explicit legal protections for trans and gender non-conforming people, and the Trump administration has been opening the door for increased discrimination through “refusal of care” rules.

Economic Justice for People with HIV

Proposed rule would make it nearly impossible to prove housing discrimination claims

The Department of Housing and Urban Development (HUD) released a proposed rule this month that would radically reshape the way that housing discrimination claims are made. It would change the “disparate impact” doctrine under the Fair Housing Act (FHA). Basically, a housing policy or rule can be found discriminatory and in violation of FHA if it disproportionately harms certain groups according to race, religion, family status, sex, or disability. Disparate impact is an important safeguard against practices that have the effect of keeping certain groups of people out of housing – even if there was no explicit intent to discriminate against that group.

The new proposed rule would make it harder to bring housing discrimination complaints by raising the burden of proof, putting much more responsibility on the person making the claim to establish discrimination early on in the case. It also creates a carveout for automated decision-making systems, or algorithms that lenders and landlords used to judge credit risk, mortgage interest rates, and more. Human bias is programed into these algorithmic based systems, meaning they often perpetuate social inequities rather than disrupting them. By safeguarding lenders and landlords from the inequitable effects of algorithms, this proposed rule creates a backdoor for discrimination.

Ending Criminalization

California passes bill to ban private prisons

The California state legislature passed a bill, AB-32, to ban private prisons in the state by 2028. In the meantime, the state will not enter or renew any contract with a private prison company unless it is forced to because of a court-ordered prison population cap. The bill would also close four major Immigration and Customs Enforcement (ICE) detention centers, which together can hold up to 4,500 people. This is a huge step in stopping the prison industry from profiting from detention and incarceration. Governor Gavin Newsom still must sign the bill, which he has indicated that he will do.