Department of Homeland Security’s Proposed Changes to Asylum Seeking Regulation Threatens Health Equity and Access to Health Care

This post is co-authored by Alex Perez, Manager, Health Equity and Dori Molozanov, Manager, Health Systems Integration.

The Department of Homeland Security (DHS) has proposed a rule that would drastically narrow the eligibility parameters for asylum seekers, including nearly a dozen new barriers to asylum that would rewrite the law to exclude nearly all people escaping persecution and seeking refuge in the United States (U.S.). The existing asylum-seeking process in the U.S. has proven to efficiently and effectively admit credible asylum seekers in ways that uphold the United States commitment to humanitarian aid and protections, yet the proposed rule aims to dismantle this system in a way that will harm vulnerable populations with disastrous public health consequences. The proposed regulation, among other things, creates additional barriers to seeking asylum for those that do not have resources to secure visas or book one-way tickets to the U.S., eliminates the possibility of future immigration relief for applicants whose applications are deemed “frivolous,” and imposes additional restrictions on who may apply for protections in the U.S., including dismissal of most claims related to gender- and gang-based violence. Although the current administration has signaled a commitment to ending the intersecting HIV and hepatitis epidemics, we cannot make progress with policies that jeopardize access to prevention, care, and treatment services, especially for those who sit at the most marginalized boundaries of society.

The dismissal of gender and gang-based violence claims is discriminatory towards women and the broader LGBTQI+ community, who are at risk for experiencing discriminatory violence both in their home countries and during migration. The proposal’s characterization of these forms of disputes as “private criminal acts” invalidates these experiences as inconsequential, ultimately reinforcing prejudicial beliefs against women, immigrants, LGBTQI+ groups, and those that live at an intersection of these identities. Gender-based and other types of sexual violence are pervasive in LGBTQI+ communities, with research indicating 21 to 35 percent of individuals living with a same-sex partner in the U.S. experience some form of physical abuse in their lifetime. The proposal, if finalized, would devalue these experiences and compound the existing stigma already experienced by the LGBTQI+ community, which continues to be a significant barrier to life-saving HIV and hepatitis prevention and care. This is particularly true for transgender and other gender non-conforming individuals, who are disproportionally impacted both by gender-based violence and the HIV epidemic and who already avoid health care services due to fear of discrimination. Coupled with the recent federal regulation eliminating critical health care non-discrimination protections for LGBTQI+ individuals under Section 1557 of the Affordable Care act, these policies compound existing discrimination against LGBTQI+ individuals and undermine the Administration’s Ending the HIV Epidemic (EHE) Initiative.

Anti-immigrant rhetoric and policies such as this proposed rule threaten to exacerbate health disparities among undocumented persons, immigrant groups, and people of color. The proposed rule makes it virtually impossible for migrants of any type to defend their claim for asylum eligibility or effectively navigate the asylum application process, which furthers harmful misconceptions about the legitimacy of asylum claims. Anti-immigrant policy and rhetoric is a proven barrier to seeking health care, with documented negative impacts on mental health, healthcare utilization due to anticipated stigma related to HIV or legal status, and increased mortality. This proposal, along with the administration’s recent public charge rule, illegal attempts to end the Deferred Action for Childhood Arrivals (DACA) program, and attempts to bar undocumented immigrants from the 2020 census together pose a significant chilling effect on immigrant communities’ access to health care, including HIV and hepatitis prevention and care services.

The disproportionate impact of this policy on the most vulnerable communities is an affront to health equity and social justice, which are crucial to ending the intersecting HIV and hepatitis epidemics. NASTAD opposes any and all policies that jeopardize access to HIV and hepatitis services and set back the progress we have made towards reaching EHE initiative goals. Experience has proven the critical role health equity and social justice play in an effective public health response and we are committed to upholding those values in our work. NASTAD calls on DHS to withdraw this proposal in it’s entirety and to promote policies that further our country’s interest in protecting the public health and advancing access to health care for all individuals on equitable terms.