Will AIDS sink our refugee boat?

HEADLINES in the papers last week indicated that more doctors and dentists are transmitting the AIDS virus and that the federal Centers for Disease Control (CDC) is finally admitting it. Thus, we are finally poking holes in the conventional wisdom that AIDS is transmitted almost exclusively through sexual contact or the sharing of infected needles.

Yet CDC has begun laying the groundwork for changes in United States immigration law that will allow people who test positive for HIV, the AIDS virus, to enter the United States.


Last November, during a congressional overhaul of existing immigration policy, a key change was made that had the effect of turning the standing health regulations inside-out. Owing to a provision adopted in 1987, which labeled AIDS a "dangerous contagious disease," prospective immigrants and refugees who test positive for HIV have been excluded from entering the U.S.

Unfortunately, in directing the CDC to rewrite the regulations, Congress may have acted too swiftly, without fully thinking through the ramifications. I felt this was the case, which is why I voted against the immigration legislation last fall.


The CDC's justification for the proposed rule changes says that "allowing HIV-infected aliens into this country will not impose a significant additional risk of HIV infection to the U.S. population, where prevalence of HIV infection is already widespread." One can express serious doubts that throwing gasoline on a fire is the best method of extinguishing it. The only conclusion I can draw is that we are going to see an increase in the number of refugees entering the country with AIDS -- a prospect with numerous negative implications.

First, the pool of state money for AIDS-related programs -- already stretched to the breaking point -- will be subject to further competition from HIV-positive refugees. Second, the amount of federal money that is necessary to fund average health-care costs for the typical refugee might go through the ceiling. Since no additional funds are provided, the net result will be that the number of refugees allowed into the country would be scaled back.

Under current law, medical expenses for newly arrived refugees are covered by the federal government for the first year. These expenses average about $500 for each refugee, according to the Office of Refugee Resettlement, the bureau responsible for oversight within the Department of Health and Human Services. After this initial period, any additional financial burden shifts to the states, primarily through Medicaid.

In 1988, through its Medicaid program, Maryland spent over $2 million in inpatient care alone on individuals diagnosed with AIDS. This figure is by no means all-inclusive because inpatient care accounts for less than 25 percent of the total AIDS-related services.

When one takes into consideration future medical advances and treatments, the annual cost of treating a person with AIDS could average $80,000 by 1993. It is important to remember that this is an estimate, based entirely on average life expectancy rates. In many cases, the actual cost of treating an AIDS patient can approach or exceed $200,000.

Overall, the number of actual refugees coming into the U.S. can be expected to rise, particularly from Africa, where the level of AIDS has reached shocking proportions. In fact, the number of refugees coming from Africa will rise to 5,000 this year -- 3,000 more than were admitted into the United States in 1989. Unfortunately, 87 percent of the refugees that tested HIV-positive in 1989 were actually from Africa.

Last year, the United States spent over $600 billion on health care, but as we all know, there never seems to be enough to satisfy the requirements of the day. My concern is that we seem to be pushing a policy that only will exacerbate the problem, without improving the situation for those already stricken with AIDS. A policy that has the effect of shifting money from AIDS health-care programs to pay for an undetermined number of refugees with AIDS seems shortsighted.

Helen Delich Bentley represents Maryland's 2nd District in Congress.