Human trafficking or “modern day slavery” has been the subject of increasing media and public policy attention. This single case study is an illustration of the complex policy and practice issues involving immigration, human trafficking, and HIV/AIDS. HIV/AIDS and other infectious diseases create ethical, legal, and economic dilemmas for health care practitioners serving undocumented immigrants. This paper provides an overview of policies impacting immigrants with HIV/AIDS, the Trafficking Victims Protection Act (TVPA) of 2000, and potential “real life” implications of these policies. Suggestions for policy and practice that may provide both individual justice and protection of the larger society are offered. Health education, both domestic and on a global level, has potential to reduce the risks to both individuals and community public health.

Marisol is a beautiful young woman with large brown eyes and shiny black hair flowing past her waist. To most people, she is the picture of good health. Marisol and her young son, Sergio, are both infected with AIDS. Marisol became aware of her HIV+ status when Sergio was extremely ill at birth. When the baby was discovered to be HIV positive, Marisol was tested and found to have AIDS. Sergio was fortunate to have been born a United States citizen and is eligible for government benefits including health care, access to medications, and government disability checks. Marisol, an undocumented or illegal immigrant, is not so lucky.

Marisol was brought across the border by “Uncle Ned” who promised her a well-paid job at a California resort. Marisol believed she had an opportunity to escape the poverty and family violence in her home country. She had her first child at age 14 after being raped by a relative. That child, Serena, remains in her home country. Marisol had only planned to stay in the United States for a short time. Hopeful that she could save money from her resort job, Marisol believed she could return to her country and use her earnings for a new start. Instead of the promised job at a glamorous resort, Marisol found herself forced into prostitution with most of her earnings going to “Uncle Ned.” Her dreams of a “new start” have been shattered by finding herself a single mother with living with AIDS. After becoming aware that she and her son were infected with AIDS, Marisol felt little choice but to remain. “If you think it is bad having AIDS here, you should see what it is like in my country.”

When Marisol first came to the attention of health care workers, she was living in a small, neat apartment with her baby son. Every month, Marisol and Sergio traveled more than 100 miles for Sergio’s medical appointments, accompanied by “Uncle Ned.” There was no pediatrician treating children with AIDS closer to her home in a small, rural community. The trip was a challenge as Sergio was often ill. Marisol did not speak English and relied on “Uncle Ned” to provide information and translation services to medical providers who assumed he was her husband or boyfriend. Marisol received her own medical care and medications through a local clinic where she was not required to provide documentation of her immigration status. She worried that she would be deported or that she would become too ill to continue to care for her son. “Uncle Ned” warned her that she would be arrested and separated from Sergio if her immigration status was known.