Marisol is probably one of hundreds of undocumented sex workers infected with AIDS. 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.

Immigration and HIV/AIDS
The United States is ambivalent about treatment of undocumented persons with HIV/AIDS. Public policies tend to be contradictory and are in a continuous state of change. In the current political climate of uncertainly for undocumented persons, fear of deportation and lack of access to health care may be increasing concerns.

Human groups in all societies have tended to maintain security and cultural identity through labeling other groups as different, deviant, or dangerous. Freud (as cited in Petkrova, 2006) was one of the first to recognize the human desire to categorize people into categories of “own” and “alien.” Persons perceived as “alien” or different from the dominant culture might encounter a range of public and reactions from sympathy to xenophobia. These range of emotions and attitudes are reflected in social policies and practices. The events of September 11, 2001 are believed to have escalated United States citizens’ fear and hostility towards “outsiders.”

Recent federal policy changes have impacted immigrants in the United States. These include the Personal Responsibility and Work Opportunity Act of 1996 and The Illegal Immigration Reform and Immigrant Responsibility Act of 1996 (Pendelton, 2004). In general, these policies have made access to legal immigration status and public benefits more challenging for undocumented immigrants. Immigration policies traditionally attempt to protect United States citizens by limiting or denying entrance to immigrants with potential health, dependency, or criminal risks. Immigrants with HIV/AIDS may encounter increased public and policy hostility, as fear of AIDS may contribute to additional discrimination. Immigration policies currently consider being HIV positive as grounds for inadmissibility to those attempting to enter the United States. Any non-citizen entering the United States is asked if “you have a communicable disease of public significance” (Gavagan & Brodyaga, 1998; Lambda Legal and Immigration Equality, 2005; Pendelton, 2004). Persons applying for permanent immigration must undergo health screening including an HIV test. HIV positive applicants will be denied unless granted an HIV waiver. In order to qualify for HIV waivers, applicants must show: (1) danger to public health is minimal; (2) possibility of the spread of infection is minimal; (3) no United States government agency will incur expense because of admission (Lambda Legal and Immigration Equality, 2005, p. 5).