Immigration policies such as increased raids by U.S. Immigration and Customs Enforcement are deterring Latinx gay, bisexual and transgender men from receiving preventive care or treatment for HIV.

“Here As I Am,” a new report from ViiV Healthcare and the Latino Commission on AIDS, found that a variety of factors contribute to the disproportionate impact that HIV has on Latinx queer and trans men. The report used a “Listening Initiative” in 11 cities across the U.S. and Puerto Rico, drawing on group discussions, interviews and storytelling with more than 760 Latinx queer and trans men living with or affected by HIV, as well as health care providers and advocates.

Many of the participants described “a heightened sense of fear” as a main outcome of anti-immigrant laws and sentiment, “causing men to delay or avoid health care.”

Immigrants faced racism long before President Trump took office, but the FBI found that anti-Latino or Hispanic hate crimes rose more than 21% in 2018. Many advocates attribute the rise at least in part to Trump’s rhetoric and immigration policies.

“In some places, people described the uptick in ICE raids in places that were previously considered safe — clinics, churches and study groups,” the report found. Several people also reported experiencing discrimination in healthcare settings due to their immigration status. Some said they also faced harassment and were yelled at or attacked for being Latinx.

The effects of anti-immigrant sentiment and laws, whether they pass or not, are widespread, the report found. “This extends beyond undocumented immigrants, as these sentiments and laws translate to prejudices and stigma based on skin color, look and accent and are experienced differently across the country.”

In addition to being targeted for their skin color or immigration status, Latinx queer and trans men can also face anti-LGBTQ violence or harassment, or discrimination if they’re living with HIV. These layers of marginalization all affect their health outcomes.

Guillermo Chacón, president of the Latino Commission on AIDS, said that Latinx LGBTQ+ communities face an overwhelming sense of insecurity now. They see images of people who look like them being detained in inhumane conditions at the southern U.S. border and news about people dying in detention centers. “That sense of not having an opportunity to see yourself and to shape your future is devastating — especially if you’re young and you belong to a sexual minority,” he says, which can have severe psychological impacts in addition to deterring people from seeking healthcare.

In 2018, 7,996 Hispanic/Latino gay and bisexual men were newly diagnosed with HIV, according to the Centers for Disease Control and Prevention. There’s an effective antiretroviral treatment for HIV, but it requires taking a medication daily.

Dr. Ben Young, the head global medical director at ViiV Healthcare, says that people living with or at risk of HIV already face a lot of barriers to receiving care: They have to get tested, see a provider, receive medication and then adhere to a strict schedule for taking it.

In addition to those hurdles, Latinx queer and trans men can face racism and language barriers. If, as a result, those living with HIV don’t receive treatment, it could have life-threatening consequences. Or, if they start and stop treatment, Young says it could lead to irreversible drug-resistant HIV that is more expensive and difficult to treat.

He said health care providers can do a better job of making the experience at clinics more welcoming and less stigmatizing. “We could do better, and better means, from the minute someone walks in the door, what is the environment?… Who’s working in the clinic, what language or languages do they speak? Is there the use of stigmatizing or even criminalizing language by personnel or the health provider themselves?” Young says. “All of these things can very much influence the experience and therefore the willingness of the person to continue through that doorstep, or leave and perhaps never coming back.”

Several of the report participants mentioned a specific law that kept them from seeking healthcare: the Trump administration’s public charge rule, which allows immigration officials to deny applications if they deem someone “more likely than not” to become a public charge by using public assistance programs.

Even before the rule took effect, “immigrant families began avoiding using services directly tied to health outcomes, especially nutritional services (SNAP), Medicaid and housing services, out of fear of being penalized or targeted,” the report found. “Because of uncertainty and the complexity of the rule, many people who will not be affected by the public charge rule (those who are already citizens or have their green card for instance) are altering their health-seeking behaviors.”

Some report participants also said they were afraid that “surveillance data” related to their HIV status could be used by ICE, which affected their willingness to access care. Medical providers are not required by law to ask about a patient’s immigration status or report it to authorities, according to the National Immigration Law Center. The Health Insurance Portability and Accountability Act (HIPAA) privacy rule “generally prohibits the use or disclosure of patient information without the patient’s consent, except when required by law,” the NILC writes. When information is requested for law enforcement purposes, providers are generally not required to share it.

Young says that health care providers have the medicine and the technology to successfully treat people with HIV, but language and policies is preventing a significant portion of people from accessing it. “The language that we use is impactful here.,” he says. “’Building the wall’ is not just political hyperbole, it’s a physical barrier, but it also has impacts in the clinic for people from Latin America.”

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