By Lilo Blank
The current xenophobic, racist, and anti-immigrant climate in the United States and its detrimental impact on immigrant communities and their health cannot be ignored. This month, gunmen have executed a series of mass shootings, including one specifically in El Paso, Texas, in which the gunman killed 22 people. The FBI is currently investigating the shooting as a suspected hate crime against immigrants. Terroristic acts of violence such as this are enough to incite fear in anyone, but especially in Hispanic communities on the border, who are facing additional forms of structural violence.
“Stigma is fundamentally about alienation and exclusion,” said stigma expert Dr. Daniel Goldberg, Associate Professor at the University of Colorado Anschutz Medical Campus’s Center for Bioethics and Humanities, in a recent interview. “Even when you control for access, people who are stigmatized get sicker and die quicker. And of course, we are social creatures. If stigma exists persistently and longitudinally, the more likely you are to be socially isolated, and social isolation is one of the most powerful predictors of mortality.”
In the wake of a targeted mass shooting, one consequence of the volatile anti-immigration social climate may be self-protective isolation from care settings. Victims may avoid hospitals and primary care facilities for fear of an Immigration and Customs Enforcement (ICE) presence, who may enforce separation and removal processes. Indeed, many already are.
Of the four states that border Mexico, Arizona and Texas have implemented section 287(g) of the Immigration and Nationalities Act, which authorizes ICE to collaborate with state and local law enforcement agencies to enforce federal immigration law during daily activities. Dr. Scott Rhodes and his team at Wake Forest School of Medicine have studied the uptake and implementation of Section 287(g), and its impact on the health of immigrants. They report seeing a resurgence of anti-immigrant sentiment.
“287(g) was on the decline until about two and a half years ago when the new administration began to prioritize and promote its expansion. However, we know that 287(g) has a deleterious effect on the health of communities,” Rhodes said.
“This is a difficult period for immigrants in the U.S.,” agreed Jorge Alonzo, JD, a senior research associate on Dr. Rhodes’s Wake Forest School of Medicine team.
Even families with mixed statuses and naturalized citizenship face new obstacles, as policy allows for and expedites separation and removal of family and social networks. Valid U.S. passports have been reportedly confiscated and denied from Hispanic citizens at the border, effectively stagnating exit and re-entry of citizens into the country.
Immigrants with HIV are particularly vulnerable to being separated from their families, as a top Border Patrol Officer described HIV-positive status as being justifiable grounds for separation, since it is a communicable disease under the guidance Border Patrol follows. This policy contradicts scientific and public health literature and reveals an unethical practice. HIV is only transmittable through direct contact with HIV-positive fluids such as blood, semen, breast-milk, rectal, and vaginal fluids. If treatment is taken reliably, individuals who are HIV-positive can have such a low viral load that it is undetectable and non-transmissible. When asked the same question about the virulence of the flu, the officer stated that simply having the flu would not be grounds for separation even though, in contrast to HIV, the common flu is far more communicable via airborne and common contact, notably risky for children and the elderly – among the most vulnerable populations. HIV-positive exceptionalism is an example of how stigma affects vulnerable populations.
Dr. Goldberg uses Bruce Link and Jo Phelan’s stigma model to describe the top-down effects of stigma: “Many effects result from the consequences of stigma. Labeling human difference at the border, ascribing deviance on the basis of it, treating HIV-positive status as different; we are separating them as literally as it gets, and this leads to status loss and discrimination.”
Policy has the potential to act both as protective and instigative in separation and removal processes at the border. The incorporation of 287(g) and other state level statutes may create obstacles for local and municipal level governments to intervene on behalf of their undocumented constituents. Dr. Rhodes and his team are currently investigating the effects of such preemption state laws that prevent the adoption of welcoming and sanctuary municipal policies on immigrant health. Stigma and national rhetoric are impactful at all levels of society and hold health implications from the population level to the intrapersonal level.
Lilo Blank is the summer communications intern for the Temple University Center for Public Health Law Research. She is a student at the University of Rochester.