Canada: HIV Legal Network seeks to rejoin a constitutional challenge against immigration law

Returning to Federal Court in constitutional challenge of Canada’s “Excessive Demand” Regime 

On September 18, 2025, at 9:30 a.m., the Federal Court will hear the HIV Legal Network’s motion to rejoin a constitutional challenge to Canada’s “excessive demand” regime in immigration law. This hearing is a critical moment in the fight to ensure that Canada’s immigration laws respect the Charter and protect the rights of people living with HIV.

This case arises from Immigration, Refugees and Citizenship Canada’s decision to deny a work permit to an applicant based on his HIV status, citing s. 38(1)(c) of the Immigration and Refugee Protection Act. This provision bars entry or stay in Canada for people whose health needs are expected to create an “excessive demand” on public healthcare services.

The HIV Legal Network has fought against this discriminatory regime since its introduction in 2001, highlighting how it stigmatizes people living with HIV and excludes them from equal access to immigration pathways. At this hearing, the Legal Network – supported by Downtown Legal Services – will argue that it should be granted public interest standing because of its deep expertise, long record of advocacy, and unique ability to bring forward the voices and evidence of people most affected by this law.

Details

  • Hearing: September 18, 2025, 9:30 a.m. (Federal Court)
  • Case #: IMM-12720-23
  • Observation: Members of the public and media can register to observe virtually via the Federal Court website (https://www.fct-cf.ca/en/court-files-and-decisions/hearing-lists). We recommend registering at least 24 hours prior to the hearing to ensure you receive a link.

Related documents:

Motion Record of the HIV Legal Network

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Memorandum of Fact and Law of the HIV Legal Network

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Affidavit of Sandra Ka Hon Chu (On behalf of the HIV Legal Network)

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Affidavit of Anonymized Applicant

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Applicant’s Memorandum of Argument

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Lithuania: Migrants influence the dynamics of HIV infection

HIV in Lithuania: migrants from Ukraine and Eastern Europe are changing the epidemiological picture.

More than a third of new HIV cases in Lithuania are from foreigners. Most of them are from Ukraine and other countries of Eastern Europe. These statistics reflect not only the migration processes caused by war and economic difficulties, but also indicate the continuing problem of the spread of HIV in the region, which Europe considered almost under control.

According to the National Center for Public Health of Lithuania, the country has seen an increase in the incidence of HIV since 2022. In the center, he is associated with the influx of infected foreign citizens.

Statistics for 2024 indicate that almost 90% of infected foreigners came to Lithuania from Eastern Europe – Ukraine, Belarus, Azerbaijan, Georgia and Moldova.

Angela Moiseenko, head of the Chernihiv branch of the charitable organization “All-Ukrainian Network of People Living with HIV/AIDS”, told LRT.lt about how the situation with HIV is developing, and how the system of detection and treatment of infection works in the conditions of military conflict.

“Ukraine occupies one of the leading places in the spread of HIV in Eastern Europe. More only in Russia and Kazakhstan,” she says.

Nevertheless, in recent years, systematic work has been built in Ukraine to combat the epidemic, especially in terms of identifying new cases. “Over the past 10 years, a lot of attention has been paid to this topic in Ukraine. We are actively engaged in HIV detection, because what we see is only the tip of the iceberg. The more tests are carried out, the better we know the real situation,” Moiseenko explains.

The system covers both state institutions and initiatives supported by international partners. The country has the Global Fund to Fight AIDS, Tuberculosis and Malaria, which funds large-scale HIV testing and prevention programs. Too, both state and public organizations participate in this process.

“We actively use rapid tests that allow us to determine the presence or absence of antibodies within 20-30 minutes. Our organization has been working in the field of overcoming HIV infection for 20 years, and we are also actively engaged in identifying, referring for treatment and accompanying people,” the expert says.

The health care system in Ukraine is built on a three-level model: primary care – family doctors, secondary – polyclinics and hospitals, as well as tertiary – specialized institutions. At the second level, there is a network of “trust offices” that provide HIV treatment services.

“There are such offices in almost all second-level hospitals. Funding goes through the National Health Service of Ukraine, which pays for medical services under the so-called packages. For example, an HIV test is included in 11 medical care packages at once,” Moiseenko explains.

Nevertheless, the proportion of foreigners among new cases is gradually decreasing:

  • in 2022 they were 47%;
  • in 2023 – 37%;
  • in 2024 – 34%;

For comparison, the EU average is about 50%.

In 2024, among registered foreign citizens with HIV, 86.8% came from Eastern European countries – Ukraine, Belarus, Azerbaijan, Georgia and Moldova. This trend has been maintained since 2022.

More than 80% of these patients receive antiretroviral therapy, which indicates an understanding of the importance of treatment and prevention.

Of the 68 foreign citizens identified with HIV in 2024, 59% are men and 41% are women. The main ways of infection:

  • 46% – heterosexual contacts;
  • 22% – homosexual contacts;
  • 4% – injecting drugs;
  • 31% – unknown ways;
  • 3% – perinatal (from mother at birth).

The age of 37% of infected foreigners is from 40 to 49 years old, and 24% are from 30 to 39.

Recommendations for HIV testing, approved by the order of the Minister of Health of Lithuania. They provide in which cases – in certain epidemiological or clinical conditions – it is recommended to conduct HIV testing. The doctor, having received information from the patient and evaluated it, should offer to conduct testing.

[Update] Türkiye: Syrian refugee regains temporary protection after HIV-related revocation

Having spent sixt months in removal centers last year, Aabo was subjected to harassment because of his sexual orientation and HIV status, and denied access to medication for extended periods.

A Syrian refugee whose temporary protection status was revoked following an HIV diagnosis has regained his legal status in Turkey.

Ahmad Aabo, 29, who has lived in Turkey for nearly 13 years, received a temporary identification document yesterday. The document restores his access to public healthcare services until he is issued a printed identity card, expected on Sep 30.

Aabo’s temporary protection status was previously removed on the grounds that he was “carrying a contagious disease,” after he was diagnosed with HIV. The decision cut him off from life-saving retroviral medication and free healthcare services.

Aabo was held in administrative detention for about six months last year in repatriation centers in İstanbul and Adana. He said he was kept in isolation, subjected to verbal harassment because of his sexual orientation and HIV status, and denied access to medication for extended periods.

Although released in Oct 2024, his temporary protection status was not reinstated, preventing him from continuing treatment.

Amnesty International campaign

Amnesty International had launched an urgent action campaign urging Turkish authorities to restore Aabo’s temporary protection.

A petition submitted to the Presidency of Migration Management read, “Although the restriction code and related deportation order were lifted, temporary protection status has not been reinstated. As a result, Aabo cannot access treatment vital for his health. Authorities must urgently reinstate his status and ensure access to free medical care.”

A lawsuit challenging the refusal to reinstate Aabo’s temporary protection remains ongoing before the İstanbul 1st Administrative Court.

Foreigners deemed to pose a threat to public health and safety due to contagious diseases may be issued a G-78 restriction code, which bans their entry into Turkey indefinitely. (EMK/VK)

South Africa: Calls grow for reform on migrant healthcare access after healthcare blockades

SA mulls law review on migrant healthcare

Non-South Africans are not entitled to the full package of comprehensive healthcare provided to this country’s citizens, the chairperson of Parliament’s Health Portfolio Committee has said, calling for urgent legislative reform to address the mounting disruptions by Operation Dudula activists.

Dr Sibongiseni Dhlomo’s remarks come in the wake of Health Minister Aaron Motsoaledi’s warning to the vigilantes that legislation governing access to public health services will not be changed under pressure.

SowetanLIVE reports that Dhlomo was addressing committee members last Thursday after videos on social media showed Operation Dudula thugs preventing foreigners from entering clinics and some hospitals.

He added that foreign nationals are entitled only to emergency medical services – and, he remarked, government was considering certain legislation in this regard.

“Our Constitution… talks about South Africa belonging to all who live in it. That part is important and ought to be respected. But the conclusion from the National Health Insurancepublic hearings was that the country should provide emergency services to all – which means foreign nationals as well – so that is binding in terms of UN rules. But comprehensive healthcare is for South Africans,” he said.

However, he said, while migrants are not entitled to the full range of health services, Operation Dudula’s approach of stopping people from entering hospitals and clinics was not the right way to deal with the issue, and a “streamlined approach” was needed.

He said the Health Department has been “engaging the organisation and other stakeholders”, and that discussions had extended to Home Affairs, with proposals to review and possibly repeal sections of key legislation such as the South African Citizenship Act, the Refugees Act, the Identification Act and the Immigration Act.

“Some of these Acts are wide and encompassing. Maybe they should have limitations. It’s not possible for us to have unlimited resources to deal with what is there,” he said.

Govern access

The portfolio committee was seeking “a more coherent legal framework to govern access … by the undocumented patients”, he added, citing vague definitions and overlapping provisions in existing legislation as contributing to administrative confusion and public frustration.

He also noted that many South Africans themselves remain undocumented, complicating efforts to distinguish between citizens and foreign nationals, reports BusinessLIVE.

According to estimates cited by the Department of Home Affairs, around 6m South Africans still lack formal identity documentation. Dhlomo also warned that any policy response must avoid penalising citizens who fall outside the formal registry.

“Minister Motsoaledi has taken the leadership of Dudula through the various policies and pieces of legislation that govern and regulate the provision of healthcare … which are beyond our control. As a department, we have to comply,” said Health Department spokesperson Foster Mohale.

Campaign percolated for months

The vigiantes have disrupted access to migrants seeking healthcare to at least 53 clinics in KwaZulu-Natal, Limpopo, Mpumalanga, Gauteng and the Eastern Cape, and with no clear interventions in place, vulnerable groups are left scrambling for life-saving healthcare.

While the targeted disruptions by these groups are not new and have been a longstanding concern for many human rights organisations, reports of the latest campaign began surfacing as early as June this year, reports Daily Maverick.

Médecins Sans Frontières (MSF) regional advocacy co-ordinator Clair Waterhouse said her organisation had tracked 15 clinics where Dudula members had been permanently stationed.

Contrary to claims that the disruptions target only illegal foreigners, the consequences are broader. People with valid work permits, permanent residence and even South African citizens have been refused care.

“Our observation shows very strongly that for migrants, it doesn’t matter if they are documented or not. We’ve seen people with South African IDs, valid visas, even passports, being told their documents are ‘not good enough’ and ordered to leave. South Africans who forget their IDs at home are also barred. We’ve even seen children and pregnant women denied care,” said Waterhouse.

Alarming cases

MSF teams on field assessments had witnessed alarming cases. In Johannesburg, a six-month-old baby with a severe respiratory infection was turned away. In other facilities, pregnant women were denied access to antenatal care.

One of the most disturbing trends MSF documented was collusion by health staff with the anti-migrant groups.

“At two clinics, the work of these groups was actively facilitated by either clinic security or staff themselves. We’ve even heard reports of nurses saying they are grateful, because it means fewer patients. In some cases, Dudula members told us they ‘check in’ with staff every morning as if they were part of the clinic’s routine,” she said.

Daily Maverick has extensively reported on the impact of these disruptions, from mothers unable to seek post-natal care, migrant parents being unable to access life-saving healthcare for their children, and injured people without documentation being turned away from clinics by Operation Dudula members.

Lack of urgency from State

Despite repeated appeals from MSF and the Treatment Action Campaign (TAC), the Department of Health has yet to issue a robust response. MSF’s Waterhouse confirmed that organisation had written to national and provincial authorities, sharing detailed concerns and even cases of collusion, but received no reply.

“We don’t believe this is being treated with the urgency it deserves,” she said. “What little has come out has not been sufficient. Seven weeks of significant blockages at health facilities is not acceptable.”

Daily Maverick asked the Department of Health for clarity on protocols to halt the disruptions, but no response had been received by the time of publication.

The TAC believes the silence reflects a deeper governance failure.

“The existence of legislation that guarantees healthcare to all means nothing if it is not enforced. We see police standing by without intervening. We see facility managers turning a blind eye. In practice, this amounts to condoning the violations,” TAC Gauteng provincial chairperson Monwabisi Mbasa said.

In the absence of decisive government action, civil society has moved to fill the gap. The TAC, long known for its grassroots fight for access to HIV and TB treatment, is now redirecting much of its energy to assist those excluded from healthcare by the Dudula disruptions.

“In just three weeks, we’ve helped more than 28 people access medication, and the number keeps growing daily. Recently, we received a list of 200 patients who had been completely turned away. They all needed urgent support to get treatment or medication, and without intervention, their lives would have been at serious risk,” Mbasa said.

The TAC operates through a network of local branches and volunteers. When a patient is denied care, the organisation steps in to connect them with comrades closer to alternative facilities, ensuring they can safely access treatment.

“We don’t want to tamper with the health system’s data, so we link patients directly to nearby facilities,” Mbasa said. “That way, treatment continues, and their medical information remains recorded in the system.”

Pregnant women denied access to viral load testing have faced the terrifying possibility of passing HIV on to their unborn children.

No law enforcement

Meanwhile, National Police Commissioner General Fannie Masemola has said that although Operation Dudula and March and March’s actions are unlawful, there is no specialised police unit dedicated to reining in their behaviour – or their restriction on undocumented foreigners accessing healthcare services, reports The Star.

Masemola told a media briefing in Pretoria that the Public Order Policing (POP) will intervene only if public disturbances occur, marking the first time he has publicly addressed the issue.

He said the job of a POP units was to deal with crowd management and public gatherings, major events and protests – although police, including some POP officers, have been deployed to some affected clinics to restore order.

“These POP units cannot wait at a clinic just in case something happens – they have a lot of other work to do,” he said.

South Africa: MSF warns of widespread denial of healthcare to foreign nationals in South Africa

Ongoing xenophobic action puts at risk the lives of several non-South African patients.

Doctors Without Borders (MSF) is deeply concerned by the persistent and systematic physical blocking of non-South Africans from accessing healthcare, including pregnant women, people living with HIV, chronic patients and children – particularly in Gauteng and KwaZulu-Natal. 

We call for immediate action by the National Department of Health (NDoH) and relevant Provincial Departments of Health to guarantee the right of access to healthcare for all, as enshrined in the country’s Constitution and the National Health Act.

For several weeks now, anti-migrant groups, have camped outside dozens of clinics and hospitals in Gauteng, preventing non-South Africans from entering public health facilities to seek medical care, irrespective of their legal documentation status.

We also call for the appropriate health departments to work with communities to address the state of healthcare facilities and to find lasting solutions to these challenges, instead of apportioning blame on non-South Africans.

MSF launched an assessment to understand the severity of these blockages and the needs of those impacted, following reports of denial of access to care at locations across South Africa. The team visited 15 hospitals and clinics in Gauteng, where they consistently witnessed patients being turned away from more than half of these healthcare facilities by groups of between 2 and 10 people, wearing civilian clothing.

The groups are either stationed at the gate or inside facilities and are demanding identification from every person who tries to enter, turning away those they deem non-South African. From MSF’s assessment, the issue is more widespread at primary healthcare clinics (PHCs) than hospitals.

“The results of our assessment are highly distressing and unacceptable. Our team even witnessed two clinics where security staff and healthcare workers worked in collusion with these anti-migrant groups. We urge the Department of Health to immediately address healthcare facilities who are enabling or encouraging any kind of denial of healthcare,” says Claire Waterhouse, MSF Southern Africa’s Director of Operational Support Unit.

The MSF team also visited and called nearly 50 patients who indicated that they were denied access to healthcare in 24 healthcare facilities in and around Johannesburg, Durban and Tshwane. The patients, consisting primarily of late-term pregnant women and people with diabetes, hypertension and HIV, have expressed fear, panic and confusion.  Most informed us that they already struggle financially and are unable to buy medication or afford private medical care.

Some patients told MSF staff that they tried to retrieve their medical files from the clinics to enable them to seek medical care elsewhere without success, leaving them unsure of next steps. Others have no prescriptions to use to refill their medication, so they are unable to buy the medication they need from pharmacies.

Due to these blockages, many pregnant women with high-risk conditions including those with hypertension, diabetes and HIV, have remained unmonitored and untreated. Many HIV patients have gone for over two weeks without their medication, while others were left with just a few days’ supply at the time MSF staff spoke to them. Defaulting HIV treatment can have serious complications for people, as well as add to the burden on the health system by becoming sicker and requiring more intensive treatment.

“It is critical that both the National Department of Health and Provincial Departments address this problem with urgency. Clinics must be made safe for all who need them through proactive measures, including safe, effective and timely police protection where needed. We also call for the appropriate health departments to work with communities to address the state of healthcare facilities and to find lasting solutions to these challenges instead of apportioning blame on non-South Africans,” adds Waterhouse.

MSF urges the National Department of Health to immediately and unequivocally reaffirm the right of all who live in South Africa to access basic healthcare, without discrimination, and to conduct health education in communities to ensure that non-South Africans feel safe to return to facilities and that South Africans understand why this is non-negotiable.

*Thando, a 33-year-old woman, was turned away on the 14th of July from a queue inside a hospital in Gauteng Province by an anti-migrant group for being undocumented. She is a 16-week high-risk pregnant patient who is also hypertensive.

“I already knew of the situation at the hospital when I went because another girl had already told me that foreigners were being turned away. But I still decided to try. So, I got to the hospital early in the morning at 07:00. There were about 7 to 8 people in the queue already”.

She says a gentleman randomly appeared holding a South African Identity card.

“He waved it, walking around and showing us. He said that if any of us didn’t have something like what he was holding, or if a passport didn’t have a permit, we should start getting out. The nurses were there, and they started laughing, supporting him. They said we don’t pay tax, and they are tired of us. They said we can go; it will be less work for them. Only four people were left inside when the rest of us had to leave,” adds Thando.  

*Tecla, a 44-year-old domestic worker who is living with HIV and taking ARVs, along with other chronic medication, has been in South Africa since 2008. She has not been blocked yet, but her landlord has been turned away, and she sees people being chased away daily as she lives across one of the clinics.

“I have medication that lasts me until 15th of August, but I am afraid to go to the clinic for my next refill, so I have tried to check if I can get medication from a pharmacy. I cannot afford [it] as the doctor wanted R500 consultation fee, additional fees for tests to determine my CD4 count and initiate me on treatment. I have considered going back home, but I have no money,” Tecla told MSF staff.

Rose, Tecla and Thando are not alone. Thousands of non-South Africans, many of whom are extremely vulnerable, are struggling to access urgently needed and basic healthcare. South Africans who have lost or forgotten their ID documents, or those they assumed ‘did not look or sound South African’ enough, are also losing access. This is not the first time anti-migrant groups have blocked non-South Africans from accessing healthcare services.

In 2022, Operation Dudula supporters protested outside Kalafong Provincial Tertiary Hospital in Tshwane, threatening and blocking access until the government publicly condemned the xenophobic protests, emphasising that the right to access basic health services was a basic human right enshrined in the South African Constitution, regardless of nationality or documentation status.

MSF has provided free medical care to vulnerable populations such as migrants, asylum seekers and refugees in South Africa since 2007 and has continuously responded to sporadic impacts of xenophobic violence on healthcare access for vulnerable people over the years. Recently, MSF supported displaced migrants with food and non-food items such as water containers, blankets, aqua tabs, baby diapers, baby formula, porridge, sanitary towels, and other hygiene essentials following violence primarily targeting of non-South Africans in Addo, Eastern Cape.

 

US: Department of Health and Human Services bans undocumented immigrants from taxpayer-funded health services

Three years before the first federally funded community health centers in the US opened their doors to patients of all backgrounds, a 1962 law authorized the creation of new clinics to treat domestic migrant and seasonal agriculture workers.

The Migrant Health Act reflected a recognition that a community’s health depends on all who are a part of it, said historian Beatrix Hoffman, PhD, who studies immigration and health policy at Northern Illinois University. “The more people who have access to care, the better,” she added.

Migrant health centers served as a precursor to community health centers, which treat patients no matter their ability to pay. Today, community health centers across the nation are a major source of primary care for another migrant population: undocumented immigrants. But this could change with new restrictions from the US Department of Health and Human Services (HHS).

On July 10, HHS announced that undocumented migrants will no longer have access to any of the department’s taxpayer-funded services classified as federal public benefits. In addition to community clinics supported by the Health Center Program, this action affects services such as Head Start, certain substance use and behavioral health programs, and the Projects for Assistance in Transition from Homelessness grant program.

The new guidelines were enacted to “strengthen the integrity and consistency of benefit eligibility,” an HHS spokesperson said in a statement to JAMA Medical News. Public health experts, however, warn the change could undermine care through these programs for all patients.

The Rationale

The new policy reverses a prior interpretation of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA), which allowed undocumented immigrants to access certain federal programs.

The change reflects the “taxpayer friendly” posture of President Donald Trump’s administration, said Ge Bai, PhD, CPA, an accounting professor at Johns Hopkins University and unpaid advisor to the Paragon Health Institute, a think tank founded by former Trump health care advisor Brian Blase. “The administration is facing the increasing deficit and worsening national debt, so they have to find all the ways they can to reduce government spending,” she said.

Undocumented immigrants pay sales tax on their purchases, and many pay income and property tax. Bai noted that these contributions do not make up a significant portion of the tax base. However, federal tax payments from undocumented immigrants totaled $59 billion in 2022, according to a report from the Institute on Taxation and Economic Policy.

The HHS has also stated that these services incentivize illegal immigration. Bai said that would-be migrants consider social programs when debating the risks and benefits of entering the country without authorization. She cited the influx of undocumented immigrants in 2021 through 2023, noting the expansion of the social safety net in response to the COVID-19 pandemic helped spark the migration surge.

Not everyone agrees. Although Hoffman allows that some undocumented immigrants may enter the country seeking specialized treatment, she countered that these cases are extremely rare. “Historically, undocumented people are afraid to access health care because they don’t want to be detected,” she said.

“People don’t migrate to the US to use health services or any other type of public benefit,” said Arturo Vargas Bustamante, PhD, MPP, a public health professor at the University of California, Los Angeles. “People migrate to the US because they have the economic incentive to get jobs.”

As undocumented immigrants tend to use fewer health services than US-born citizens and are ineligible for many federal programs including Medicare, Bustamante argued that their tax contributions subsidize health services for US citizens. A 2022 analysis in JAMA Network Openconcluded that tax contributions and premiums from undocumented immigrants exceeded expenditures by more than $4000 per person.

Bustamante said the benefits of offering services such as vaccinations and prenatal consultations to undocumented immigrants outweigh costs to taxpayers. He doubts the new guidelines will curb health care spending, in part because it could increase reliance on emergency care. Emergency departments remain open to undocumented immigrants because of the Emergency Medical Treatment and Labor Act, which prevents hospitals that receive Medicare dollars, as the overwhelming majority do, from refusing to treat patients in emergency conditions. There, care may be covered by emergency Medicaid that is available regardless of immigration status with qualified expenses varying by state.

An Ounce of Prevention?

Without primary care services through community health centers, Bustamante and others predict that undocumented immigrants will forgo treatment for as long as possible until they require emergency care.

“They won’t go to get medication. They won’t go to get regular checkups. They won’t go to get preventive care,” said Annie Ro, PhD, associate professor at the University of California Irvine Joe C. Wen School of Population and Public Health.

Losing access to primary care leaves people with fewer options to manage chronic conditions, which can lead to new health problems like infectious disease, said Nicole Swartwood, MSPH, who studies public health at Harvard University.

For example, unmanaged diabetes might increase the odds that a latent tuberculosis infection will become active and contagious—and individuals born in many countries outside the US are already at greater risk of tuberculosis.

Homelessness and intravenous drug use are also linked to tuberculosis, Swartwood added. The new restrictions would block undocumented immigrants from HHS services related to those concerns as well.

Meanwhile, community health centers play a role in infectious disease surveillance, including screening for asymptomatic latent tuberculosis. If undocumented patients are barred from these clinics, their condition may not be identified and they may transmit tuberculosis to others. “Nondocumented migrants are not living in isolation,” said Swartwood, adding that they are part of their communities and interact with others.

The Broader Implications

Impaired infectious disease monitoring is just one way the HHS policy may affect more than just undocumented immigrants. Multiple experts said they worry the new rules will sow fear that deters migrants from accessing care even when they qualify for it.

Ro pointed out that many undocumented immigrants have children who are US citizens by birth. “These kids are not targeted by these restrictions, but because their parents are concerned, we’ll probably see a chilling effect within families,” she said.

Determining eligibility could itself pose a challenge for clinics. “Providers are legally bound to provide care when it’s needed, but they’re put in this position where they have to verify somebody’s immigration status,” Ro continued. “That’s not really their job.”

HHS has not yet released program-specific guidance, but Ro fears that calling on understaffed clinics to enforce these restrictions will divert time and resources away from patient care.

“Everyone is going to be affected, not only immigrants themselves, but also migrant families, mixed-status families, and US-born citizens who are going to encounter more expensive health services, longer waitlists, and less provider availability,” Bustamante said.

A Policy Pattern

The HHS rules are not the only rollback of services for undocumented immigrants this year. California, Illinois, and Minnesota have each scaled down or cut eligibility for state Medicaid coverage previously offered to immigrants of any status.

In April, the Idaho state legislature passed HB 135, which excluded undocumented immigrants from services such as food pantries and prenatal care. Controversially, the bill originally required proof of legal status from patients receiving medication at programs funded through Part B of the federal Ryan White HIV/AIDS Program.

“HIV is very treatable, and we have great medications for it,” said Abby Davids, MD, MPH, who treats patients with HIV at a federally qualified community health center in Boise. “But if you lose access to your antiretrovirals, then HIV is universally fatal.”

Davids added that without medication, people living with HIV could transmit the virus to others: “From an individual patient standpoint and from a community standpoint, it’s a really horrific situation.”

The portion of HB 135 restricting HIV treatment was blocked by a federal judge in late June following a lawsuit by the American Civil Liberties Union on behalf of Davids and 5 unnamed patients. The next month, a federal judge granted a preliminary injunction preventing immigration status–based restriction to Ryan White Part B programs until all litigation is settled.

HHS has not responded to requests from JAMA Medical News for comment about how eligibility for Ryan White–funded programs may change because of the new federal guidelines.

Undocumented immigrants can still receive emergency Medicaid in all 50 states, although the Centers for Medicare & Medicaid Services has agreed to share information about Medicaid enrollment with Immigrations and Customs Enforcement, the Associated Press reported in July.

“This administration has been so aggressive in targeting any kind of benefit that would remotely touch the undocumented immigrant population,” Ro said.

Published Online: August 8, 2025. doi:10.1001/jama.2025.12999

Conflict of Interest Disclosures: None reported.

Turkey: Refugee’s legal protection revoked after HIV diagnosis in breach of Turkish regulations

Amnesty urges Turkey to reinstate legal status of Syrian asylum seeker diagnosed with HIV.

Amnesty International has called on Turkish authorities to immediately restore the temporary protection status of Syrian asylum seeker Ahmad Aabo, who remains without access to essential medical care despite a court decision lifting his deportation order and related security restrictions.

Aabo, 29, has lived in Turkey since 2012, when he arrived as an unaccompanied minor fleeing persecution based on his perceived sexual orientation. He was granted temporary protection in 2017. However, in 2023, shortly after being diagnosed with HIV, Aabo’s legal status was revoked following the assignment of a G-78 security code on the grounds that he carried a “communicable disease.”

Since 2014 Syrians seeking protection in Turkey are registered as asylum seekers under temporary protection, a status that gives them access to services including health, education and social services and have the right to work under the Temporary Protection Regulations.

Article 12 of the Temporary Protection Regulations outlines the circumstances in which temporary protection may be removed, none of which includes the presence of a communicable disease.

In 2024 Aabo was detained for six months in İstanbul and Adana removal centers. He has reported being held in isolation and subjected to inhumane and degrading treatment, including verbal abuse and having food thrown at him through his cell door, mistreatment he believes was motivated by discrimination related to his HIV status and sexual orientation.

Although Turkish authorities lifted the G-78 security code and rescinded the deportation order in October 2024, Aabo’s temporary protection has not been reinstated. His most recent application was rejected in December 2024 on the grounds of posing a “threat to public order and security.” Appeals to suspend the decision were dismissed in January and June, and his substantive appeal remains pending before an İstanbul administrative court.

Without legal status, Aabo has been unable to access free antiretroviral medication or medical monitoring, placing his health at serious risk, Amnesty said. He was denied treatment for over three months while in detention but eventually managed to receive medication in July 2024 that brought his viral load under control.

Call to action

Amnesty International said Turkish law does not allow for the withdrawal of temporary protection based on communicable disease. Furthermore, as a signatory to the International Covenant on Economic, Social and Cultural Rights, Turkey is obligated to ensure non-discriminatory access to healthcare.

In a letter to Hüseyin Kök, the head of Turkey’s Presidency of Migration Management, Amnesty urged the immediate restoration of Aabo’s legal status and access to healthcare.

“Ahmad Aabo’s health and wellbeing remain at serious risk. Turkish authorities must act now to ensure his rights are protected,” the organization said.

A report by Syrians for Truth & Justice (STJ) in April, based on firsthand testimony from 19 former detainees held in centers across Turkey in 2024, documented widespread violence, including beatings and deprivation of basic necessities. The report revealed that Syrian refugees in Turkish detention centers faced physical abuse and were allegedly coerced into signing “voluntary” return documents.

Turkey has granted legal status to approximately 3.5 million Syrian nationals who fled the civil war in Syria that began in 2011. Initially welcomed under a temporary protection policy, many Syrians settled in Turkish cities, sparking debates about integration, economic strain and cultural differences.

At the end of 2024, Turkey hosted nearly 2.9 million registered Syrian refugees and asylum seekers. Although returns had remained low for years, 2025 brought a sharp reversal with the ouster of Syrian president Bashar al-Assad in December 2024.

More than 200,000 Syrians have returned to their homeland from Turkey since the fall of the Assad regime, according to Turkish authorities.

Uzbekistan adopts law denying work permits to foreigners diagnosed with HIV or TB

Translated with Google translate. For original article in Uzbek, please scroll down.

Foreigners with HIV and tuberculosis will be banned from working in Uzbekistan

The Senate of Uzbekistan has approved a law according to which foreign citizens diagnosed with HIV/AIDS or tuberculosis will not be able to obtain a work permit in the country.

The explanatory note to the law notes that the number of citizens returning from abroad has increased. In 2024, out of 1.7 million who returned, only 25% underwent voluntary testing for HIV – the infection was detected in 1,512 people, writes Fergana.

Since the statistics only cover those who were voluntarily tested, it remains unclear how widespread infectious diseases are among those who did not take tests.

In this regard, mandatory medical examination for HIV is being introduced for citizens of Uzbekistan aged 18 to 60 years who have been abroad for more than 90 days, as well as for foreigners and stateless persons permanently residing or coming to the country for the purpose of employment.

For citizens of Uzbekistan and stateless persons permanently residing in the republic, the examination will be free of charge — at the expense of the state budget. But labor migrants and foreigners will have to pay for it themselves or at the expense of the employer.

In case of detection of HIV/AIDS or tuberculosis, foreign citizens will be officially denied the right to employment.

The law also stipulates that private employment agencies must train citizens traveling abroad in the rules of stay in the countries of employment.

The document will come into force after it is signed by the President of Uzbekistan.

Иностранцам с ВИЧ и туберкулёзом запретят работать в Узбекистане

Сенат Узбекистана одобрил закон, согласно которому иностранные граждане, у которых выявлены ВИЧ/СПИД или туберкулез, не смогут получить разрешение на трудовую деятельность в республике.

В пояснении к закону отмечается, что число граждан, возвращающихся из-за рубежа, увеличилось. В 2024 году из 1,7 млн вернувшихся лишь 25% прошли добровольное тестирование на ВИЧ — инфекция была выявлена у 1512 человек, пишет Фергана.

Так как статистика охватывает только добровольно обследованных, остается неясным, насколько широко распространены инфекционные заболевания среди тех, кто не сдавал анализы.

В связи с этим вводится обязательное медицинское обследование на ВИЧ для граждан Узбекистана в возрасте от 18 до 60 лет, которые находились за границей более 90 дней, а также для иностранцев и лиц без гражданства, постоянно проживающих или приезжающих в страну с целью трудоустройства.

Для граждан Узбекистана и лиц без гражданства, постоянно проживающих в республике, обследование будет бесплатным — за счет госбюджета. А вот трудовым мигрантам и иностранцам придется оплачивать его самостоятельно, либо за счет работодателя.

В случае выявления ВИЧ/СПИДа или туберкулеза, иностранным гражданам будет официально отказано в праве на трудоустройство.

Также законом предусмотрено, что частные агентства занятости должны обучать выезжающих за границу граждан правилам пребывания в странах трудоустройства.

Документ вступит в силу после его подписания президентом Узбекистана.

 

HIV positive Turkmen man fears persecution and death if deported

An HIV-positive gay man who fled Turkmenistan, one of the most repressive countries in the world, risks being deported, imprisoned and tortured, he and several non-governmental groups told AFP.

Emir — whose name has been changed for safety reasons — fled the ex-Soviet Central Asian country in 2018 for fear of being persecuted for his homosexuality.

He then found a job in a territory in Europe that is not internationally recognised.

To avoid compromising his safety and that of his relatives back home, AFP has chosen to keep his exact location secret, but was able to interview him in person in July.

The 30-year-old said he tested positive for HIV in 2024.

He showed the results of medical lab tests, which AFP was able to authenticate, and said he had no access to antiviral treatment.

“My condition is getting worse. My body and stomach are hurting, I have pain under my ribs,” he said.

“I can’t sleep anymore, I sleep four or five hours, thinking about my health every day. I don’t want to get AIDS,” he added in a faint voice.

Mortal threat

Because of his HIV-positive status, Emir said he had been fired from his job in his current place of residence, lost his income, and now faces deportation to his home country.

In Turkmenistan, he said, he would be arrested: “Because of my illness, they will torture me, abuse me, and kill me.”

Emir is unable to leave the place where he is now because he would have to first return to Turkmenistan to renew his passport, a photograph of which he provided to AFP.

Swiss nonprofit Life4me+ sent him six months of antiviral treatment before stopping it due to the exhaustion of their “remaining medication stocks,” the organisation’s president, Alex Schneider said.

Emir then received a few irregular shipments of medication, but for almost four months now he has been without medication.

On three occasions, the health authorities in the territory where he is based have refused to provide him with treatment.

A local LGBTQ rights group said it was currently unable to provide Emir with the necessary medication for financial and legal reasons.

In an email to AFP, it said it had helped find Emir a psychologist who diagnosed him with “severe anxiety and depression symptoms with thoughts of suicide”.

‘Place forgotten by God’

In Turkmenistan, homosexuality is punishable by jail under the criminal code provision prohibiting “sodomy”.

HIV-positive people, instead of receiving treatment, regularly find themselves imprisoned and tortured, according to several human rights groups.

The nonprofits and exiled independent media reported waves of arrests targeting LGBTQ people several times in recent years.

People detained as part of the repressions have been reported to disappear into the prison system and held incommunicado.

Turkmenistan — a gas-rich desert country rich officially home to seven million people — is considered one of the most reclusive in the world.

Internet access is severely limited, and no independent nonprofits are allowed to operate there.

“It’s a place forgotten by God where people suffer terrible things,” said Evi Chayka, founder of EQUAL PostOst, a rights group helping LGBTQ people who are victims of repression in the former communist bloc.

According to reliable sources familiar with the situation on the ground, speaking on condition of anonymity, the unrecognised territory where Emir is located does not have a “formal asylum framework” which prevents him from being taken into care by international bodies.

Stuck in the maze, the young man said he still hopes that someone will find a way to help him.

Even if, he added, “thousands of other people are suffering” throughout the world.

US: Health services now out of reach for many immigrants

New Policy Bars Many Lawfully Present and Undocumented Immigrants from a Broad Range of Federal Health and Social Supports

On July 14, 2025, the U.S. Department of Health and Human Services (HHS) issued a notice of a policy change to update the definition of “federal public benefits” as outlined in the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA) to add an additional 13 programs to the 31 programs considered “federal public benefits” that are restricted to individuals with a “qualified” immigration status. The notice further indicates that the updated list of federal benefits is not exhaustive, and additional programs may be added in the future. This change bars many groups of lawfully present immigrants as well as undocumented immigrants from accessing many health care, educational, and other social services and will likely have negative impacts on the health and well-being of immigrant families due to more limited access to services as well as confusion and fear about using services. It also may create new challenges and complexities for service providers. Many implementation questions remain unclear and subject to future guidance, including how verification of immigration status may occur and how the policy will be reconciled with existing conflicting statutory and regulatory requirements, which supersede the guidance. This policy change took effect immediately upon publication of the notice in the federal register on July 14, 2025, although it provides for a 30-day comment period. It also indicates that it will issue further implementation guidance.

Prior Policy under PRWORA

When enacted in 1996, PRWORA established federal requirements that limited eligibility for “federal public benefits” to groups who are “qualified immigrants.” The groups defined as “qualified immigrants” are more limited than groups who are considered lawfully present in the U.S. and exclude undocumented immigrants. Notably, qualified immigrants do not include people with Temporary Protected Status and people with deferred action, including Deferred Action for Childhood Arrivals recipients, among other lawfully present groups (Box 1).

Box 1: Lawfully Present Immigrants by Qualified Status

Qualified Immigrants Other Lawfully Present Immigrants
  • Lawful permanent resident (LPR or green card holder)
  • Refugee
  • Asylee
  • Cuban/Haitian entrant
  • Paroled into the U.S. for at least one year
  • Conditional entrant granted before 1980
  • Granted withholding of deportation
  • Battered noncitizen, spouse, child, or parent
  • Victims of trafficking and their spouse, child, sibling, or parent or individuals with pending application for a victim of trafficking visa
  • Member of a federally recognized Indian tribe or American Indian born in Canada
  • Citizens of the Marshall Islands, Micronesia, and Palau who are living in one of the U.S. states or territories (referred to as Compact of Free Association or COFA migrants)
  • Granted Withholding of Deportation or Withholding of Removal, under the immigration laws or under the Convention against Torture (CAT)
  • Individual with Non-Immigrant Status, includes workers visas, student visas, U-visa, and other visas, and citizens of Micronesia, the Marshall Islands, and Palau
  • Temporary Protected Status (TPS)
  • Deferred Enforced Departure (DED)
  • Deferred Action Status
  • Lawful Temporary Resident
  • Administrative order staying removal issued by the Department of Homeland Security
  • Resident of American Samoa
  • Applicants for certain statuses
  • People with certain statuses who have employment authorization

The PROWRA legislation provided discretion to federal agencies to determine which benefits and programs are “federal public benefits,” while also identifying specific exemptions such as treatment for emergency medical conditions, certain disaster relief, immunizations, and testing and treatment for communicable diseases. It also clarified that non-profit organizations were not required to verify the immigration status of individuals receiving benefits or services. Under policy established in 1998, HHS identified 31 health and social programs considered to be “federal public benefits” restricted to “qualified immigrants,” including major health coverage programs such as Medicaid (excluding emergency Medicaid), Medicare, and the Children’s Health Insurance Program (CHIP).

Changes under the 2025 Policy

The 2025 policy expands the list of programs considered “federal public benefits” by adding 13 additional programs, including Head Start, the health center program, the Title X family planning program, among others (Box 2). The notice further indicates that the list is not exhaustive, and additional programs may be added to in the future.

Box 2: New Programs Considered “Federal Public Benefits” Under the 2025 Policy Change

  • Certified Community Behavioral Health Clinics
  • Community Mental Health Services Block Grant
  • Community Services Block Grant (CSBG)
  • Head Start
  • Health Center Program
  • Health Workforce Programs not otherwise previously covered (including grants, loans, scholarships, payments, and loan repayments)
  • Mental Health and Substance Use Disorder Treatment, Prevention, and Recovery Support Services Programs administered by the Substance Abuse and Mental Health Services Administration
  • Projects for Assistance in Transition from Homelessness Grant Program
  • Substance Use Prevention, Treatment, and Recovery Services Block Grant
  • Title IV-E Educational and Training Voucher Program
  • Title IV-E Kinship Guardianship Assistance Program
  • Title IV-E Prevention Services Program
  • Title X Family Planning Program
  • List is not exhaustive and may be added to in the future

Source: U.S. Department of Health and Human Services (July 2025), “HHS Bans Illegal Aliens from Accessing its Taxpayer-Funded Programs”

Implications of the Policy Change

The policy change bars many lawfully present and undocumented immigrants from services that are important for their health and well-being. These programs include certain programs that are particularly important for immigrant families, such as the federal Health Center program, which funds a network of Community Health Centers (CHCs). Community health centers are a national network of over 1,300 safety-net primary care providers located in medically underserved communities and serve all patients regardless of their ability to pay, providing a range of medical, behavioral, and supportive services. Data from the 2023 KFF/LA Times Survey of Immigrants show that three in ten immigrant adults say a CHC is their usual source of care, with this share rising to about four in ten among likely undocumented immigrant adults (42%) and those with limited English proficiency (39%) (Figure 1). The policy also bars immigrants without a “qualified” immigration status from accessing federally funded mental and behavioral health services at a time when many immigrant families are experiencing heightened stress and anxiety due to immigration-related fears and financial uncertainty, as well as from Title X services, which provide comprehensive family planning services to low-income and uninsured individuals.

Beyond health care, the policy also limits access to services that support education, including the Head Start Program. Research shows that adults with higher educational attainment tend to have longer lifespans and be healthier than their counterparts with lower educational attainment. High educational attainment also is associated with better jobs that are more likely to provide employer-sponsored health coverage and higher incomes which, in turn, improve access to health care and resources to support health.

The new policy also will affect service providers who may need to update their policies and procedures to comply with the changes. Under PRWORA, program benefit providers are prohibited from providing “federal public benefits” to people who are not citizens or qualified immigrants and are required to verify that an applicant is a qualified immigrant eligible for services. The notice confirms an existing exemption in the law that non-profit charitable organizations are not required to verify immigration status. However, many implementation questions currently remain unclear and subject to future guidance, including how verification of immigration status may occur. Moreover, the policy does not supersede existing statutory and regulatory requirements. For example, although the notice limits the health center program to “qualified immigrants,” it does not change the underlying statutory requirements for CHCs to serve patients regardlessof immigration status. While federal law supersedes guidance, this conflict creates challenges for CHCs in how they will apply this guidance, and it remains to be seen how enforcement of the guidance will affect CHCs’ ability to provide care. Additionally, as noted, the notice indicates that the list of programs affected by the change is not exhaustive, so additional programs may be added in the future.

The notice estimates that the policy change will result in savings from reduced use of programs by certain immigrants as well as new administrative costs. Savings are estimated to derive from excluding certain immigrants from HHS programs with a corresponding increase in benefits for U.S. citizens and qualified immigrants. There also are estimated to be new administrative costs associated with individuals being required to document their eligibility, for immigration status to be verified, and for changes in program eligibility and operating policies and procedures.

The policy change occurs against a backdrop of other policy changes restricting immigrant access to health and other programs and increased immigration enforcement activity. These changes include new restrictions established under budget reconciliation that limit Medicaid, Medicare, and subsidized Affordable Care Act (ACA) Marketplace coverage to lawful permanent residents, certain Cuban and Haitian entrants, and citizens of the Freely Associated States (COFA migrants). Together, these changes will likely have broad chilling effects on immigrant families, resulting in increased reluctance to access services and programs due to fear and confusion. More limited access to programs and services may lead to negative impacts on their health and well-being. These effects may extend across immigrant families, who often include citizen children—with one in four children in the U.S. living with at least one immigrant parent—and have broader impacts on communities, given immigrants’ role in the workforce.