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.

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.

[Update] US: Idaho immigrants regain HIV treatment access through legal ruling

Federal Judge Restores Access to HIV Treatment for All Immigrants in Idaho

BOISE — Today, a federal judge granted provisional class-action status and extended a temporary restraining order (TRO) in the lawsuit Davids v. Adams. This ruling means access to HIV treatment through the Ryan White HIV/AIDS Program remains available for all immigrants throughout the state, regardless of their immigration status. Before the ruling, the TRO protected access to the program only for the five anonymous patient plaintiffs in the lawsuit.

The judge’s order defines the protected class as “all current or future persons residing in Idaho who have been diagnosed with HIV and who would qualify for federally funded services through the Ryan White Program unless required to verify [their immigration status] for those benefits.”

A decision on the preliminary injunction is expected in the coming weeks.

Davids v. Adams was filed on June 26, 2025 by the American Civil Liberties Union (ACLU) of Idaho, the National Immigration Law Center (NILC), and private law firms Nixon Peabody LLP and Ramirez-Smith Law in response to House Bill 135.

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The ACLU of Idaho is a non-partisan, non-profit organization dedicated to the preservation and enhancement of civil liberties and civil rights. The ACLU of Idaho strives to advance civil liberties and civil rights through activities that include litigation, education, and lobbying. Learn more at acluidaho.org.

Established in 1979, the National Immigration Law Center (NILC) is one of the leading organizations in the U.S. exclusively dedicated to defending and advancing the rights of low-income immigrants. At NILC, we believe that all people who live in the U.S. should have the opportunity to achieve our full potential. Over the years, we’ve been at the forefront of many of the country’s most pressing immigration issues, and we play a major leadership role in addressing the real-life impact of policies that affect the ability of all of us to prosper and thrive.

Nixon Peabody LLP is an American Lawyer top-100 law firm in the United States and has 15 offices worldwide. Our firm delivers exceptional service to our clients and our communities by combining high performance, entrepreneurial spirit, deep engagement, and an unwavering commitment to a culture of collaboration and humanity.

Ramirez-Smith Law is a leading immigration law firm dedicated to defending the rights of immigrants, asylum seekers, and underserved communities across the United States. With a proven commitment to justice, the firm advocates for individuals facing systemic barriers within the immigration system and beyond. Headquartered in Nampa, Idaho, Ramirez-Smith Law provides compassionate, high-impact legal representation in removal defense, asylum, family-based immigration, humanitarian relief, employment-based immigration, and federal litigation—including complex litigation challenging unlawful government practices and policies. Our firm is proud to stand at the intersection of legal advocacy and social justice, using the law as a tool to protect human dignity and hold institutions accountable. We believe every client deserves to be heard, and every community deserves to be defended. For more information, visit www.nrsdt.com or contact us at 208-461-1883.

Global study reveals 50 countries still enforce HIV-related travel restrictions

A new global study presented this week at the 13th IAS Conference on HIV Science in Kigali (IAS 2025) has revealed that 50 countries around the world continue to enforce HIV-related travel and residence restrictions, in clear violation of international human rights principles.

The data, shared by the HIV Justice Network through its new platform Positive Destinations, highlights the persistence of discriminatory laws and policies that prevent people living with HIV from freely travelling, working, studying, or settling in many parts of the world.

Despite progress – 83 countries now have no HIV-specific travel restrictions, and many others have adopted more inclusive approaches – 17 countries still impose severe measures such as outright entry bans, mandatory testing, and deportation. These include Bhutan, Brunei, Egypt, Iran, Kuwait, Malaysia, Russia, and the United Arab Emirates. Migrants and students are often disproportionately affected, with some unaware of the rules until after testing or disclosure, resulting in forced returns, loss of income, and separation from families.

Another 33 countries – including Australia, Canada, Kazakhstan, the Philippines, Saudi Arabia, and Singapore – have partial restrictions. These include requirements for HIV testing in visa applications, discretionary decisions based on perceived healthcare costs, and reduced access to essential services. Although these policies may appear neutral on the surface, they continue to disadvantage people living with HIV.

“These restrictions are rooted in outdated public health thinking and perpetuate stigma,” said Edwin J Bernard, HIV Justice Network’s Executive Director. “They obstruct access to healthcare, education, and family life, especially for migrants and refugees.”

   Click on the image to download the poster

In 2024, Positive Destinations documented several cases of deportation based solely on HIV status: Kuwait deported over 100 people, Russia’s Dagestan region deported nine, and Libya deported two. Such practices are increasingly being challenged by legal action. In Canada, for example, a court case led by the HIV Legal Network contests the “excessive demand” clause of immigration law, arguing it violates the country’s Charter of Rights and Freedoms.

However, policy reform has been uneven. Australia raised its health cost threshold for visa eligibility, slightly easing access to temporary stays, but permanent residency remains elusive for many people with HIV. A recent case saw an Italian teacher denied residency due solely to his HIV-positive status.

The study also underscores how HIV-related migration barriers often intersect with other forms of criminalisation and discrimination. In Uzbekistan and Russia, HIV criminalisation laws are paired with mandatory HIV testing for migrants. In the U.S., HIV-positive and LGBTQ+ asylum seekers continue to face mistreatment in detention centres. And in a tragic case in Turkey, a Syrian trans woman was reportedly deported after her HIV status was disclosed and later killed upon return.

The authors of the study call for urgent action: “Eliminating these harmful policies is essential to ending AIDS, achieving universal health coverage, and upholding the dignity and rights of people living with HIV everywhere,” said Bernard.

Positive Destinations, which hosts the updated Global Database on HIV-Specific Travel and Residence Restrictions, is available at www.positivedestinations.info

EP0623 Addressing HIV-related travel restrictions: Progress and challenges in eliminating discriminatory policies by Edwin J Bernard, Sylvie Beaumont, Elliot Hatt, and Sofía Várguez was presented at IAS2025 by Brent Allan at the 13th IAS Conference on HIV Science, Kigali, Rwanda.

South Africa: Overview of healthcare access for undocumented migrants in South Africa

Healthcare Access for Undocumented Migrants in South Africa: What You Need to Know

Access to healthcare is a fundamental human right enshrined in South Africa’s Constitution. However, the reality for undocumented migrants seeking medical care in the country remains complex and often fraught with challenges. This article provides a clear, factual overview of healthcare access for undocumented migrants in South Africa. It highlights legal rights, barriers faced, and ongoing debates.

Section 27(1) of the South African Constitution guarantees everyone the right to access healthcare services, including reproductive healthcare. This right extends to all individuals within the country’s borders, regardless of nationality or legal status. Specifically, Section 27(3) mandates that emergency medical treatment must not be denied to anyone. This underscoring the country’s commitment to human dignity and health rights.

The National Health Act further supports this by stating that primary healthcare services are available to all people, irrespective of immigration status. Refugees, asylum seekers (with or without permits), permanent residents, and even undocumented migrants are entitled to emergency healthcare services. However, at the very least.

Categories of Migrants and Their Healthcare Rights

  • Refugees and Asylum Seekers: Recognised refugees and those awaiting status have the same rights to healthcare as South African citizens. This includes access to clinics, maternal and child healthcare, HIV and TB treatment, and mental health support.
  • Permanent and Temporary Residents: These groups also have access to public healthcare. Temporary residents are often required to pay fees based on income.
  • Undocumented Migrants: While lacking legal documentation, undocumented migrants retain the constitutional right to emergency medical care. Access to non-emergency services is more limited and often subject to administrative discretion, but denying emergency care is unlawful.

Barriers and Challenges in Practice

Despite clear legal protections, undocumented migrants frequently face obstacles when seeking healthcare:

  • Medical Xenophobia: Many migrants report discrimination and refusal of services by healthcare providers. This is due to their foreign status or lack of documentation. This practice undermines public health and violates constitutional rights.
  • Fear of Deportation: Undocumented migrants may avoid seeking care due to fears. They fear that healthcare providers will report them to immigration authorities, as required by the Immigration Act.
  • Cost and Accessibility: Some migrants are charged fees or denied free services, despite legal provisions. Language barriers and lack of information further complicate access.
  • Policy Conflicts: The National Health Insurance Bill and Immigration Act introduce conflicting requirements. These sometimes restrict undocumented migrants’ access to healthcare. This contrasts with constitutional guarantees.

Access For All?

The South African Constitution guarantees healthcare access for undocumented migrants, especially in emergencies. Yet, challenges such as discrimination, fear, and conflicting policies persist. Continued legal advocacy, public education, and policy reform are essential. They are necessary to ensure that all individuals, regardless of documentation status, can access the healthcare they need.

US: Federal Judge blocks Idaho’s Immigration Law from targeting HIV program

Federal judge temporarily protects HIV program from new Idaho immigration law

A federal judge has temporarily blocked Idaho from applying a new state law meant to prevent unauthorized immigrants from accessing publicly funded assistance to one health program.

U.S. District Judge Amanda Brailsford on Monday issued a temporary restraining order blocking the Idaho Department of Health and Welfare from requiring citizenship status reviews for a federally funded HIV treatment program.

The decision blocks the law’s application to this program until a court hearing in two weeks about whether the court should block the law for longer.

The new law, House Bill 135, took effect Tuesday. It cuts the few publicly funded services that unauthorized immigrants can receive in the state.

The judge’s ruling came days after ACLU of Idaho sued over the new law, alleging the law is unconstitutional by violating equal protection, conflicts with federal laws and even denies federal funds to people eligible under federal law.

US: Lawsuit filed to block Idaho law restricting access to HIV treatment for Immigrants

BOISE — On Thursday, June 26, 2025, the American Civil Liberties Union (ACLU) of Idaho, the National Immigration Law Center (NILC), and private law firms Nixon Peabody LLP and Ramirez-Smith Law filed a lawsuit against the state of Idaho to stop enforcement of House Bill 135, which is set to go into effect July 1, 2025.

House Bill 135 was passed during the 2025 legislative session to impose new immigration status verification requirements on programs that are not restricted under federal laws, including access to food pantries and soup kitchens, prenatal and postnatal care, vaccines and life-saving medications to treat communicable diseases such as HIV, among others. Prior to the new law, these benefits were available to Idaho residents without having to verify immigration status.

The lawsuit, Davids v. Adams, is seeking a temporary restraining order (TRO) preventing the state from barring access to federally funded HIV medication for immigrants who cannot verify their lawful presence. The TRO is necessary because the Idaho Department of Health and Welfare, which administers the federal funding, has determined that on and after July 1, 2025, recipients of this funding must meet the lawful presence criteria outlined in the law. Without access to this medication, many immigrant residents will suffer a variety of serious health issues, including, potentially, death.

The plaintiffs in Davids v. Adams are Dr. Abby Davids, a doctor who treats patients living with HIV, and five immigrant Idahoans living with HIV.

The lawsuit argues that House Bill 135 attempts to circumvent federal law, which allows access to certain federally funded benefits programs, including the federal program that provides HIV medication (known as the Ryan White HIV/AIDS Program), without regard to citizenship or immigration status.

“Nobody benefits from barring access to life-saving HIV medication,” said Dr. Abby Davids, practitioner at Full Circle Health. “Both for individual patients and for the health of our community as a whole, all people living with HIV need to be able to access consistent care and treatment. Infections like HIV do not infect people based on their immigration status, and treatment should not be limited by legal status, either. I am genuinely afraid for my patients who currently take medication for HIV; without it, their lives will be in jeopardy.”

“HB 135 is designed to dehumanize our immigrant neighbors by denying them the basic necessities of life — medicine, food, and shelter. It subverts constitutional rights and interferes with federal regulation of immigration,” said Paul Carlos Southwick, ACLU of Idaho Legal Director. “Along with HB 83, this is the second unconstitutional bill we’ve sued to stop this year. It is part of the state’s campaign to displace immigrant residents, which will separate families and inflict lasting trauma. The state’s actions are legally indefensible and morally wrong.”

“This inhumane bill unconstitutionally seeks to block full public access to essential health care, including life-saving HIV care and treatment, and threatens the health and wellbeing of Idahoans across the state,” said Joanna Cuevas Ingram, senior staff attorney at the National Immigration Law Center. “Federal law has expressly exempted the Ryan White HIV AIDS Program, among others, from citizenship and immigration status requirements, ensuring that vulnerable individuals are not denied life-saving care due to their immigration status and to meet nationwide public health goals in reducing HIV transmission. H.B. 135 cannot subvert federal law or the will of Congress. A restraining order and injunction are necessary.”

“The message to immigrant and Latine communities is clear: No matter what kind of person you are, no matter how meaningfully you contribute to Idaho, no matter how hard you struggle to support your family, you are not wanted here,” said Ruby Mendez-Mota, ACLU of Idaho Interim Advocacy Director. “This law isn’t about safety or security, it’s not about limited resources; it’s about making an already vulnerable part of Idaho’s hardworking community feel like they aren’t good enough to be treated with dignity. This fight is not over.”

 

France: Young man with HIV detained without treatment faces expulsion, despite years of residency

For two months, the 23-year-old man has been detained at the CRA in Cornebarrieu (Haute-Garonne), where he has not received his HIV treatment. The associations are asking for a reassessment of his file. Politis was able to reach him.

His voice is weakened, almost inaudible. He seems exhausted. Joes arrived in France at the age of 11, then was adopted by his grandmother. He has 22 today. All his life is here. He went to college and then high school in the North, did two years of art school and then multiplied odd jobs, in catering and sales. In the meantime, he learns that he has HIV. He should have filed his birth certificate at the age of 18 to be officially regularized but he forgot and then covid-19 arrived and the administrations remained closed. He receives an OQTF (obligation to leave French territory).

“I didn’t really take it seriously. Instead of challenging her, I preferred to work, keep a low profile, thinking that things would work out, “says the young man. “If my birth certificate had been filed, they could have registered me in the civil registry and I would be French. From there, everything degrades. The man, detained at the administrative detention center (CRA) in Cornebarrieu, near Toulouse, was to be expelled by plane on Monday, June 23 to his country of origin in the Democratic Republic of Congo (DRC). A country he doesn’t know.

International aid stopped

To avoid being sent back, Cimade advised him to apply for asylum as a matter of urgency to the French Office for the Protection of Refugees and Stateless Persons (Ofpra). The aim was to re-evaluate his case. A new element was added, as Julie Aufaure, in charge of detention at Cimade, explains: “Care for people with HIV in the DRC is a little better than it used to be. But doubts have returned with the decision by the United States to withdraw its international aid, particularly on health issues”.

More and more foreign nationals living with HIV are being refused entry to the country.It was the Pepfar programme (President’s Emergency Plan for AIDS Relief), which financed a very large part of access to treatment in developing countries – particularly the DRC – with almost 54%. However, “this decision is not yet measurable, but there are major concerns on the ground. And the professionals in the field know that this is going to become a real problem very, very quickly”, continues Julie Aufaure.

This concern is shared by Adrien Cornec, head of mission for the AIDS charity Aides. He explains that France has had a right to residence on medical grounds since 1990. “But for some years now, the authorities have been calling it into question. We’re seeing more and more foreign nationals living with HIV being refused residence. In particular, people who have been refused residency following applications for renewal. In other words, people who have been here for several years.

He adds: “From one day to the next, these people find themselves in an irregular situation, obliged to leave French territory and go to a country where they haven’t lived for long and are not guaranteed access to care.

“We were rejected everywhere”

Julie Aufaure admits that Joes’ situation is complicated. “We’ve been rejected everywhere, unfortunately, because the prefectural authorities and the European Court of Human Rights base their decision on the decision of the Office’s doctor, who says that the treatment exists.

Joes, for his part, ‘hopes from the bottom of his heart’ for a positive response from Ofpra. Especially as he has been subjected to mockery in the detention centre since his arrival on 6 April. Medical confidentiality has been broken. He has been subjected to ‘moral and physical harassment’ by both ‘officers and detainees’. According to him, the detention centre officers spread the information to everyone in the centre. Some felt sorry for them, others laughed. His fellow detainee added that this stigmatisation was recurrent.

Apart from his roommate, with whom he talks, the young man has withdrawn into himself. “It’s still really a wolf’s world here. I prefer to be on my own. People can fight over a piece of bread or a cigarette. It’s a disgrace”, says Joes.

Worse still, he says he has never received his treatment since his arrest. When he arrived, he had a blood test and a check-up a fortnight later. But since then, radio silence. ‘They nearly put me on the plane, in this state, without me having had the treatment…’. As he is HIV-positive, it is essential that he takes his medication every day. The absence of treatment can have serious effects on his health, such as a drop in his immunity, making him extremely vulnerable to other illnesses. According to the Cimade employee, this is a case that ‘borders on the legal’, but she assures us that the procedure is long and going well.

Action still possible

If the asylum application is rejected or deemed inadmissible, Julie Aufaure plans to lodge an appeal with the national court for the right of asylum (CNDA) and ask the administrative court to suspend the deportation until the court has made its decision, but ‘that’s pretty much the last option for him’, she says.

Adrien Cornec says he is very concerned about ‘these refusals of residence and their accommodations’. Aides and the other associations are calling for the application of the decree of 5 January 2017, which states that ‘in all developing countries, it is therefore not yet possible to consider that HIV-positive people can have access to antiretroviral treatment or to the medical care required for all carriers of an HIV infection as soon as they are diagnosed’.

The Aides representative alerted Senator Anne Souyris. The ecologist sent letters to the prefects of the Pyrenees and Haute-Garonne, and also directly to the Minister of the Interior, Bruno Retailleau. “We don’t expel people who can’t be treated in their own country. There’s a political issue behind it”, she told Politis.

According to the senator, this is a real ‘death sentence’ for Joes, given that international funding has stopped. The senator goes further than the individual case and calls for all the people who could be affected to be automated: “There should be a circular (…). This should also be a textbook case for managing this situation.

US: LGBTQ migrants with HIV face systemic failures and neglect in U.S. custody

Queer, Undocumented and HIV Positive

The current political climate is making immigrants feel unwelcome in America.

Immigration continues to be a hot-button issue in the United States. Whether they are seeking asylum from a violent region of the world or coming here for a better life for your family, immigrants (specifically non-white immigrants) face a host of challenges.

LGBTQ immigrants living with HIV, face downright Sisyphean challenges. Undocumented people can’t access any health services without paying out of pocket, which can be monumentally expensive. Even if they are welcomed at a clinic, it’s possible that no one there will be able to speak their language or understand their culture. And currently, there’s the added risk that Immigration and Customs Enforcement (ICE) officers may be staking out the place.

If an LGBTQ person and/or a person living with HIV is taken to jail, it’s very likely that they’ll suffer abuse. A 2024 study published by Immigration Equality, the National Immigrant Justice Center (NIJC) and Human Rights First reports that ICE and Customs and Border Patrol (CBP) agents at detention centers regularly abuse queer people and people living with HIV who are in their custody.

The study reported that one third of the participants experienced sexual, physical and mental abuse and sexual harassment, while nearly all reported incidents of verbal abuse and threats of violence. A quarter of the participants in the study reported being separated from loved ones, whether a partner, a spouse or sibling, and half of those in the study were kept in solitary confinement. Many had to scramble to find legal representation and sometimes were denied access to their attorney.

Most detainees also stated that they were given inadequate medical care or denied care altogether. Of the detainees living with HIV, most reported neglect or denial of HIV care. Nearly half reported suffering mental health problems, including panic attacks, flashbacks and self-harm. More than half stated that their HIV status, gender identity, sexual orientation, medical or other confidential information was disclosed without their consent.

More disturbing is the fact that many of those immigrants came here seeking amnesty, fleeing violence or other harsh ramifications in their homeland for simply being queer or because they’re living with HIV.

People living with HIV who are trying to emigrate to the United States cannot be denied entry based on their HIV status. (In 2010, President Obama lifted the “HIV ban” that had been in effect for 22 years.) Also, no one can be denied entry solely based on their sexual or gender identity.

As U.S. HIV and LGBTQ communities strive to keep healthy and safe, they must also remember those who need extra protection and care. Our arms must be big enough to hold fast to those who are extra vulnerable.