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HHS scales back estimate for HIV cases due to immigration change
  July 01, 2009
In its move this week to eliminate the ban on immigration to the U.S. by people with HIV or AIDS, the Obama administration put forward and then retracted some scary-looking estimates of new HIV infections.
On Monday, the Department of Health and Human Services sent the proposal to end the HIV-related immigration policy to the Federal Register, an official journal of government actions and meetings.
However, late Monday, the proposed rule was pulled from publication in Tuesday's edition at the request of HHS Secretary Kathleen Sebelius. "HHS inadvertently submitted an incomplete version of the proposed regulation," a notice on the Register's website said.
A new version of the proposal is set for publication in tomorrow's Register. While the first one was said to be "incomplete," it was actually 12 pages longer than the replacement. In the redo, HHS dotted some I's, crossed a few T's and reordered some sections. However, the newer version also contains different data than the original about the potential for the move. And those different calculations could ease sticker shock.
The new proposal estimates that after five years under the new policy admitting HIV-inflected immigrants, the number of additional HIV cases in the U.S. - excluding the new immigrant population - would be 676.
The first document, however, used a different calculation. Instead of a five-year prediction, 20 years was used. And the estimate included both the population already in the U.S. and the newly arrived immigrants. So in the original document, that measly 676 was a whopping 37,780.
Calculating 20 years out obviously had made the cost higher, too.
The new document estimates the additional health care expenditure five years from now at $342 million per year (for treating the immigrant population) plus $96 million (for treating the original population). You have to do the math - they don't print outright the combined cost.
The 20-year estimate would be over $952 million, or what critics could easily call "nearly $1 billion." The total cost over the 20-year period is another figure removed in the second document. However, it was estimated in the original document that the cumulative, undiscounted costs after 20 years could be more than $12.7 billion.
The Centers for Disease Control, which prepared the documents, did not respond to questions today about the changes.
In updating its document, the CDC also deleted some potentially controversial prose.
Here's one of the statements that ended up on the cutting room floor: "HIV infection among immigrant populations indicate that these groups have less risky social behaviors and more restricted and closed social networks than those in the general U.S. population. Thus, onward transmission rates are likely to be lower."
The new version has a bit more hemming and hawing on this point. "Results from published research indicate that immigrants to the United States, regardless of their race or ethnicity, often have an initial better health profile than native-born Americans across diverse health behaviors and outcomes," the new proposal says. After several more sentences of explanation, it concludes: "Thus, it is not unreasonable to assume that onward transmission rates amongst HIV-infected immigrants will be lower than among HIV-infected persons born in the U.S."
The federal government has taken down the original version of the proposal, but we've posted it here. The new proposal is here.
(Reported by Kathryn McGarr)
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