16. Telegram From the Department of State to All Diplomatic and Consular Posts1

67663. Subject: Proposed AIDS Screening for U.S. Visa Applicants: Update and Press Guidance. Ref: State 51793.2

1. Background: Reftel describes Department of Health and Human Services (HHS) proposal to designate AIDS as a dangerous, contagious disease, making it grounds for exclusion from the United States. Because AIDS cannot be diagnosed easily, implementation of the proposed rule would mandate blood screening for antibodies to the AIDS causing virus as a part of the medical examination required of all immigrant visa applicants, including refugees. A negative result from the antibody screening test would be a precondition for issuance of an [Page 43]immigrant visa. Posts should note that applicants for non-immigrant visas would not be subject to this requirement.

2. Post responses to reftel have been valuable to the preparation of Department’s comments on the proposed rule. Many posts have noted one or more of the following problems should the proposed rule be adopted:3 1) lack of testing facilities, 2) delays in processing and increased costs to applicants, 3) Consulate workloads, 4) the proposed rule will reach only a small fraction of visitors and immigrants to the U.S., and 5) the anticipated adverse reaction in many countries and challenges to our credibility since the U.S. is widely perceived as the largest exporter of the AIDS causing virus. Department comments will be submitted to the Office of Management and Budget,4 which will determine whether to permit publication of the “Notice of Proposed Rulemaking.” If published as a proposed rule, HHS must allow a 60 day period for public comment before deciding whether to develop a final rule. This, once again, must be circulated for agency comment before final approval by OMB. Estimated time, from publication of a proposed rule to the effective date of a final rule, if any, is nine to twelve months.

3. Department understands several posts have been queried by the local press and offers the following guidance.

Q: Is the U.S. Government planning to institute screening of visa applicants for AIDS?

A: AIDS is not at this time considered a condition warranting exclusion from the United States on medical grounds. The U.S. Department of Health and Human Services (HHS) has proposed a rule change which would designate AIDS as a dangerous, contagious disease, and, as such, make it grounds for exclusion from the United States. The proposed rule is under review by agencies within the U.S. Government. If the Government decides to publish the proposed rule, there would be a sixty day period for public comment. Following the comment period, if HHS decides to issue a final rule, it would again undergo agency review before becoming effective. The entire process, if carried to completion, would probably take nine to twelve months.

If the proposed rule is ultimately adopted, it would have the effect of adding a test for antibodies to the AIDS-causing virus to the medical [Page 44]exam already required of immigrant visa applicants. Non-immigrant visa applicants would not be affected by this proposed rule.

Q: What tests will be required, and what if the results are positive?

A: Presently, the simplest and most economical test is the ELISA test. If this test gave a positive result, and the applicant wished to pursue the application, the Western Blot test would be used. A negative result on the Western Blot test, following a positive ELISA test result, would be sufficient for meeting the proposed HHS requirement.

Q: What if there are no facilities capable of performing antibody testing in an immigrant visa applicant’s home country?

A: The absence of appropriate testing facilities in many areas, and the additional inconvenience and expense to the applicant, are two of several issues which have been brought to the attention of the Department of Health and Human Services. Because there has been no final decision to adopt this rule, we prefer not to speculate on such hypothetical situations.

Shultz
  1. Source: Department of State, Subject Files, Other Agency and Channel Messages and Substantive Material—World Health Organization (WHO), 1986, Lot 90D36, 86 HLTH WHO Programs AIDS Jan–June. Limited Official Use; Priority. Drafted by Weeks; cleared in CA/PC, M/MED, RP/RAP/AP, and S/S; approved by Benedick.
  2. In telegram 51793 to all diplomatic and consular posts, February 20, the Department requested that Embassies provide their views on the effects of the proposed HHS rule. (Department of State, AIDS, 1984–1987, Lot 89D137, AIDS Department Policy Guidelines/Press)
  3. In telegram 745 from Manama, February 25, the Embassy provided a list of objections to the proposed HHS rule. (Department of State, Central Foreign Policy File, D860143–0591)
  4. An unknown hand underlined this sentence through “Budget,” and wrote in the margin: “What position did State take?” Just above this was the handwritten comment: “Was this necessary?” in the same hand.