New Citizenship and Immigration Services regulations requiring HPV vaccination for young immigrant women seeking adjustment of status only erects further barriers in an already onerous immigration process.
This July, the U.S.
Citizenship and Immigration Services (USCIS) announced new requirements, including five new vaccinations for individuals seeking adjustment of immigration status. One of these vaccinations is Gardasil, the human papillomavirus (HPV) vaccine. Gardasil, manufactured by
Merck, is the only HPV vaccine in the U.S.–also the most expensive
vaccine on the market and the only vaccine to be approved for use in only one sex. The
CDC’s Advisory Committee on Immunization Practices (ACIP) is the only
federal body that makes recommendations about immunizations; the
committee’s recommendations serve as the template that USCIS uses to
determine immunization requirements for immigration procedures. These new requirements put increased barriers and additional
burdens on women’s access to adjustment of immigration status and
applications for visas to enter the U.S. and stoke the already reverberating anxieties
among communities of color about the HPV vaccine.
Most immigration applicants are currently required to undergo a medical
exam by a certified "civil surgeon." These civil surgeons complete
an I-693 medical
examination and vaccination record. The new
regulations that require the HPV vaccine apply to female applicants between
the ages of 11 to 26. This is the only sex-specific vaccination requirement,
putting particular burden on immigrant women applying for a visa or
adjustment of status, further marginalizing a group that already has reduced
access to health information and services that are affordable, accessible and
culturally and linguistically competent.
According to the Census, there are approximately 17.5 million immigrant
women in the United States
today, 3 million of whom are undocumented, and 16 percent that live in
poverty. These women encounter obstacles to employment and health access; they
also face violence and discrimination. Immigrant rights and reproductive
justice are intrinsically linked because the reproductive health of immigrant
women is profoundly affected by immigration policy. For women seeking
adjustment of status, the USCIS’ additional vaccine requirements create tremendous
barriers to one of the many steps towards a pathway to citizenship.
While women of color, many who
are immigrants, face disproportionate rates of cervical cancer in the U.S.
(Latina women get cervical cancer at twice the rate of white women; and Vietnamese
women get cervical cancer at five-times the rate of white women), efforts
should be made to increase access and education about HPV and the vaccine,
rather than creating further impediments to the already onerous immigration
process. The HPV vaccine is out of
reach for many women with its high price tag: at a minimum, it costs $360 for
the three shot regimen. Publicly-funded access to the HPV vaccine varies
state-to-state, although all low-income adolescents between the ages of 9
through 19 who are either uninsured, Medicaid-eligible, American Indian, or
Alaska Native, have access to the vaccine through the federal Vaccines for
Children (VFC) program. Immigrant women over the age of 19 may have greater
challenges in obtaining the vaccine. According to the Kaiser
Commission on Medicaid and Uninsured and the National Council of La Raza
(NCLR), between 45% and 51% of immigrants lack health coverage in the US.
The lack of health insurance, coupled with the high cost of the vaccine, limits
access to the vaccine for low-income immigrant women. In addition, for
immigration visa applicants abroad, the global availability and accessibility of
the vaccine is questionable.
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States also use the CDC’s Advisory Committee on Immunization Practices
recommendations when developing their own vaccine requirements for
entry. Calls for state school mandate bills for this vaccine seem to
have calmed down, allowing advocates the opportunity to provide
much-needed education and
advocacy around HPV and cervical cancer prevention. Now this new
threatens that critical work.
Instead of mandating vaccines for immigrant
women’s bodies, the U.S.
government should increase access to health information and services that are
unbiased, age-appropriate, culturally-competent and non-coercive. Mandating a
vaccine that specifically targets young non-citizen women is both sexist and
xenophobic. It will only add to the current anxieties among many communities
of color about the vaccine and the government’s interest in vaccinating a
particular community, in this case, immigrant women.
"The individuals and their families impacted by this horrific tragedy aren’t getting any special treatment or cutting the line," said Immigration Equality Client Programs Director Pamela Denzer, "they are eligible for something that was already established many years ago.”
In the hours after the shooting at an Orlando, Florida, gay nightclub that would leave 49 people dead and more than 50 injured, information emerged that almost all of the victims lived at the intersection of being Latino and LGBTQ-identified. In the days since, it’s become clear that one of the deadliest mass shootings in the United States has also taken its toll on Orlando’s immigrant community.
The victims came from all over, including South Africa and the Dominican Republic, and Fusionwas able to confirm that two survivors of Sunday’s shooting are undocumented. A third undocumented man, a 31-year-old from Mexico, was also killed during the attack.
Survivors as well as the spouses, partners, or close relatives of those killed in the attack could qualify for U visas, which, according to U.S. Citizenship and Immigration Services, are “set aside for victims of certain crimes who have suffered mental or physical abuse and are helpful to law enforcement or government officials in the investigation or prosecution of criminal activity.” After three years and if certain requirements are met, U-visa holders become eligible to adjust their status and become lawful permanent residents.
Immigration Equality, an immigrant rights organization based in New York that provides assistance to LGBTQ and HIV-positive communities, is currently offering to help those affected by the massacre apply for U visas. Through its national hotline, the organization is offering help accessing attorneys, filing the proper paperwork, and addressing any language barriers.
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Its client programs director, Pamela Denzer, told Rewire that like many others, her organization became aware of how hard-hit immigrant communities were by the attack thanks to news reports. But before long, survivors, friends, and family members of victims were contacting the immigrant rights organization inquiring about the services available, and what the organization could do on behalf of undocumented families affected by the tragedy.
Denzer told Rewire both immigrant and undocumented victims and their families have benefits available to them other than U visas. Immigration Equality is currently offering victims’ families assistance filing the various forms required for a visa or humanitarian parole, as well as assisting those who speak English as a second language to provide a detailed explanation and evidence of their circumstances, as is required.
“Parents or family members of victims who don’t live in the country and who want to see their child or attend their funeral, might need help getting a visa or getting humanitarian parole. If their child passed away or is critically injured, they need to be with them, and we can help with that,” Denzer said.
This was the case for the mother of 26-year-old Oscar Aracena-Montero, who moved to Florida from the Dominican Republic when he was a child. He was killed in Sunday’s attack, and in the days since, his image has circulated on social media in the hope that someone “who can help” would see the plea and assist his mother in obtaining a visa so she could attend Aracena-Montero’s funeral. The Dominican Republic-based newspaper Listin Diario has since reported that Aracena-Montero’s mother was able to obtain a visa, but now needs assistance ensuring Aracena-Montero’s siblings in the Dominican Republic are also able to attend his funeral.
As Fusion reported, immigration status is creating additional challenges for survivors of Sunday’s attack and for the families of those who lost their lives. There is uncertainty about whether they qualify for state and federal assistance programs that would assist with hospital care.
Over the years, as the number of undocumented people in the United States has risen, many states have attempted to narrow the definition of “emergency” as a way of limiting what hospitals will cover for undocumented patients. PBS reported that in 2012, “Florida changed its policy to pay for emergency services for eligible undocumented immigrants only until their conditions had been ‘stabilized.’ Previously, its policy was to pay for care that was ‘medically necessary to relieve or eliminate the emergency medical condition.’”
Immigrant families were also not prepared for the costs of burying their loved ones, many of whom were only in their 20s and 30s. That process would require repatriating and burying their bodies in their countries of origin. The family of the undocumented man from Mexico who was killed in Sunday’s attack told Fusion that it would cost them up to $6,000.
Those showing support online for the undocumented victims of Sunday’s shooting and spreading information about the possibility of U visas for survivors and family members are already fielding negative responses from anti-immigrant social media users, who are comparing the Orlando shooting to “winning the lottery,” and claiming that victims are benefiting from a tragedy.
The U-visa program has existed since 2000, and Denzel said there is nothing that “uniquely qualifies” victims of this shooting for this visa.
“There are a wide range of scenarios that make a person qualified for this, from being kidnapped to experiencing the murder of a loved one. If a person survived this tragedy, it entitles them to a U visa because they are not a citizen and they experienced a violent crime,” Denzel told Rewire. “We’re not doing anything we don’t already do; we’re not creating services that didn’t already exist. This isn’t a special project. The individuals and their families impacted by this horrific tragedy aren’t getting any special treatment or cutting the line; they are eligible for something that was already established many years ago.”
To her immigration attorney, Nicole Ramos, M’s case is troubling because like many of her clients, M did exactly what she was supposed to do in accordance with U.S. law. But still, her rights were trampled on.
“M” is deeply familiar with the brutal nature of the U.S. immigration system. After waiting in line for more than 30 hours at the San Ysidro Port of Entry to enter the United States from Tijuana, and being held at an immigration facility for almost two weeks, she was released from San Diego’s Otay Mesa Detention Center on April 11.
To her immigration attorney, Nicole Ramos, M’s case is troubling because like many of her clients, M did exactly what she was supposed to do in accordance with U.S. law. But still, Ramos noted, her rights were trampled on.
M, whose name is being withheld to protect her privacy, is considered one of the “lucky ones” (when compared to other immigrants’ cases) for having an attorney who can advocate on her behalf. But even having an attorney couldn’t protect her from inappropriate and abusive behavior that her legal advocates say she experienced while attempting to return to the United States, where she had lived for over two and a half decades before leaving for Mexico to visit a fatally ill parent.
M’s case echoes findings in a new Human Rights Watch report about trans women in detention that suggested the U.S. immigration system often further traumatizes an already vulnerable population.
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Though Rewire was unable to speak to M directly, her attorney explained in an interview last month that M was smuggled by traffickers into the United States from Mexico 25 years ago. As a transgender teenager, M was the victim of multiple sexual assaults, but she was able to escape her traffickers and build a life in San Diego and, eventually, in Los Angeles.
According to Ramos, M received word last year from relatives in Mexico that her mother was gravely ill and dying. Despite being undocumented and unsure of how she would return to the United States, M sold her belongings to pay for her trip to say goodbye to her mother.
M knew it would be a difficult trip, her attorney explained to Rewire, but what she didn’t anticipate was the response from her own family concerning her gender identity. M’s appearance had changed a great deal during her years in the United States, something her family and those in the local community did not respond well to. According to Ramos, M was “pretty much chased out of town.”
“It was not a safe environment for her,” Ramos, who is based in Tijuana, told Rewire. M’s family “basically disowned her, with some family members becoming physically aggressive toward her. She tried to stay at a niece’s and later at a sister’s, but M began receiving threats from men in the area who were known in the neighborhood for targeting members of the LGBTQ community, and trans women in particular.”
To escape from her relatives after an unexpectedly short visit, M left her mother’s town in the middle of the night, hiding under a blanket in a borrowed truck, according to Ramos. A family member drove her to the nearest bus station so M could take a bus to Tijuana.
While staying in Tijuana, M faced more violence and transphobia, Ramos told Rewire. She was repeatedly turned down for housing, she was verbally abused by a therapist from whom she sought treatment, and she was threatened with assault by a bus driver.
“She was in Mexico since last May and she came to me for help at the end of December because it just became too much for her,” Ramos said. “Every time she left her house, she was harassed or threatened. Her bus driver threatening her was the last straw.”
Ramos agreed to help M apply for asylum status in the United States, which would allow her to stay in the country until her claim could be fully evaluated by United States Citizenship and Immigration Services, since she would potentially face persecution should she return to her country of origin.
There are two ways to request asylum: Migrants can apply within a year of being in the United States, though one in five fail to file their application within that timeframe due to language barriers or lack of legal information or resources, among other reasons. Failure to do so puts them at risk for deportation. For those outside the United States, migrants fleeing violence can present themselves at the border or a port of entry and request asylum. There are more than 300 land, air, and sea ports where people and goods can enter the country, according to U.S. Customs and Border Protection (CBP).
However, there are many challenges to getting an asylum claim approved. For asylum seekers whose claims aren’t deemed legitimate, because for example, they can’t prove their identity, they are deported. But even if the process goes smoothly, an asylum seeker will spend an average of 111 days in a detention center. After a “credible fear” interview with an asylum officer, in which they share personal details about their case and why they will be in danger if they are forced to return to their country of origin, they will be held in detention while they await their hearing in immigration court.
“Parole” can be requested, allowing the asylum seeker to avoid a detention center stay, but only if they can verify their identify; if they have family or other contacts in the area; and if they can post a bond, which ranges from $1,500 to $10,000, depending on various factors.
Before accompanying her to the San Ysidro Port of Entry, where M would present herself and request asylum, Ramos explained all of this to M, as she explains it to all of her clients. What Ramos couldn’t prepare M for, she said, was the verbal abuse from CBP officers and their refusal to provide M with food for more than 30 hours. Upon being presented with a letter from Ramos that detailed M’s disabilities and special needs, a CBP officer at the port told M she “wasted her money on an attorney” and that “the letter doesn’t mean shit,” Ramos explained to Rewire.
“I highlighted [in her letter] that [M] has mental health issues, cognitive disabilities; that she has a seizure disorder. She is entitled to special protections because of her mental health issues. I made all of this known, according to [CBP’s] policies, but none of that mattered,” said Ramos: M was still met with disdain and verbal abuse by CBP officers.
M’s experience at the port led Ramos to contact Mitra Ebadolahi, staff attorney of the San Diego ACLU’s Border Litigation Project, which works to “document, investigate, and litigate” human and civil rights abuses in an effort to hold CBP more accountable.
In a complaint filed by the Border Litigation Project to CBP on March 23, Ebadolahi outlined the “unprofessional and abusive comments made” by an officer to M and how officers did not offer M food for 34 hours while she waited in line for processing, something the staff attorney said is unconstitutional and a violation of CBP’s own policies.
Ebadolahi wrote that asylum seekers must wait in line to present their claims for many hours—and sometimes even days. However, a CBP supervisor had assured Ramos that “CBP officers fed individuals awaiting asylum processing three times per day.”
Ramos visited M nearly 24 hours after she had escorted her to the port of entry. She spoke to port staff again about why her client wasn’t being fed and received different responses. One officer said it was M’s own responsibility to bring food to the port. Later in the day, a CBP supervisor named Chief Knox told Ramos that CBP “was not obligated to feed people on the Mexican side,” which Ebadolahi wrote is a “nonsensical” statement “given the fact that CBP officers line up asylum seekers awaiting processing in the U.S.-controlled area of the port.”
This conflicting information indicates CBP officers are not properly trained, wrote Ebadolahi, “or worse—that there is an intentional practice of obfuscating what is required of the agency so that members of the public are confused and can’t assert their rights. Either one of those things is unacceptable.”
This is not the first time the ACLU has filed a complaint against CBP. In 2012, the ACLU Southern Border Affiliates, along with other ACLU programs, demanded a federal investigation into abuse allegations of individuals, including U.S. citizens and legal residents, by CBP agents at ports of entry along the United States-Mexico border. The complaint highlighted 11 cases in which CBP appeared to disregard the civil and human rights of individuals crossing the border in violation of the U.S. Constitution, international law, and agency guidelines. Ebadolahi told Rewire no investigation has taken place.
San Diego’s ACLU Border Litigation Project also hasn’t received a response from local CBP authorities regarding the complaint they filed on behalf of M. The organization is now working on escalating the complaint to national CBP authorities.
In a statement to Rewire post-publication, a CBP spokesperson said that the federal agency “intends to respond to the ACLU this week.” The spokesperson added: “CBP is committed to providing appropriate care for those in our custody, and takes allegations that we have not met those standards of care seriously.”
Ramos has accompanied multiple clients to the port and each time, she said, she has been shocked by the behavior of CBP officers and what appears to be either a complete lack of understanding of laws and regulations, or outright attempts to dissuade migrants from seeking asylum. Once, while helping an unaccompanied minor fleeing violence in Central America, Ramos said an officer was incredulous that the child was presenting himself as an asylum seeker, saying, “You don’t apply for asylum here.” But asylum seekers can present themselves at the border or ports of entry and request a credible fear interview.
M had her paperwork in order, had an attorney, and lawfully presented herself at the port to request asylum. Still, CBP officials violated her rights, according to her attorney.
One of the “Fortunate” Ones
After 34 hours of waiting to be processed, M was then held in San Ysidro in CBP custody for three days. While there, Ramos said M was subjected to verbal abuse from officers who mocked her transgender identity, with one officer passing her cell and saying, “What’s the story with this one,” according to M’s attorney. Eventually, M was transferred to Immigration and Customs Enforcement (ICE) custody at San Diego’s Otay Mesa Detention Center, where M says the trauma continued, explained Ramos.
M was held in a cell with men for 12 hours as she was processed into Otay Mesa, with one detainee staring at her aggressively for the entire 12 hours, according to her attorney. After processing, M was placed in medical isolation for reasons Ramos said she could not share out of respect for M’s privacy. Later, M was brought into the shower area with men. Though she was given her own private stall, male detainees showered nearby, Ramos said.
“She began experiencing flashbacks and felt like she was going to be raped again,” Ramos said. “She felt helpless because the officers were not taking her concerns seriously. It was incredibly traumatizing.”
Ramos’ biggest concern was that once released from medical isolation, M would be placed with men in detention.
“I made numerous pleas to ICE via email and via telephone saying this woman cannot be placed with men. She’s the survivor of multiple sexual assaults at the hands of men because she’s transgender,” Ramos told Rewire. “I literally said, ‘Please give me assurance that she will not be placed with men.’”
An employee at Otay Mesa told Ramos the facility doesn’t have a unit for transgender people, which ICE confirmed in an email statement to Rewire, so once out of isolation, if she wasn’t released from detention, M would be placed with male detainees or in “protective custody.” According to Solitary Watch, involuntary protective custody is “especially common” for LGBTQ individuals and other “at-risk prisoners who live in indefinite isolation despite having done nothing wrong.”
And yet, according to ICE’s own policies, detaining trans women with men should not be a standard practice. In July 2015, ICE released the Transgender Care Memorandum, new guidelines pertaining to transgender detainees in detention, including how officials should assign individuals to facilities based on their gender identity. But Ramos has heard from a trans woman in Otay Mesa that trans women are still detained alongside men.
“It doesn’t appear ICE’s new policies are being followed,” Ramos said. “When I called the facility and spoke with a supervisor, he explained that if [M] still has male genitalia, then she will be placed with male detainees and any special, protective custody would have to come through ICE. Trans detainees shouldn’t have to choose between going into protective custody and being on lockdown for 23 hours a day or being placed in a shark’s tank.”
Human Rights Watch’s report, Do You See How Much I’m Suffering Here?: Abuse Against Transgender Women in US Immigration Detention, sheds light on how M’s experience is not unusual for undocumented transgender immigrants. Based on 28 interviews with transgender women held or being held in U.S. immigration detention between 2011 and 2015, the report details the abuses that transgender women suffer in immigration detention and the U.S. government’s inadequate efforts to address this abuse.
According to the report, it appears as if ICE isn’t prioritizing the needs of trans women in detention despite the fact that, by its own count, there are approximately 65 transgender women in its custody on any given day.
From the report:
In early 2016, the US government appeared to move away from holding transgender women in men’s facilities and began transferring many of them to a segregated unit at the Santa Ana City Jail that exclusively houses transgender women. However, at time of writing, ICE officials were unable to state whether the agency had abandoned the practice of housing transgender women with men, and they had not announced any concrete plans to do so. Under ICE policy, immigration officials may still elect to house transgender women in men’s facilities—placing them at exceptionally high risk of sexual assault and other kinds of trauma and abuse. Others may be kept indefinitely in conditions of isolation simply because authorities cannot or will not devise any safe and humane way to keep them in detention.
Even within the segregated detention unit, trans women are not safe, according to the report. Several who were detained inside Santa Ana City Jail told Human Rights Watch that they were “regularly subjected to humiliating and abusive strip searches by male guards; have not been able to access necessary medical services, including hormone replacement therapy, or have faced harmful interruptions to or restrictions to that care; and have endured unreasonable use of solitary confinement.”
Ebadolahi told Rewire current U.S. immigration policies only subject traumatized, vulnerable asylum seekers to more trauma—and M is one of the more “fortunate” ones. After successfully passing her credible fear interview, M was released from detention on April 11.
“We’re talking about a transgender woman who is a survivor of multiple rapes, who has post-traumatic stress disorder, who has disabilities, including a seizure disorder, who has gone through a lifetime of hurt, and for who the simple act of appearing at the port of entry and applying for asylum took an enormous effort—and despite all of these things, she is considered one of the fortunate ones because she has a pro-bono lawyer working on her behalf,” Ebadolahi said.
“How M and her attorney were treated at the port of entry and … in detention, is unconstitutional, unethical, and outrageous. We shouldn’t tolerate it. This treatment serves absolutely no legitimate, government purpose and only serves to further traumatize and marginalize very vulnerable people. No one should be subject to this kind of abuse. This has to stop.”
UPDATE: This piece has been updated to include a statement from CBP’s spokesperson.