Where is the National Strategy on AIDS?

Karen Ocamb

During the intense healthcare reform debate President Obama occasionally mentioned HIV infections and AIDS-related illnesses as among those pre-existing conditions that could no longer be used by health insurance companies to automatically exclude consumers from health insurance coverage. Yet the broader scope and crisis of the HIV and AIDS epidemic in America failed to garner much attention.

During the intense health care reform debate President Obama occasionally mentioned HIV infections and AIDS-related illnesses as among those pre-existing conditions that could no longer be used by health insurance companies to automatically exclude consumers from health insurance coverage. Yet the broader scope and crisis of the HIV and AIDS epidemic in America failed to garner much attention.

Some HIV and AIDS activists and healthcare providers, meanwhile, are experiencing that crisis as if it were the early 1980s when the Reagan administration expressed little concern about the early AIDS epidemic even as the death toll mounted.

Since 2007, activists have clamored for a national strategy on AIDS. And now they are pleading for emergency help as the economic downturn forces drastic cuts in the budgets of non-profit AIDS organizations while new HIV infection rates rise and more people need services.

Where is the sense of urgency in the Obama White House to manage the confusion and handle the crisis, they ask?

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In 2006, candidate Obama seemed to understand the need for urgency calling for “an all-hands-on-deck effort.” The first priority of the candidate’s HIV and AIDS platform was to develop a national HIV/AIDS strategyin the first year of his presidency,” a strategy “designed to reduce HIV infections, increase access to care, and reduce HIV-related health disparities” with “measurable goals, timelines, and accountability mechanisms.”

President Obama outlined the scope of the crisis on the front page of the National Office of AIDS Policy (ONAP) website: “When one of our fellow citizens becomes infected with HIV every nine-and-a half minutes, (emphasis added) the epidemic affects all Americans.”

NOAP recently stressed the impact of HIV on women:

The statistics are sobering: Every 35 minutes, a woman tests positive for HIV in the United States. While women in the U.S. represented 8 percent of AIDS diagnoses in the 1980’s, they now account for 27 percent. The HIV epidemic in the U.S. disproportionately impacts women of color: HIV/AIDS is one of the leading causes of death among black women and Latinas.

The demographic disparities of AIDS cases (as of 2007) are dramatic: Whites, who make up 66 percent of the population, account for 30 percent of AIDS cases; Blacks/African Americans, 12 percent of the population, account for 49 percent of AIDS cases; Hispanic/Latino, 15 percent of the population, account for 19 percent of AIDS cases. Asians, American Indians/Alaska Native and Native Hawaiian/Other Pacific account for less than one percent of the AIDS cases.

The CDC statistics for men who have sex with men (MSM) are alarming. Though only an estimated 4 percent of the U.S. male population (ages 13 and older), MSMs account for nearly half (48 percent) of the more than one million people living with HIV and more than half (53 percent) of all new HIV infections each year. The CDC reports that new infections have declined among heterosexuals and injection drug users, but the “annual number of new HIV infections among MSM has been steadily increasing since the early 1990s,” which the CDC attributes to complacency resulting from the availability of antiretroviral treatment and reduced use of condoms. (See CDC Surveillance breakdown here).

But the headline-grabbing news came in August 2008 when the CDC discovered they had been underreporting the annual rate of new HIV infections. They estimated that there were approximately 56,300 new HIV infections in 2006, about 40 percent higher than the 40,000 new infections per year the CDC previously reported.

Dr. Kevin Fenton, director of the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, made it clear that the new estimate did not represent an actual increase in the number of new HIV infections, but resulted from more sophisticated monitoring systems.

Richard Wolitski, then-acting director of the CDC’s division of HIV/AIDS prevention, said the new estimates “reveal that the U.S. epidemic is — and has been — worse than previously estimated and serve as a wake-up call for all Americans.”

But the wake up call has been largely ignored, according to a survey released by the Kaiser Family Foundation in April 2009. That study found that “Americans’ sense of urgency about HIV/AIDS as a national health problem has fallen dramatically,” as had concern for personal risk of HIV infection.

There are consequences for complacency. Newsweek reported on February 26 — citing a recent report in the New England Journal of Medicine — conditions in Washington, D.C. remain near-overwhelming:

More than 1 in 30 adults in Washington, D.C., are HIV-infected—a prevalence higher than that reported in Ethiopia, Nigeria, or Rwanda. Certain U.S. subpopulations are particularly hard hit. In New York City, 1 in 40 blacks, 1 in 10 men who have sex with men, and 1 in 8 injection-drug users are HIV-infected, as are 1 in 16 black men in Washington, D.C. In several U.S. urban areas, the HIV prevalence among men who have sex with men is as high as 30 percent—as compared with a general-population prevalence of 7.8 percent in Kenya and 16.9 percent in South Africa.

Additionally, “more than 20 percent of the estimated 1 million HIV-positive Americans are unaware of their status.” Newsweek concluded: “It’s time to admit that HIV is still a major threat to Americans.”

Last April, NOAP launched a new five year AIDS Awareness campaign and on April 1 the CDC announced an expansion of their HIV testing initiative by $31.5 million, for another three years to approximately $142.5 million over all. The CDC said they tested over 1.4 million Americans since the initiative began in 2007, with more than 10,000 people newly diagnosed with HIV and “the vast majority” linked to care.

There are other signs the Obama administration is trying to respond to the crisis. This February, the White House released its proposed budget for fiscal year 2011 with increases for domestic HIV and AIDS programs. The total U.S. government-wide spending on HIV and AIDS would increase from $26 billion to $27 billion and the total discretionary funding for the Department of Health and Human Services spending on HIV and AIDS would increase from $6.9 billion to $7.1 billion in 2011. The funding calls for an expansion and focus on treatment, care and prevention “consistent with the President’s pledge to develop a National HIV/AIDS Strategy.” In addition to funding for HIV testing, the budget proposes funding for collaborative efforts to help people with HIV with co-infections of tuberculosis, hepatitis, and sexually transmitted diseases.

The budget proposal also calls for:

  • $40 million increase in funding for the Ryan White HIV/AIDS Program for care and treatment programs to a total of $2.3 billion, of which $679 million is for Ryan White Part A medical and support services in eligible metropolitan areas and transitional grant areas and $855 million is for the AIDS Drug Assistance Program – an increase of $20 million;
  • an increase of $37.9 million for prevention at the CDC;
  • a $98.7 million increase for the National Institutes of Health for research for a total of $3.2 billion in 2011.
  • Obama also proposes a $5 million increase to  $340 million for the Housing and Urban Development (HUD) Housing Opportunities for Persons with AIDS (HOPWA) program and a request (emphasis added) for $19 billion for the Housing Choice Voucher program to help more than two million extremely low- to low- income families with rental assistance. Obama’s budget also includes $117 million for the Substance Abuse and Mental Health Services Administration Budget.

There has also been some movement on the development of a national strategy on AIDS. The White House convened three consultations plus an inter-agency meeting which is posted online — and ONAP held 14 community meetings with the intention of presenting the national strategy on AIDS by June.

On Friday, (April 9), ONAP released a summary of those meetings and online suggestions in a report, Community Ideas for Improving the Response to the Domestic HIV Epidemic, which cites “a core set of common themes…including: improving access to care, reducing stigma surrounding HIV, and coordinating HIV prevention and treatment.”  ONAP Director Jeffrey S. Crowley said he hopes the report “will serve as a resource as we strive to develop a new strategic approach to tackling the HIV/AIDS epidemic in the United States and take steps to better coordinate the federal government’s response.”  

But Obama’s budget has yet to be approved by Congress and many AIDS activists are frustrated that there is still no overall coordinated AIDS strategy. Crowley promised a plan by the end of 2009 but instead issued a “Call to Action” that appeared to go largely unheeded.

The Coalition for a National AIDS Strategy issued its own call and came up with its own set of recommendations for a strategy. Jeffrey King, executive director of In The Meantime Men, an HIV-focused wellness group for African American MSMs, said the community meeting in Los Angeles occurred on the same Sunday as AIDS Project Los Angele’s popular AIDS Walk. King said only about 100 people attended, many of whom were from an HIV housing facility begging for help not to be closed. It closed anyway.

King said he is trying to keep his small agency afloat during the economic downturn. But finding funding is difficult and the director of the California Office of AIDS plays politics with funding grants, he said. The L.A. County Office of AIDS Programs and Policy has been very helpful, however.

Pedro García, director of Youth Services & Proyecto Orgullo at BIENESTAR, a grass-roots Latino-oriented non-profit that helps underserved communities of color disproportionately impacted by HIV/AIDS (including straight and LGBTs immigrants and a large transgender cliental) said his organization is also facing financial difficulties.

“The cuts in funding that took place last year impacted BIENESTAR heavily. We lost complete funding for the Youth Program from the [LA County] Office of AIDS Programs and Policy. We also were heavily impacted in cuts for Care Services programs such as Case Management, Peer Support, Treatment Education and Housing, to name a few. And in addition, BIENESTAR currently has NO funding for Latina Women at Sexual Risk – however, services for this population have not been interrupted. This is the type of commitment that BIENESTAR has toward the Latino Community.”

“What this decreased funding for programs and services translates to is more cases of HIV infection occurring in the Latino population and making the work that BIENESTAR does, that much harder to achieve,” said Oscar De La O, Executive Director of BIENESTAR.

Ronald Johnson, the African American HIV-positive deputy director of AIDS Action Council, countered the prevailing perception.

“Actually there is a sense of real urgency within the White House both by the President and the National Office of AIDS Policy,” Johnson said. “I realize its taking longer than some of us thought to see a draft [of the Strategy] but it’s our understanding that the draft is underway and I think any delay – and certainly the focus on health care reform – which benefits people living with HIV/AIDS – is a factor.”

Johnson said that evidence of the urgency is in the sheer amount of work the White House is doing to reverse “eight years of absolute neglect of the domestic HIV epidemic from the previous administration.”

He noted that for the first time, the CDC is funding prevention messages that target MSM and the new national surveillance system resulted in the revised estimates of new HIV infections each year.

Further evidence might be the April 5 announcement by Health and Human Services Secretary Kathleen Sebelius of the release of more than $1.84 billion in grants though Health Resources and Services Administration, which oversees the Ryan White HIV/AIDS program.

“These grants help ensure Americans, especially those in underserved rural and urban communities, affected by HIV/AIDS get access to the care they need through quality health care and support systems,” Sebelius said in a press release.

The grants are allocated in three areas of the Ryan White program: Part B gets about $1.145 billion sent to states and territories, with $800 million of that total designated for ADAP, with other money going to 16 states based on a formula (list of Part B awards here). Part A gets $652 million for primary care and support services, including $44.8 million for the Minority AIDS Initiative and Part C receives more than $48.1 million for early intervention services administered by community-based organizations.

But Michael Weinstein, president of the Los Angeles-based global treatment and advocacy AIDS Healthcare Foundation is not overly impressed. “The combination of flat funding and steep drug price rises has put the ADAP program in great jeopardy,” Weinstein said. “We should be able to expect something much better from the Democrats on AIDS.”

Johnson said AIDS Action Council and other AIDS groups are gearing up for the expected budget fight as Congress takes up appropriations. “We are going to press the case that even though there are increases in the president’s budget, the need and the epidemic are such that even greater funds are called for.”

But an even larger issue looms: figuring out how to integrate the AIDS appropriations into the National AIDS Strategy – overlayed with the new heath care reform bill, which Johnson said they are still reading, with its implementation “down the road. That is the work we are doing now.”
For instance, the health care reform bill eliminates the coverage cap – otherwise known as the “hole in the donut” for Medicare Part D Prescription drugs  by 2020. While non-HIV infected Americans who need prescription medications may have difficultly deciphering the year changes in the plan, for people living with HIV and AIDS the issue is expensive and could mean life or death.

“We’re still asking ourselves what this means,” Johnson said. Immediately, some people will be eligible for a $250 rebate. “It’s small but in these times, every 50 cents helps for some people,” especially since many people living with AIDS are not able to get out of the donut hole. In 2011, the 50 percent discount for name brand drugs will go into effect for people in the coverage gap.

“People living with HIV/AIDS can use ADAP to count for the true out of pocket expenses requirement,” Johnson said. But reminded that many state ADAPs are in danger of being cut for lack of funding, Johnson said, “above and beyond health care reform, we’ve strongly advocated for a $126 million emergency appropriations for ADAP this year and also for the appropriations bills that Congress will be developing for the fiscal year that begins October 1. The funding situation for ADAP continues to be a critical issue.”

With rising HIV infection rates, with budget shortfalls severely impacting the local service agencies at a time when more services are needed, with state governments cutting funding to deal with their own financial woes, and with a lack of an overall emergency strategy – the day may soon come when AIDS activists will no longer feel as if they were living in the early 1980s – they may actually be reliving them.

Analysis Human Rights

From Protected Class to High-Priority Target: How the ‘System Is Rigged’ Against Unaccompanied Migrant Children

Tina Vasquez

Vulnerable, undocumented youth who pose no real threat are being stripped of their right to an education and instead sit in detention awaiting deportation.

This is the first article in Rewire’s two-part series about the U.S. immigration system’s effects on unaccompanied children.

Earlier this month, three North Carolina high school students were released from a Lumpkin, Georgia, detention center after spending more than six months awaiting what seemed like their inevitable fate: deportation back to conditions in Central America that threatened their lives.

Wildin David Guillen Acosta, Josue Alexander Soriano Cortez, and Yefri Sorto-Hernandez were released on bail in the span of one week, thanks to an overwhelming community effort involving pro bono attorneys and bond money. However, not everyone targeted under the same government operation has been reprieved. For example, by the time reports emerged that Immigration and Customs Enforcement (ICE) had detained Acosta on his way to school in Durham, North Carolina, the government agency had already quietly deported four other young people from the state, including a teenage girl from Guatemala who attended the same school.

Activated in January, that program—Operation Border Guardian—continues to affect the lives of hundreds of Central American migrants over the age of 18 who came to the United States as unaccompanied children after January 2014. Advocates believe many of those arrested under the operation are still in ICE custody.

Department of Homeland Security (DHS) Secretary Jeh Johnson has said that the goal of Operation Border Guardian is to send a message to those in Central America considering seeking asylum in the United States. But it’s not working, as Border Patrol statistics have shown. Furthermore, vulnerable, undocumented youth who pose no real threat are being stripped of their right to an education and instead sit in detention awaiting deportation. These youth arrived at the border in hopes of qualifying for asylum, but were unable to succeed in an immigration system that seems rigged against them.

“The laws are really complicated and [young people] don’t have the community support to navigate this really hostile, complex system. That infrastructure isn’t there and unless we support asylum seekers and other immigrants in this part of the country, we’ll continue to see asylum seekers and former unaccompanied minors receive their deportation orders,” said Julie Mao, the enforcement fellow at the National Immigration Project of the National Lawyers Guild.

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“A Grossly Misnamed” Operation

In January, ICE conducted a series of raids that spanned three southern states—Georgia, North Carolina, and Texas—targeting Central American asylum seekers. The raids occurred under the orders of Johnson, who has taken a hardline stance against the more than 100,000 families who have sought asylum in the United States. These families fled deadly gang violence in El Salvador, Honduras, and Guatemala in recent years. In El Salvador, in particular, over 400 children were murdered by gang members and police officers during the first three months of 2016, doubling the country’s homicide rate, which was already among the highest in the world.

ICE picked up some 121 people in the early January raids, primarily women and their young children. Advocates argue many of those arrested were detained unlawfully, because as people who experienced severe trauma and exhibited symptoms of post-traumatic stress disorder, generalized anxiety, and depression, they were disabled as defined under the Rehabilitation Act of 1973, and ICE did not provide reasonable accommodations to ensure disabled people were not denied meaningful access to benefits or services.

Just a few weeks later, on January 23, ICE expanded the raids’ focus to include teenagers under Operation Border Guardian, which advocates said represented a “new low.”

The media, too, has also criticized DHS for its seemingly senseless targeting of a population that normally would be considered refugees. The New York Times called Operation Border Guardian “a grossly misnamed immigration-enforcement surge that went after people this country did not need to guard against.”

In response to questions about its prioritization of former unaccompanied minors, an ICE spokesperson told Rewire in an emailed statement: “As the secretary has stated repeatedly, our borders are not open to illegal migration. If someone was apprehended at the border, has been ordered removed by an immigration court, has no pending appeal, and does not qualify for asylum or other relief from removal under our laws, he or she must be sent home. We must and we will enforce the law in accordance with our enforcement priorities.”

DHS reports that 336 undocumented Central American youth have been detained in the operation. It’s not clear how many of these youth have already been deported or remain in ICE custody, as the spokesperson did not respond to that question by press time.

Acosta, Cortez, Sorto-Hernandez, and three other North Carolina teenagersSantos Geovany Padilla-Guzman, Bilmer Araeli Pujoy Juarez, Pedro Arturo Salmeron—have become known as the NC6 and the face of Operation Border Guardian, a designation they likely would have not signed up for.

Advocates estimate that thousands of deportations of low-priority migrants—those without a criminal history—occur each week. What newly arrived Central American asylum seekers like Acosta could not have known was that the federal government had been laying the groundwork for their deportations for years.

Asylum Seekers Become “High-Priority Cases”

In August 2011, the Obama administration announced it would begin reviewing immigration cases individually, allowing ICE to focus its resources on “high-priority cases.” The assumption was that those who pose a threat to public safety, for example, would constitute the administration’s highest priority, not asylum-seeking high school students.

But there was an indication from DHS that asylum-seeking students would eventually be targeted and considered high-priority. After Obama’s announcement, ICE released a statement outlining who would constitute its “highest priorities,” saying, “Specifically individuals who pose a threat to public safety such as criminal aliens and national security threats, as well as repeat immigration law violators and recent border entrants.”

In the years since, President Obama has repeatedly said “recent border crossers” are among the nation’s “highest priorities” for removal—on par with national security threats. Those targeted would be migrants with final orders of removal who, according to the administration, had received their day in court and had no more legal avenues left to seek protection. But, as the American Civil Liberties Union (ACLU) reported, “recent border entrant” is a murky topic, and it doesn’t appear as if all cases are being reviewed individually as President Obama said they would.

“Recent border entrant” can apply to someone who has been living in the United States for three years, and a border removal applies “whenever ICE deports an individual within three years of entry—regardless of whether the initial entry was authorized—or whenever an individual is apprehended by Customs and Border Protection (CBP),” explained Thomas Homan, the head of ICE’s removal operations in a 2013 hearing with Congress, the ACLU reported.

Chris Rickerd, policy counsel at the American Civil Liberties Union’s Washington Legislative Office, added that “[b]ecause CBP refuses to screen the individuals it apprehends for their ties to the U.S., and DHS overuses procedures that bypass deportation hearings before a judge, many ‘border removals’ are never fully assessed to determine whether they have a legal right to stay.”

Over the years, DHS has only ramped up the department’s efforts to deport newly arrived immigrants, mostly from Central America. As the Los Angeles Times reported, these deportations are “an attempt by U.S. immigration officials to send a message of deterrence to Central America and avoid a repeat of the 2014 crisis when tens of thousands of children from Honduras, El Salvador and Guatemala arrived at the U.S. border.”

This is something Mao takes great issue with.

“These raids that we keep seeing are being done in order to deter another wave of children from seeking asylum—and that is not a permissible reason,” Mao said. “You deport people based on legality, not as a way of scaring others. Our country, in this political moment, is terrorizing young asylum seekers as a way of deterring others from presenting themselves at the border, and it’s pretty egregious.”

There is a direct correlation between surges of violence in the Northern Triangle—El Salvador, Guatemala, and Honduras—and an uptick in the number of asylum seekers arriving in the United States. El Salvador, known as the murder capital of the word, recently saw an explosion of gang violence. Combine that with the possible re-emergence of so-called death squads and it’s clear why the number of Salvadoran family units apprehended on the southern border increased by 96 percent from 2015 to 2016, as Fusion reported.

Much like Mao, Elisa Benitez, co-founder of the immigrants rights’ organization Alerta Migratoria NC, believes undocumented youth are being targeted needlessly.

“They should be [considered] low-priority just because they’re kids, but immigration is classifying them at a very high level, meaning ICE is operating like this is a population that needs to be arrested ASAP,” Benitez said.

The Plight of Unaccompanied Children

Each member of the NC6 arrived in the United States as an unaccompanied child fleeing violence in their countries of origin. Acosta, for example, was threatened by gangs in his native Honduras and feared for his life. These young people should qualify as refugees based on those circumstances under international law. In the United States, after they present themselves at the border, they have to prove to an immigration judge they have a valid asylum claim—something advocates say is nearly impossible for a child to do with no understanding of the immigration system and, often, with no access to legal counsel—or they face deportation.

Unaccompanied children, if not immediately deported, have certain protections once in the United States. For example, they cannot be placed into expedited removal proceedings. According to the American Immigration Council, “they are placed into standard removal proceedings in immigration court. CBP must transfer custody of these children to Health and Human Services (HHS), Office of Refugee Resettlement (ORR), within 72 hours.”

While their court proceedings move forward, HHS’s Office of Refugee Resettlement manages the care of the children until they can ideally be released to their parents already based in the country. Sometimes, however, they are placed with distant relatives or U.S. sponsors. Because HHS has lowered its safety standards regarding placement, children have been subjected to sexual abuse, labor trafficking, and severe physical abuse and neglect, ThinkProgress has reported.

If while in the care of their family or a sponsor they miss a court date, detainment or deportation can be triggered once they turn 18 and no longer qualify for protections afforded to unaccompanied children. 

This is what happened to Acosta, who was placed with his mother in Durham when he arrived in the United States. ICE contends that Acosta was not targeted unfairly; rather, his missed court appearance triggered his order for removal.

Acosta’s mother told local media that after attending his first court date, Acosta “skipped subsequent ones on the advice of an attorney who told him he didn’t stand a chance.”

“That’s not true, but it’s what they were told,” Benitez said. “So, this idea that all of these kids were given their day in court is false. One kid [we work with] was even told not to sign up for school because ‘there was no point,’ it would just get him deported.”

Benitez told Rewire the reasons why these young people are being targeted and given their final orders of removal need to be re-examined.

Sixty percent of youth from Central America do not ever have access to legal representation throughout the course of their case—from the time they arrive in the United States and are designated as unaccompanied children to the time they turn 18 and are classified as asylum seekers. According to the ACLU, 44 percent of the 23,000 unaccompanied children who were required to attend immigration court this year had no lawyer, and 86 percent of those children were deported.

Immigration attorneys and advocates say that having a lawyer is absolutely necessary if a migrant is to have any chance of winning an asylum claim.

Mao told Rewire that in the Southeast where Acosta and the other members of the NC6 are from, there is a pipeline of youth who arrived in the United States as unaccompanied children who are simply “giving up” on their valid asylum claims because navigating the immigration system is simply too hard.

“They feel the system is rigged, and it is rigged,” Mao said.

Mao has been providing “technical assistance” for Acosta and other members of the NC6. Her organization doesn’t represent individuals in court, she said, but the services it provides are necessary because immigration is such a unique area of law and there are very few attorneys who know how to represent individuals who are detained and who have been designated unaccompanied minors. Those services include providing support, referrals, and technical assistance to advocates, community organizations, and families on deportation defense and custody issues.

Fighting for Asylum From Detention

Once arrested by ICE, there is no telling if someone will linger in detention for months or swiftly be deported. What is known is that if a migrant is taken by ICE in North Carolina, somewhere along the way, they will be transferred to Lumpkin, Georgia’s Stewart Detention Center. As a local paper reported, Stewart is “the last stop before they send you back to whatever country you came from.”

Stewart is the largest detention center in the country, capable of holding 2,000 migrants at any time—it’s also been the subject of numerous investigations because of reports of abuse and inadequate medical care. The detention center is run by Corrections Corporation of America, the country’s largest private prison provider and one that has become synonymous with maintaining inhumane conditions inside of its detention centers. According to a report from the National Immigrant Justice Center, Stewart’s remote location—over two hours away from Atlanta—hinders the facility from attracting and retaining adequate medical staff, while also creating barriers to visitation from attorneys and family members.

There’s also the matter of Georgia being notoriously tough on asylum seekers, even being called the “worst” place to be an undocumented immigrant. The Huffington Post reported that “Atlanta immigration judges have been accused of bullying children, badgering domestic violence victims and setting standards for relief and asylum that lawyers say are next to impossible to meet.” Even more disconcerting, according to a project by Migrahack, which pairs immigration reporters and hackers together, having an attorney in Georgia had almost no effect on whether or not a person won their asylum case, with state courts denying up to 98 percent of asylum requests. 

Acosta, Cortez, and Sorto-Hernandez spent over six months in Stewart Detention Center before they were released on baila “miracle” according to some accounts, given the fact that only about 5 percent of those detained in Stewart are released on bond.

In the weeks after ICE transferred Acosta to Stewart, there were multiple times Acosta was on the verge of deportation. ICE repeatedly denied Acosta was in danger, but advocates say they had little reason to believe the agency. Previous cases have made them wary of such claims.

Advocates believe that three of the North Carolina teens who were deported earlier this year before Acosta’s case made headlines were kept in detention for months with the goal of wearing them down so that they would sign their own deportation orders despite having valid asylum claims.

“They were tired. They couldn’t handle being in detention. They broke down and as much as they feared being returned to their home countries, they just couldn’t handle being there [in detention] anymore. They’d already been there for weeks,” Benitez said.

While ICE claims the average stay of a migrant in Stewart Detention Center is 30 days, the detention center is notorious for excessively long detainments. Acosta’s own bunkmate had been there over a year, according to Indy Week reporter David Hudnall.

As Hudnall reported, there is a massive backlog of immigration cases in the system—474,000 nationally and over 5,000 in North Carolina.

Mao told Rewire that the amount of time the remaining members of the NC6 will spend in detention varies because of different legal processes, but that it’s not unusual for young people with very strong asylum cases to sign their rights away because they can’t sustain the conditions inside detention.

Pedro Arturo Salmeron, another NC6 member, is still in detention. He was almost deported, but Mao told Rewire her organization was able to support a pro bono attorney in appealing to the Board of Immigration Appeals (BIA) to stop proceedings.

Japeth Matemu, an immigration attorney, recently told Indy Week’s David Hudnall that “the BIA will tell you that it can’t modify the immigration judge’s ruling unless it’s an egregious or obvious miscarriage of justice. You basically have to prove the judge is off his rocker.”

It could take another four months in detention to appeal Salmeron’s case because ICE continues to refuse to release him, according to the legal fellow.

“That’s a low estimate. It could be another year in detention before there is any movement in his case. We as an organization feel that is egregious to detain someone while their case is pending,” Mao said. “We have to keep in mind that these are kids, and some of these kids can’t survive the conditions of adult prison.”

Detention centers operate as prisons do, with those detained being placed in handcuffs and shackles, being stripped of their personal belongings, with no ability to move around freely. One of Acosta’s teachers told Rewire he wasn’t even able to receive his homework in detention.

Many of those in detention centers have experienced trauma. Multiple studies confirm that “detention has a profoundly negative impact on young people’s mental and physical well-being” and in the particular case of asylum seekers, detention may exacerbate their trauma and symptoms of post-traumatic stress disorder. 

“People are so traumatized by the raids, and then you add detention on top of that. Some of these kids cannot psychologically and physically deal with the conditions in detention, so they waive their rights,” Mao said.

In March, Salmeron and fellow NC6 member Yefri Sorto-Hernandez received stays of deportation, meaning they would not face immediate deportation. ICE says a stay is like a “legal pause.” During the pause, immigration officials decide if evidence in the case will be reconsidered for asylum. Sorto-Hernandez was released five months later.

Benitez said that previously when she organized around detention, a stay of deportation meant the person would get released from detention, but ICE’s decision to detain some of the NC6 indefinitely until their cases are heard illustrates how “weirdly severe” the agency is being toward this particular population. Mao fears this is a tactic being used by ICE to break down young people in detention.

“ICE knows it will take months, and frankly up to a year, for some of these motions to go through the court system, but the agency is still refusing to release individuals. I can’t help but think it’s with the intention that these kids will give up their claims while suffering in detention,” Mao said.

“I think we really have to question that, why keep these young people locked up when they can be with their communities, with their families, going to school? ICE can release these kids now, but for showmanship, ICE is refusing to let them go. Is this who we want to be, is this the message we want to send the world?” she asked.

In the seven months since the announcement of Operation Border Guardian, DHS has remained quiet about whether or not there will be more raids on young Central American asylum seekers. As a new school year approaches, advocates fear that even more students will be receiving their orders for removal, and unlike the NC6, they may not have a community to rally around them, putting them at risk of quietly being deported and not heard from again.

News Health Systems

The Crackdown on L.A.’s Fake Clinics Is Working

Nicole Knight

"Why did we take those steps? Because every day is a day where some number of women could potentially be misinformed about [their] reproductive options," Feuer said. "And therefore every day is a day that a woman's health could be jeopardized."

Three Los Angeles area fake clinics, which were warned last month they were breaking a new state reproductive transparency law, are now in compliance, the city attorney announced Thursday.

Los Angeles City Attorney Mike Feuer said in a press briefing that two of the fake clinics, also known as crisis pregnancy centers, began complying with the law after his office issued notices of violation last month. But it wasn’t until this week, when Feuer’s office threatened court action against the third facility, that it agreed to display the reproductive health information that the law requires.

“Why did we take those steps? Because every day is a day where some number of women could potentially be misinformed about [their] reproductive options,” Feuer said. “And therefore every day is a day that a woman’s health could be jeopardized.”

The facilities, two unlicensed and one licensed fake clinic, are Harbor Pregnancy Help CenterLos Angeles Pregnancy Services, and Pregnancy Counseling Center.

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Feuer said the lawsuit could have carried fines of up to $2,500 each day the facility continued to break the law.

The Reproductive Freedom, Accountability, Comprehensive Care, and Transparency (FACT) Act requires the state’s licensed pregnancy-related centers to display a brief statement with a number to call for access to free and low-cost birth control and abortion care. Unlicensed centers must disclose that they are not medical facilities.

Feuer’s office in May launched a campaign to crack down on violators of the law. His action marked a sharp contrast to some jurisdictions, which are reportedly taking a wait-and-see approach as fake clinics’ challenges to the law wind through the courts.

Federal and state courts have denied requests to temporarily block the law, although appeals are pending before the U.S. Court of Appeals for the Ninth Circuit.

Some 25 fake clinics operate in Los Angeles County, according to a representative of NARAL Pro-Choice California, though firm numbers are hard to come by. Feuer initially issued notices to six Los Angeles area fake clinics in May. Following an investigation, his office warned three clinics last month that they’re breaking the law.

Those three clinics are now complying, Feuer told reporters Thursday. Feuer said his office is still determining whether another fake clinic, Avenues Pregnancy Clinic, is complying with the law.

Fake clinic owners and staffers have slammed the FACT Act, saying they’d rather shut down than refer clients to services they find “morally and ethically objectionable.”

“If you’re a pro-life organization, you’re offering free healthcare to women so the women have a choice other than abortion,” said Matt Bowman, senior counsel with Alliance Defending Freedom, which represents several Los Angeles fake clinics fighting the law in court.

Asked why the clinics have agreed to comply, Bowman reiterated an earlier statement, saying the FACT Act violates his clients’ free speech rights. Forcing faith-based clinics to “communicate messages or promote ideas they disagree with, especially on life-and-death issues like abortion,” violates their “core beliefs,” Bowman said.

Reports of deceit by 91 percent of fake clinics surveyed by NARAL Pro-Choice California helped spur the passage of the FACT Act last October. Until recently, Googling “abortion clinic” might turn up results for a fake clinic that discourages abortion care.

“Put yourself in the position of a young woman who is going to one of these centers … and she comes into this center and she is less than fully informed … of what her choices are,” Feuer said Thursday. “In that state of mind, is she going to make the kind of choice that you’d want your loved one to make?

Rewire last month visited Lost Angeles area fake clinics that are abiding by the FACT Act. Claris Health in West Los Angeles includes the reproductive notice with patient intake forms, while Open Arms Pregnancy Center in the San Fernando Valley has posted the notice in the waiting room.

“To us, it’s a non-issue,” Debi Harvey, the center’s executive director, told Rewire. “We don’t provide abortion, we’re an abortion-alternative organization, we’re very clear on that. But we educate on all options.”

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