United States of America

The US HIV ban - additional information

Due to the large number of inquiries on the US entry restrictions for people living with HIV/AIDS, the authors collected more detailed information on this special page.

The reader will find information on
  • background and history of the law,
  • who is concerned by the law,
  • how the law is enforced,
  • how to enter the US legally as a person with HIV/AIDS,
  • strategies on how people try to circumvent the regulations,
  • the first ever study on the effects of the law (Brighton study). 
Legal information on the US entry and residency restrictions: Go to Regulations on Entry, Stay and Residence for PLHIV - United States of America

Since 1987, HIV-positive foreigners are banned from entering the USA. Today, the forced repatriation of HIV-positive tourists still happens. Although the US HIV tourist ban has been almost universally criticised – both from within and outside the US – the restrictions remain after almost 20 years. Due to the convoluted nature of the history of this discriminatory piece of legislation, an act of Congress is required to remove it.

As our ongoing survey shows, the US is one of only a handful of countries to completely ban HIV-positive visitors, even for short term tourist stays (other countries are: Armenia, Brunei, China, Fiji, Iraq, Korea (South), Moldavia, the Russian Federation, Saudi Arabia).

Who is concerned by the law?
  • Immigrants
  • Residency and work permit applicants
  • Non-immigrant visitors requiring a visa
  • Non-immigrant visitors entering with the green I94-W form
The prohibition against entry to the United States by those with HIV applies to both immigrants and non-immigrant visitors. Immigrants with HIV face significant problems in remaining permanently in the United States. For some immigrants, however, a "waiver" of the exclusionary policy may be available. Immigrants with HIV should consult an attorney familiar with immigration standards in this area. The same is true for HIV-positives applying for a work permit or who want to pursue studies.

HIV-infected non-citizens with a legal U.S. immigration status may travel outside the United States, but should first determine whether they will be subject to the HIV exclusion upon their return and whether a waiver of the exclusion is available.

Non-immigrant visitors entering with the green I94-W form:
Citizens of certain countries are allowed to enter the US for up to 90 days without applying for a visa, as long as they are not terrorists, communists, convicts or “afflicted with a communicable disease”. These visitors will have to complete the green I94-W form before proceeding through immigration. The forms are distributed by the flight attendants. There is no specific question related to HIV on the form, but an HIV infected person is ineligible to receive a visa and ineligible to be admitted to the United States (see 2nd paragraph chapter “How is the law enforced”). [1]

Non-immigrant visitors requiring a visa:
Visa applicants are asked the same question as travellers entering with the I94-W form (“Are you afflicted with a communicable disease of public health significance?”).

The following paragraph applies for both non-immigrant visitors requiring a visa & non-immigrant visitors entering with the green I94-W form:

According to the web site www.aidsandthelaw.com “if the applicant is not aware that HIV is such a disease under US immigration law, he or she could respond ‘no’. In that case, the application would not be fraudulent. But if the applicant answers ‘no’, while knowing that individuals with HIV are barred from entry, then the applicant has committed immigration fraud, which, if discovered, is a permanent, non-waivable, basis for inadmissibility”.

How is the law enforced?

Initially, the policy was adopted by the former U.S. Immigration and Naturalization Service, now U.S. Citizenship and Immigration Services (USCIS) within the Department of Homeland Security. Subsequently, however, the U.S. Congress put this exclusion into the Immigration and Nationality Act itself, Section 212(a)(1)(A)(i) [8 U.S.C. § 1182(a)(1)(A)(i)]: 

"Any alien . . . who is determined (in accordance with regulations prescribed by the Secretary of Health and Human Services) to have a communicable disease of public health significance, which shall include infection with the etiologic agent for acquired immune deficiency syndrome" is ineligible to receive a visa and ineligible to be admitted to the United States.” 

Reform of the law in this area will require another act of Congress to repeal the ban. 

In 1990, U.S. Immigration and Naturalization Service issued an "advisory" policy regarding border inspections regarding HIV/AIDS. In the event that this policy is violated by immigration officials, however, there is no remedy or recourse available for the traveller. Under this policy, immigration and customs enforcement officials should not inquire about HIV status unless there are physical symptoms of illness or the individual makes an unambiguous and unsolicited statement of his or her status. Carrying literature pertaining to HIV/AIDS or related materials should not cause questioning regarding HIV status. However, discovery of medications used to treat HIV illness may result in questioning and a referral for a medical examination. 

In the event that an individual with HIV is identified at the border, immigration officials generally attempt to persuade the individual to return to his or her country of origin. In many cases, they will release the individual, either with or without posting any bond. The individual is then required to appear within a few days for a "deferred inspection." The individual can present evidence and have legal counsel present. Immigration officials will then determine whether the individual will be legally admitted to the United States. If an individual with HIV is identified at the border, however, immigration officials have the authority to detain the individual indefinitely, without any right to release on bail. The individual has no right to counsel and may not be permitted to communicate with others who may be able to help the individual. 

Source: www.aidsandthelaw.com/issues/entry%20to%20US.htm

Since 69% if US visits in the Brighton study were for tourism – which, according the latest INS fact sheet is not a valid reason to be granted an HIV visa waiver – many (43,4%) were concerned that they would be denied a visa if they did declare their status. [2]

However, the media often report confliction and confusing (mis-)information regarding who exactly is eligible for the HIV waiver, including this article from The Guardian. “Inadmissibility because of HIV/AIDS ‘is routinely waived’, a [US Embassy] spokesman said. ´People are given visas and the waiver many times and do travel on holidays, business and as students. It is a public health issue. In some cases it is a financial concern as well. It is not saying there is anything wrong with the person.’” [3]

Is it possible to enter the US legally with HIV?

Yes, it is possible, under certain circumstances:
  • to attend conferences
  • to receive medical treatment
  • to visit close family members
  • to conduct business
However, this requires applying for a stigmatising HIV visa waiver. Even if the waiver is granted – which may take three months or longer to obtain, and requires a personal interview at the US Embassy – the person’s passport is endorsed to show that this person may not enter the US without the waiver, which must be renegotiated on each entry. This also means that people who once apply for an HIV visa waiver will always have to go through this process when they plan to visit the US in the future, irrespective of the fact if the waiver has been granted or not.

This can cause further HIV disclosure issues on entering other countries, where immigration officers and consular staff may want to know why the passport holder is barred from the US.

Experiences collected from our contacts and other sources
  1. The passport will be marked with the mention “Allowed to enter the U.S. with HIV visa waiver only”.
    HIV-Nachrichten, Germany, no 80, May 2004
  2. A stamp is put in the passport unless the applicant asks for it to be put on a separate piece of paper attached to the passport. However, most PWHA aren't told about this option when they apply for the visa.
    Terrence Higgins Trust, by e-mail, Aug 10, 2004
  3. As I applied for a J1 and an H1B working visa including an HIV waiver, this was stamped in my passport:
    For the J1 visa:
    Annotation A77 681 388
    212 (D) (3) (A) Waiver

    The J1 visa is a non-immigrant visa for exchange visitors (e.g. au-pairs, guest professors, post doctoral associates and other short term workers) and is issued for the maximum period of 3 years). In my case, the visa was issued for 20 months from the US Consulate in Berlin (August 2001). My sponsor was the Council of International Educational Exchange. I was the first of 40.000 participants in this exchange program who openly declared her HIV status. I had to bring my entire family (although they were all HIV negative) to a physician licensed to issue health certificates for the US consulate (costs $350).

    For the H1B visa:
    Annotation 212(A) (I)

    The H1B visa programme is the primary method for bringing foreign professionals to work in the USA. If you do not have HIV, were not born in a country behind the "axis of evil" or have no other characteristics the immigration law does not favor, you can apply for a green-card with the H1B visa. The H1B visa can be issued for up to 5 years for non-immigrants. This time the University of Miami applied for my visa for duration of three years and the visa was issued in July 2003 by the US consulate in Frankfurt.

    For both visas I had to appear in person at the US consulates. A proof of coverage of my HIV related treatment from Germany and the letter of the physician licensed by the US consulate were required.

    None of the consulates informed me that there was the option to have the annotation attached on a separate form. I did not ask and was not aware of this option.

    Although the annotation in the H1B visa does not say explicitly that I required a waiver, I got pulled out at customs at entry and an officer asked me why I required a visa. He was very friendly after he heard that I was HIV infected and gave me a webpage with treatment information and wished me good health.
    HK, Germany, by e-mail, Aug 10, 2004
What are people doing to enter the US anyway?

This is not very difficult, as long a visitor has no visible symptoms of illness and/or no antiretrovirals to take. For people on treatment however, the question becomes tricky.

People on ARVs use more or less crafty strategies to circumvent the regulations. We do not legally recommend any of those.

We try to describe the US policies and how they might apply in various circumstances, and then let the reader make their own decisions about what to do.

It might well be that some of the bypassing strategies below would also be a violation of US immigration laws or other US laws. We don’t know what the consequences of such violations might be. It could be that they, too, result in a permanent ban on entry. That might not make much difference to someone, since once they're found out, they're found out and barred from re-entry anyway.

1. The probably safest strategy
  • Rebottle medications with non-prescription packaging
  • Have a letter from a clinician on you

Get the meds rebottled in neutral packaging and properly labeled by your pharmacy (which means without mentioning the nature or brand name of the drugs). To comply with US law, you need to carry a letter from a clinician which states that your drugs are prescribed for a personal medical condition. This letter should not mention HIV. Be ready to answer the question why you need these meds without hesitation (blood pressure, coronary problems, etc.).

Small, especially with today’s therapies (reduced number of pills). Plan well ahead to have everything ready.

You should carry the drugs in your hand luggage. Checked luggage is sometimes late or can get lost completely. However, be aware that the drugs can be detected more easily that way.

2. Carry the needed drugs on you, or in your luggageThis is, as the Brighton study shows below, what most people do. 

There is a certain risk of being detected, by immigration officials, or by customs. Since September 11 2001, luggage is checked more frequently and more thoroughly. If this happens, you may face deportation by the next available flight. As a consequence, there is zero chance of being readmitted to enter the US at a later occasion.


  • HIV-positives are advised to take enough medication to cover delays.
  • To comply with US law, you need to carry a letter from a clinician which states that your drugs are prescribed for a personal medical condition. This letter should not mention HIV. Be ready to answer the question why you need these meds without hesitation (blood pressure, coronary problems, etc.).
  • You should carry the drugs in your hand luggage. Checked luggage is sometimes late or can get lost completely. However, be aware that the drugs can be detected more easily that way.
  • Leaving the US with remaining ARVs in the hand luggage is not free of risk. The authors know of a case where an HIV-positive person had his hand luggage searched through customs officials after boarding the plane. His drugs were detected, he cannot return to the US anymore.
  • Take a last dose to be safe during travel, before checking in, eliminate remaining meds and ensure to have drugs available when needed after arrival. However, there is a small risk in case of delayed departure.
3. Send your meds in advance by mail 

This needs to be carefully planned:
  • Identify a US citizen to whom you can mail the drugs safely.
  • Put a note in the parcel, saying that the drugs are a donation (this is credible, as many people in the United States have no health insurance and live on donated drugs).
  • Make sure that the sender of the parcel is an HIV-negative family member, friend or a US citizen.
Plan the mailing well in advance to have enough time for a second parcel in case the first one is lost.

The most surprising conclusion of the Brighton study was that people who took up the option of mailing their drugs to the US were more likely to stop treatment than those who chose to carry their drugs with them.

This was because of the 12 people who attempted to mail their drugs ahead of time, only seven were successful (58%). This compares with 62/83 (75%) of those who took their drugs with them.

Of the five who were unsuccessful, two reported that their drugs did not reach the USA (most likely prevented from entering by US customs); one reported that their drugs arrived late; and a further two found that they were unable to mail their drugs at all. Since 9/11 the Post Office and courier firms now require a detailed description of the contents of any package sent to the US, with full details of the sender as well as the addressee. This makes the sending of antiretrovirals anonymously impossible, and once the sender includes their details, the same fears of discovery by US officials would then apply. 

This method is no longer safe.

4. Buy your meds in the US 

This looks simple, but also needs some planning.
  • Contact your health insurance to learn if drugs you purchase in the US are reimbursed (medication, including antiretrovirals, are often more expensive in the US than elsewhere).
  • Get a prescription for the medication you are taking from your doctor.
  • Take a last dose of your meds before leaving the plane.
  • Get an appointment with an HIV specialist on arrival to get a prescription.
  • Buy your drugs through a US pharmacy. 
US contacts to locate HIV specialists:
5. Considerations before stopping medications

As the Brighton study shows below, some people decide to interrupt treatment before travelling to the US. THIS CAN BE VERY RISKY.

If you are thinking of stopping your medications when travelling to the US it is imperative that you consult with either your HIV clinician or pharmacist well ahead before doing so, otherwise you run the risk of acquiring new or further resistance that could have significant future health risks. Remember also that if you do stop HAART that you may feel ill during your trip, and that you may also be more infectious.

US organisations to get in touch with:  IMPORTANT: Never ever discuss your HIV status with US officials! 

First-ever study on ban’s health effects

Until recently, there had been no research on the physical, emotional and psychological effects of the ban on HIV-positive people. Late 2003, however, a study from Brighton and Sussex University Hospitals was presented as a poster at the European AIDS Conference in Warsaw. [4]

The study sought to determine whether those attending the Lawson Unit HIV Outpatients’ Clinic in Brighton travelled with a visa waiver and/or medical insurance, and to establish how they managed their HAART medications when travelling.

A self-completion questionnaire was given to everyone who attended the clinic in February and March last year. Of 642 attendees, 346 completed the questionnaire, of which 96.5% were male, with an average age of 41.

In total, 135 (39%) respondents had travelled to the US since their HIV diagnosis, all but two of them “illegally”.

One-in-eight interrupted treatment

The most striking – and worrying – finding of the Brighton study was the way people travelling to the US without an HIV waiver managed their drugs.

Of the 83 respondents on HAART who travelled to the US, 10 (12,5%) stopped their drugs for the duration of their stay. Five chose to take treatment interruptions prior to leaving for the States, and five had problems with mailing their drugs.

Of the ten who interrupted their treatment, five were on NNRTI-based HAART, which, due to its longer half-life, must be stopped ahead of the other HAART components in order to reduce the likelihood of NNRTI mutations that could lead to clinical resistance.

In the Brighton study, only one of the five on NNRTI-based regimens stopped their NNRTI in the best-possible way after consulting with their HIV clinician. This person switched from efavirenz to tenofovir two weeks prior to stopping all drugs. The remaining four stopped their NNRTI two days, one day or at the same time as the rest of their HAART combination.

Of the three people who had short- or long-term problems due to their treatment interruption, one subsequently developed NNRTI drug resistance. This was a highly drug experienced patient who has subsequently run out of options now that he has also developed resistance to T-20.

The other two developed intermittent fevers, arthralgia, headaches and diarrhea, symptomatic of a viral load rebound, whilst in the US.

The study results confirm the fears that people with HIV are still travelling to the US and it seems they choose to go on an unplanned drug holiday because they fear they will have their drugs found on them.

Inadequate insurance

Despite the fact that 62% (n=215) of all respondents were aware that an HIV waiver was required, more than two-thirds (n=88) of all those who travelled to the US did so without adequate HIV medical insurance. This is not only risky, it is also another reason that the US says the HIV travel ban is in place: to make sure that foreigners do not place undue stress upon the US public health system.

Indeed, according to Section 212(a)(1)(A)(i) of the Immigration and Nationality Act: “The applicant must demonstrate that he or she is not currently afflicted with symptoms of the disease; there are sufficient assets, such as insurance, that would cover any medical care that might be required in the event of illness while in the United States; the proposed visit to the United States is for 30 days or less; and that the visit will not pose a danger to public health in the United States.” [5]

It is highly recommended to anybody, HIV-positive or not, to inquire the need for additional insurance coverage before any trip to any country.
Citizens of the EU, the EEA and CH are covered for trips within these countries. Form E111 needs to be carried along.

A blunt instrument

Although one of the reasons for the US HIV ban is to control and monitor HIV-positive people entering the country, of the 135 who travelled to the US, only two (1,5%) actually travelled with an HIV waiver: 98,5% entered then country without the US knowing their HIV status. The most common reason (83%) given for not applying for an HIV waiver concerned disclosure to both the US and travelling companions.

Ironically, if the law is there to prevent onwards transmission of HIV from foreign visitors, by forcing a significant minority into treatment interruption – which invariably leads to a rise in viral load and therefore, theoretically, a rise in the likelihood of transmission – it is counterproductive. [6]


President Reagan and Congress add AIDS to the list of “dangerous, contagious diseases for excluding persons from the United States”. Senator Jesse Helms’ “Helms amendment” add HIV to the exclusion list.

Dutch HIV-prevention expert Hans Paul Verhoef jailed for four days in Minneapolis en route to an AIDS meeting in San Francisco, after AZT discovered in his suitcase.

Mass boycott of 6th International AIDS Conference in San Francisco; thousands demonstrate.

International AIDS Conference moves from Boston to Amsterdam; Clinton campaign promises end to the ban by executive order.

Congress adds amendment to NIH Reauthorization Act adding HIV to the list of “communicable diseases for excluding people from the United States”. Clinton signs the bill, making the policy law.

9/11 results in increased security and bag searches, increasing concerns that HIV medication would be found.

Terrence Higgins Trust (UK) launches the „Stop the Ban“ campaign.

Senator Kerry is promising to lift the US travel ban in case of his election.
(July 10, 2004)

The President has directed the Secretary of State to request and the Secretary of Homeland Security to develop a categorical waiver for HIV-positive people seeking to enter the United States on short-term visas. The President considers the participation of people living with HIV/AIDS a critical element in the global HIV/AIDS response. A 1993 law prohibits HIV-positive people from receiving visas to visit the United States without a waiver. A categorical waiver would enable HIV-positive people to enter the United States for short visits through a streamlined process. [7] 

Authors’ note: To date, such a process has not been implemented


  1. Countries participating in the visa waiver programme (VWP):
    Andorra, Australia, Austria, Belgium, Brunei, Denmark, Finland, France, Germany, Iceland, Ireland, Italy, Japan, Liechtenstein, Luxemburg, Monaco, Netherlands, New Zealand, Norway, Portugal, San Marino, Singapore, Slovenia, Spain, Sweden, Switzerland, United Kingdom. Citizens of the mentioned countries are admitted to the United States for tourism or business for 90 days or less without obtaining a visa. 
  2. HIV Infection: Inadmissibility and Waiver Policies, US Department of Justice July 10, 1998 see www.uscis.gov/propub/ProPubVAP.jsp?dockey=2a99077363b05b4f57f9a903fc0ca1d6 
  3. www.uscis.gov/propub/ProPubVAP.jsp?dockey=bff81c6f743142d536054ea514c22282 
  4. Boseley S. Drive to end US curb on HIV visitors, The Guardian March 5, 2002 
  5. Ponnusamy K et al. A study of knowledge attitudes and health outcomes in HIV positive patients following travel to the United States of America. 9th EACS, abstract 10.1/2, 2003. 
  6. www.immigration-usa.com/ina_96_title_2.html 
  7. George W. Bush, State of the Union Address to Congress 2007, January 23, 2007, www.whitehouse.gov/stateoftheunion/2007/initiatives/hivaids.html
    consulted July 11, 2008