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I. Executive Summary

Victoria’s condition steadily worsened during the month of July, and she began to vomit blood, and blood appeared in her urine. The detainees in Pod 3 at San Pedro became increasingly concerned for her welfare as she became too weak to sit up in her bunk. Victoria was seen in the medical clinic, but she was told only to take Tylenol and drink large amounts of water…she died a week later.

—excerpt from a cellmate’s account of the death in immigration detention of Victoria Arellano, a 23-year-old transgender detainee with HIV/AIDS

The death of Victoria Arellano in federal immigration custody is an extreme, but not surprising, example of the suffering experienced by immigration detainees with HIV/AIDS. The US Department of Homeland Security (DHS) fails to collect basic information to monitor immigrant detainees with HIV/AIDS, has sub-standard policies and procedures for ensuring appropriate HIV/AIDS care and services, and inadequately supervises the care that is provided. The consequence of this willful indifference is poor care, untreated infection, increased risk of resistance to HIV medications, and even death.

Human Rights Watch’s investigation of HIV/AIDS care for detained immigrants which included interviews with current and former detainees, DHS and detention facility officials, and an independent medical review of treatment provided, found that ICE- supervised facilities:

Failed to deliver complete anti-retroviral regimens in a consistent manner. This practice creates a risk of drug resistance that endangers the health of the detainee and can impact public health.

Failed to conduct the necessary monitoring of detainees’ clinical condition, including CD4 and viral load testing as well as resistance testing. These tests are fundamental to effective treatment of HIV and AIDS.

Failed to prescribe prophylactic medications when medically indicated to prevent opportunistic infections.

Failed to ensure continuity of care as detainees are transferred between facilities, including failure to ensure access to necessary specialty care.

Failed to ensure confidentiality of medical care, exposing detainees to discrimination and harassment.

With inadequate monitoring and unenforceable standards, it is not surprising that Human Rights Watch found that medical care for HIV positive detainees in ICE custody was delayed, interrupted, and inconsistent to an extent that endangered the health and lives of the detainees.

DHS fails to collect basic information concerning HIV/AIDS cases in the hundreds of detention facilities contracting with Immigration and Customs Enforcement (ICE) to incarcerate immigrants. Human Rights Watch requested, through the Freedom of Information Act, data as fundamental as the number of immigration detainees with HIV/AIDS—only to discover that this information is “not tracked.” Failure to collect this vital information, as well as information about the treatment and services provided to detainees with HIV/AIDS, prevents DHS from improving its programs to meet the needs of this vulnerable population.

The DHS policies and procedures for HIV/AIDS should describe appropriate treatment protocols for people living with HIV/AIDS to be followed in its own facilities as well as those it utilizes to provide care.  DHS policies and procedures, however, are conflicting, confusing and incomplete, and fail to conform to national and international guidelines for HIV/AIDS care in correctional settings. Further, DHS has failed to adopt the detention standards as formal administrative regulations, making the standards largely unenforceable. Although ICE “outsources” much of its immigration detention to local jails and facilities across the United States, its responsibility for adequate standards of care may not be delegated or evaded by contracting with third parties.

The current ICE inspection system is limited to one brief visit per year to each jail or detention center. These visits fail to provide the oversight necessary to identify and resolve the deficiencies in medical care. The Government Accountability Office (GAO) recently found serious flaws in ICE’s mechanisms for ensuring that detainee complaints, including those pertaining to medical care, are properly monitored and resolved. Further, ICE has no policies designed to protect HIV-positive detainees from harassment and discrimination by staff or other prisoners.

Without improved standards for medical care, strengthened external and internal oversight and meaningful accountability to the public, immigrant detainees with HIV/AIDS will continue to needlessly suffer, and in some cases, die in US immigration detention.  

December 2007

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