Training and Technical Assistance for U.S. Immigration and Customs Enforcement (ICE) Clinicians: HIV Champions Pave the Way

U.S. Immigration and Customs Enforcement (ICE) deported a record high of nearly 410,000 individuals in 2012; 96% of these removals fell into one of ICE's enforcement priorities of identification and removal of those that have broken criminal laws, recently crossed our border, repeatedly violated immigration law or are fugitives from immigration court.In past years, the majority of deportees were from Mexico and Central America.2 Although data are unavailable, a conservative estimate on our part of how many of those individuals are infected with HIV is 1,230 (using Mexico’s HIV prevalence rate, the lowest rate among the U.S. and Central America). An internal needs assessment conducted by U.S. - Mexico Border AETC Steering Team (UMBAST) in 2009 revealed that additional training was needed on how to connect HIV infected detainees to care when they were deported to their country of origin. This assessment launched AETC’s effort to address HIV training needs among U.S. ICE providers.

In working with ICE, we had to identify who to talk to, establish how to prioritize HIV training for busy clinicians, and understand how we could best gain access to facilities that house ICE detainees. Tom decided to start with the top, requesting that Congresswoman Roybal-Allard write a letter to ICE leadership advocating for AETC training. That letter ultimately connected us to Dr. Diana Elson, Chief of the Public Health, Safety, and Preparedness Unit at ICE Health Service Corps (IHSC). Diana immediately saw the value in HIV training and began to advocate for HIV training within her organization. She and Tom organized the first national ICE clinician webinar in April 2011. Over 100 ICE federal and contract clinicians participated in the webinar, Continuity of HIV Care for Patients Who May Return to Mexico or Central America. Diana, Tom, and Nicolé Mandel from the AETC National Resource Center also worked together to develop the fact sheet, Information for Health Care Providers With Patients Who Have Been Detained by U.S. Immigration and Customs Enforcement (ICE). This fact sheet provides clinicians with information on how to find out if their patient has been detained by ICE and who to contact if their patient has significant continuity of care needs.

Diana introduced us to LCDR Brent Stephen, a Health Service Administrator for the ICE Service Processing Center in Florence, Arizona. LCDR Stephen organized two in-person, interactive trainings in February and April 2013. He connected us to a Health Service Administrator at Pinal County Jail that houses an ICE section where we presented a third HIV workshop. In June 2013, we traveled to El Centro, CA and presented a fourth HIV training at the El Centro Service Processing Center. Diana also introduced us to Dr. Edith Lederman, a staff physician who is board certified in infectious diseases who helped us to continue in-person trainings, gather relevant information, and summarize training and TA findings with ICE.

We have found great partnerships with ICE.  With leadership from our champions, we easily found that perceived hurdles that were once thought to be barriers in working with ICE were more a matter of connecting with the appropriate people.  At every level we have found true partners and champions that have advocated for HIV training enabling us to provide ICE clinicians with critical information on how to link patients to HIV care in Mexico and Central America. Click here for fact sheets for providers who have patients leaving the United States for Mexico and Central American countries.

The UMBAST Federal Training Center Collaborative formally thanked Congresswoman Roybal-Allard and Dr. Diana Elson at the 2012 International AIDS Conference in Washington D.C. (click here to see video). Without the leadership and advocacy from our champions this work would not have been possible. We are grateful for their hard work and look forward to future collaborations with ICE in 2014 and beyond. We’ve chosen to share this story on ShareSpot in hopes that other AETCs may be inspired to initiate trainings and collaborate with UMBAST and ICE in their region. 

  1. U.S. Immigration and Customs Enforcement. Removal Statistics–Charts and Graphs Accessed November 5, 2013.
  2. Simanski, J and Lesley M. Immigration Enforcement Actions 2011 Annual Report. Department of Homeland Security. Accessed November 5, 2011.