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Primary Submission Category: Migration
Impact of 2018 Immigration Policy Shifts on Hispanic HIV Incidence Across Divergent Local Policy Environments in the United States
Authors: Jordan Herring, Carlos Rodriguez-Diaz,
Presenting Author: Jordan Herring*
Background and Objective: In 2018, proposed public charge rule changes—amid intensified anti-immigrant rhetoric and heterogeneous local immigration enforcement—were widely publicized and have been linked to reduced health care access among Hispanic populations, potentially increasing HIV risk, yet little is known about how local policy context shapes these health impacts. This study examined how shifts in immigration policy and rhetoric post-2018 affected Hispanic HIV incidence rates across anti-sanctuary and sanctuary counties in the United States.
Methods: County-level HIV incidence rates for 2010-2022 were from AIDSVu. Counties were sorted into anti-sanctuary counties, sanctuary counties, or baseline counties using a county-level policy scoring system from the Immigrant Legal Resource Center. Sanctuary counties aimed to limit cooperation with federal immigration enforcement, hypothesized to protect and encourage health care access among Hispanic populations. Conversely, anti–sanctuary counties, a relatively new phenomenon, aimed to increase cooperation with federal enforcement dramatically, hypothesized to deter health care access and usage through amplifying federal immigration policy and enforcement among Hispanic populations. A triple difference-in-differences (DDD) model estimated changes in Hispanic HIV incidence rates after 2018 by county type using White HIV incidence rates as a comparison group. Black HIV incidence rates were included as placebo tests.
Findings: DDD models estimated a statistically significant 17.7% increase in HIV incidence rates among Hispanic populations in anti-sanctuary counties relative to baseline counties after 2018. Estimates for Black populations were not statistically significant, and point estimates were negative, opposite the direction for Hispanic populations, supporting the interpretation that post-2018 immigration policy shifts uniquely affected Hispanic populations.
Conclusion: Results from this study indicate that immigration policy can work against public health policy to end the HIV epidemic. Hispanic HIV incidence rates may have increased due to fear and chilling effects stemming from immigration policy, impeding the progress to end the HIV epidemic in the United States. Implications extend beyond HIV, indicating that anti-immigrant policies could lead to deterioration in a wide range of health outcomes.