Herring and Rodriguez-Diaz on public charge policy and HIV incidence

HIV incidence among Hispanic populations rose 16.8% in antisanctuary counties relative to baseline counties after the Trump administration announced changes to the public charge rule in 2018, according to a study in Milbank Quarterly. Jordan Herring, Ph.D., an assistant professor at the University of South Carolina Arnold School of Public Health, led the study. Carlos Rodriguez-Diaz, Ph.D., chair and professor of community health sciences at Boston University School of Public Health, is the senior author.

The 2018 announcement expanded the public charge rule to let officials deny green cards to noncitizens based on their use of public benefit programs such as Medicaid, the Supplemental Nutrition Assistance Program and housing assistance. The researchers used AIDSVu data on county-level HIV incidence from 2010 to 2022 and sorted counties into three groups. Sanctuary counties show limited support of U.S. Immigration and Customs Enforcement (ICE) policies, anti-sanctuary counties have formal contracts with ICE to enhance enforcement, and baseline counties reflect common practice, the authors explained.

In the analysis, new HIV cases appeared to rise only in antisanctuary counties and declined in sanctuary and baseline counties. Limiting the analysis to 2010 through 2019, before the COVID-19 pandemic, the team still calculated a 12.8% increase in Hispanic HIV incidence in antisanctuary counties. Rodriguez-Diaz said the study period overlapped with the same administration's initiative to end the HIV epidemic in the United States, at a time when qualitative and experiential data were already pointing to rising new infections among Latinos.

In this interview with Managed Healthcare Executive, Herring and Rodriguez-Diaz discuss why they examined the effect of the 2018 announcement at the county level and what the pattern suggests.