Following the Trump administration’s 2018 announcement of changes to the public charge rule that would penalize immigrants for using public benefit programs, antisanctuary counties in the US saw a 16.8-percent increase in HIV cases among Hispanic populations, compared to baseline counties.
Aggressive immigration policies and rhetoric have defined both the first and second Trump administrations, and a new study led by researchers at Boston University School of Public Health (BUSPH) and the University of South Carolina reveals that this hardline immigration agenda may have contributed to an increase in HIV transmission among Hispanic populations in US counties that amplify and enforce federal anti-immigrant policies.
Published in the journal Milbank Quarterly , the study focused on the first Trump administration’s 2018 announcement of changes to the public charge rule, which greatly expanded previous versions of the rule by permitting officials to deny green cards to non-citizens based on their usage of public benefit programs such as Medicaid, the Supplemental Nutrition Assistance Program (SNAP), housing assistance, and other factors. The analysis compared county-level HIV incidence before and after the announcement of this rule, dividing counties into three categories based on their political environment and support of Immigration Customs and Enforcement (ICE) policies: sanctuary counties (limited support of ICE), antisanctuary counties (formal contracts with ICE to enhance policy enforcement), and baseline counties (general support of ICE within common practice).
After the announcement of the new public charge rule in 2018, the study showed a 16.8-percent increase in HIV incidence among Hispanic populations living in antisanctuary counties, compared to baseline counties. The researchers also examined HIV incidence by race, and found no comparable increase among Black populations, which further indicates that post-2018 immigration policies and rhetoric uniquely affected Hispanic communities.
These results reveal how anti-immigration policies can impede public health policy and prevent the US from achieving its longstanding goal to end the HIV epidemic.
“Fear and the chilling effects of anti-immigrant policies can deter people from seeking healthcare, testing, prevention, and treatment,” says study senior author Dr. Carlos Rodriguez-Diaz , chair and professor of community health science at BUSPH. “These findings underscore a critical reality: efforts to end the HIV epidemic cannot succeed when immigration policies make communities afraid to access essential services.”
These findings also provide important context and insight as a new public charge rule under the current Trump administration will soon go into effect in September. The new rule rescinds the Biden-era changes to the rule, which had limited inadmissibility factors for green card applications. This policy will once again permit officials to consider use of public benefit programs in determining whether green card applicants should be denied legal status on the basis that they will be unable to financially support themselves.
“Our findings show that public charge rule changes affect access to healthcare and, ultimately, health outcomes,” says study lead and corresponding author Dr. Jordan Herring , who conducted the study while at Stanford University School of Medicine, and is currently an assistant professor in the Department of Health Services Policy and Management at the University of South Carolina Arnold School of Public Health. “Immigration law is confusing and hard to understand. Many immigrants err on the side of immense caution—even those who are legally present. The new proposed public charge rule changes are even more ambiguous than before and will likely invoke further and more severe chilling effects, leading to worse access to healthcare and widening disparities.”
For the study, Dr. Rodriguez-Diaz and Dr. Herring analyzed county-level HIV incidence rates in sanctuary, antisanctuary, and baseline US counties from 2010–2022, using data from AIDSVu, an online mapping tool that visualizes the effects of the HIV epidemic in US communities. New cases of HIV appeared to rise only in antisanctuary counties, and declined in sanctuary and baseline counties.
While safety precautions and strains on the healthcare system led to delays in healthcare testing and treatment services during the COVID-19 pandemic, the researchers were able to determine that pandemic-related challenges did not substantially contribute to the observed rise in HIV cases among Hispanic residents in antisanctuary cities. When restricting the analysis to 2010-2019 (the period prior to the pandemic), the team still calculated a 12.8-percent increase in Hispanic HIV incidence in antisanctuary counties. The results also showed a decrease in prescription rates for pre-exposure prophylaxis (PrEP)—medication that is taken to lower the risk of contracting HIV—in antisanctuary counties, although the association was not strong.
Broadly, the study reveals the need for the US to better address the social and structural barriers that prevent people from accessing HIV care and prevention services. Hispanic individuals account for nearly one-third of all new HIV infections in the US and are more likely to learn their HIV status at a late stage. Importantly, the researchers also emphasize that hostile policies and xenophobic language that targets immigrants and restricts their basic rights can lead to negative health consequences beyond HIV.
“Immigration policy is health policy,” says Dr. Rodriguez-Diaz. “When laws and rhetoric push people into the shadows, they do not make communities safer and undermine the health of us all.”
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About Boston University School of Public Health
Founded in 1976, Boston University School of Public Health is one of the top ten ranked schools of public health in the world. It offers master's- and doctoral-level education in public health. The faculty in six departments conduct policy-changing public health research around the world, with the mission of improving the health of populations—especially the disadvantaged, underserved, and vulnerable—locally and globally.
Milbank Quarterly
Observational study
People
Impact of 2018 Immigration Policy Shifts on Hispanic HIV Incidence Across Divergent Local Policy Environments in the United States
3-Aug-2026