As a public health student, first in college, now in grad school, I’ve heard the same message in almost every class: progress isn’t real progress unless everyone moves forward. On World AIDS Day, I’m reminded of how far that ideal is from reality.
We celebrate enormous scientific breakthroughs, like this summer’s FDA approval of a twice-yearly HIV-prevention injection, yet the people who need these tools most rarely have access to them.
For refugee, migrant, and asylum-seeking communities globally, HIV risk is shaped by forces far beyond individual behavior. Displacement strips people of healthcare access, exposes them to sexual violence, and forces survival decisions no one should face.
Women and girls are disproportionately harmed. These same pressures —trauma from displacement, unstable legal status, disrupted care, and chronic underinsurance—follow refugees long after they arrive here in Connecticut. Yet, we have almost no U.S.-specific data on these risks because we do not systematically track them. In Connecticut and throughout the U.S., access to antiretroviral therapy (ART) and prevention tools like PrEP is closely tied to legal status. When treatment is delayed or interrupted, people develop AIDS and drug-resistant HIV strains emerge, creating a slew of avoidable public health threats.
The painful irony is that HIV is now one of the most preventable and treatable infectious diseases on the planet. PrEP reduces HIV risk by more than 99%, and ART allows people to live long, healthy lives. Scientifically and financially, it is within reach to end HIV transmission–and subsequently, AIDS–altogether. But none of that matters if immigrant, asylum-seeking, and undocumented families can’t get near these medications. Barriers appear at every step: insurance eligibility rules, pharmacy refusals, complex paperwork, or simply the fear of interacting with institutions that could jeopardize someone’s status.
We don’t have to look beyond our own cities to see these consequences. New Haven’s refugee health and resettlement programs are closing after a $5 million federal funding cut, combined with new federal restrictions; another hit after years of reductions that began under the Trump administration and never fully reversed. In a city where 17% of residents are immigrants, most remain disconnected from HIV prevention and care. When our local resettlement agencies close, it’s not just case management that disappears. Healthcare access disappears with it.
Even programs meant to close gaps often unintentionally reinforce them. Yale New Haven Health’s Financial Assistance Program is open to all residents, but the administrative hurdles make it incredibly difficult and frustrating for many immigrant families to navigate. The Yale Refugee Health Program is a thoughtful, trauma-informed model staffed by committed clinicians, but it can only serve refugees who arrive through formal federal pathways. That excludes asylum seekers, whose cases may take years; humanitarian parolees; and undocumented families who arrived with the same need for safety and stability.
As someone new to the Northeast, living in New Haven often feels like its own version of A Tale of Two Cities. It’s not lost on me that I sit in classrooms at one of the wealthiest universities in the world, learning about cutting-edge HIV prevention tools and trials, and then walk outside into a community where many residents cannot access them at all.
HIV does not care about borders, documentation status, or visa categories. But our healthcare system does, deeply. When we tie basic prevention and treatment to immigration status, we don’t just create illness; we undermine our own national goals to “end the HIV/AIDS epidemic.” We cannot claim progress while structurally excluding the very communities most in need.
The good news is that solutions exist, and Connecticut can adopt them. California created a statewide program offering PrEP regardless of insurance or immigration status. Some cities have adopted “don’t ask, don’t report” policies, ensuring clinics do not become de facto immigration enforcement sites. Connecticut could do the same. We could expand the state PrEP Assistance Program to cover all residents. We could support pharmacies and clinics in serving people without documentation. And we could restore state-level funding for resettlement agencies, because their absence leaves a gap no cutting-edge scientific breakthrough can fill.
World AIDS Day, December 1, should not be a moment of self-congratulation. It should be a reminder that epidemics, like HIV/AIDS, are social before they are biological. As the daughter and granddaughter of immigrants, I know what it means when systems quietly signal that certain people don’t count.
If we are truly serious about ending HIV in this state and this country, then everyone must have a seat at the table. Until refugees and migrants are fully included in prevention and care, not as an afterthought but as a priority, HIV/AIDS will remain a disease of exclusion. And as U.S. healthcare continues to show us, it is no measure of health to be well adjusted to a profoundly sick society.
Nikki Tehrani is a student at the Center for Interdisciplinary Research on AIDS, Yale School of Public Health.