Peace Corps Updates and Clarifies HIV Policies

Earlier this year Peace Corps medically separated volunteer Jeremiah Johnson because he had become HIV positive while serving in Ukraine. In his case, Peace Corps had used a longtime policy related to medical conditions acquired during service. It stated that if a medical condition could not be resolved within 45 days, a volunteer was judged unable to return to his or her post and would be medically separated from Peace Corps.

Johnson felt he had been discriminated against and that his health and ability to continue Peace Corps service had not been properly evaluated. He contacted the ACLU. One of their attorneys took a look at the case and felt that Peace Corps had violated the Rehabilitation Act of 1973. The ACLU wrote a letter to Peace Corps. What followed was much bad press for Peace Corps, support for Mr. Johnson, and questions from Senator Christopher Dodd, Chairman of the Senate Foreign Relations Committee and a former Peace Corps Volunteer. We had the busiest discussion ever on our listserv. While a troubling and traumatic experience for Johnson, it was a public relations mess for Peace Corps.

I wrote a letter to Peace Director Tschetter on our organization’s behalf, objecting to Johnson’s treatment and suggesting that this negative and embarrassing situation was an opportunity for Peace Corps to re-look and update its policies regarding HIV as an issue impacting Peace Corps service.

Since the later nineties Peace Corps’ policy regarding applicants who are HIV positive is to treat each case individually, and make judgments about an applicant’s ability to serve based on an individual’s medical history, current health, and other medical information. I have been told that such factors as viral load and T cell count and the consistency of these and other factors over time go into the decision making. I am not aware of any HIV positive nominee making it through the medical evaluation process, and then going on to serve as a volunteer. Peace Corps is legally required to keep all medical information about volunteers confidential. We only know what Mr. Johnson himself has told us, along with some of the Peace Corps correspondence he has released.

Peace Corps service for volunteers living with HIV is further complicated by the fact that a significant number of countries where Peace Corps serves require Peace Corps Volunteers to be tested and shown to be free of HIV. In some cases visas and other documents such as work permits are required, and these are not issued to anyone with HIV. Ukraine is one of these countries. So even if Peace Corps would have been willing to keep Mr. Johnson as an active volunteer, he would have had to be transferred to another country that did not have the same or similar HIV status requirement.

Peace Corps’ Updated Practices and Policies:

Peace Corps was under fire and did react fairly quickly, It appointed an internal HIV task force to examine Peace Corps’ policies and practices regarding HIV as a medical factor affecting service, either for volunteers starting service with HIV disease or acquiring it during their tour.

I received a response to my April 14 letter to Director Tschetter on June 19. In it he outlined some of the continuing practices and policies along with some changes.

This first is a restatement of an ongoing policy that has been in place using this or similar language since the later 90s. Terms like “reasonable accommodation” and “without undue hardship” refer to language in the Rehabilitation Act of 1973.

“The Peace Corps has a policy in place to ensure that applicants for Volunteer service who have legally disabling conditions, including HIV, are provided individualized medical assessment and are not automatically excluded from consideration. This policy is designed to ensure that applicants receive individualized medical assessments to determine whether accommodations are necessary and, if so, whether accommodations are reasonable and may be provided without undue hardship.”

Next is a revision of the current 45 day limit to resolve a medical condition that occurs during service.

“In cases where the Peace Corps determines that the individualized assessment cannot be made with respect to HIV, or other conditions constituting legally recognized disabilities within the standard 45-day period, the Peace Corps will invoke an existing authority to extend that period up to an additional 60 days. In addition, since we have recently changed our medical technical guidelines to provide that the return of newly diagnosed, HIV-positive Volunteer to the U.S. is no longer mandatory, the assessment can be made in a Peace Corps country to the extent possible as determined by our doctors.”

Director Tschetter then continues with an important commitment.

“Thus, our commitment to accommodate HIV-positive applicants and Volunteers where reasonable and possible is firm. If qualified applicants and qualified Volunteers can be reasonably accommodated without placing and undue burden on the agency, they will not be medically disqualified, or medically separated from service, as the case may be.”

My own take is that a lot of mindset at Peace Corps about HIV and Peace Corps service has been stuck in the past. Although Peace Corps did change its policies regarding HIV infection and service after medications became available that allowed HIV to be treated as a chronic rather than fatal condition, I think a lot of the old attitudes and concerns remained. There was little sense that people living with HIV could perform well as volunteers, and stay well while they were serving. One good thing to come out of Jeremiah Johnson’s bad experience is what looks like a new and fresh look by Peace Corps.

The Realities of Serving as a Volunteer with HIV:

In his letter to me, and in other statements Peace Corps has made over the last couple of months, Director Tschetter described some of the realities facing Peace Corps Volunteers in the field. They typically live and work at the grassroots level, often in remote and inhospitable locations. Reasonable health care facilities are rarely nearby.

As an organization, our Steering Committee (our board) has long taken the position that Peace Corps should provide opportunities for volunteers with HIV in countries and locations where health conditions and health care are reasonable. Those of us who know the challenges of living in remote African or Latin American villages where hardship and disease are endemic would advise anyone with a compromised immune system to avoid serving in such an environment. But there are other Peace Corps assignments in the Caribbean, perhaps countries like South Africa, maybe Botswana, and in the larger cities of Latin America where health conditions and medical facilities are reasonable.

There is the reality of many Peace Corps countries that require proof of negative HIV status of Peace Corps volunteers assigned there. Strange to think about this at the time when the Senate and House have just voted to repeal the HIV Travel and Immigration Ban in our own country, as part the reauthorization of PEPFAR (The President’s Emergency Plan for AIDS Relief). Perhaps this will encourage some of the countries where Peace Corps serves to lift their bans.

Most of us have friends who are long time survivors of HIV. I asked two friends, both having become infected with HIV after their Peace Corps service if they would be comfortable serving in Peace Corps again or Peace Corps Response (was Crisis Corps). Their answers were interesting.

Michael, who is an AIDS activist and author had actually considered a Peace Corps Response AIDS related assignment. He has done much travel in the developing world, and has written extensively about AIDS activism, education, prevention and care in Africa, India and Southeast Asia.

I asked him about getting and taking his medications while in some of the remote areas he visited. He said he just took a couple of months supply along with him, and that he was never more than a couple of days away from towns or cities where HIV medication was available at pharmacies, if his medications would become lost or stolen. He also noted that there are usually no consequences missing a few days of HIV medications if one is strong and healthy. He did say that he would probably keep his HIV status to himself because of potential security issues.

Another friend, Craig, is also well traveled. He returned recently to the West African country where he served, and has traveled extensively in Latin America, all since his HIV infection. He also took extra supplies of medications along on his trips, and had no concerns about getting additional medications if he ran out. He also has expressed interest in Peace Corps Response. Three years ago he had actually applied for a Crisis Corps assignment in Fiji that matched his area of expertise perfectly. There were some delays in getting the project going, and Craig took on another assignment at his then current job that prevented him from accepting the Fiji assignment.

I asked Craig about opportunistic infections and diseases that people with HIV need to avoid. He did have some concerns, and felt that assignments in much of Africa and some other parts of the developing world might be risky for people with HIV. On the other hand, Peace Corps was in many countries where such health concerns were minor.

There is so much talent and energy in the HIV community. It seems to me that Peace Corps Response would be an ideal and successful testing ground for volunteers who are living with HIV.

Jeremiah Johnson Tells His Story:

In the July/August 2008 POZ Magazine, Jeremiah Johnson tells his story to reporter/writer Bob Ickes. It’s a terrific piece and we hear the story from Johnson’s point of view. I encourage you all to read it.