Fortunata Kasege outside her hom in the Bronx, N.Y. (Credit: Amy Lieberman)

NEW YORK (WOMENSENEWS)-- More than three years after the United States lifted a 22-year-old travel ban on people living with HIV, Fortunata Kasege still feels the acute distance between New York City and her native Dar es Salaam, Tanzania.

"It's my dream that some miracle worker takes me home and reunites me with my mom. She has high blood pressure and I worry about her all the time," Kasege, 38, told Women's eNews. "I'm just begging her to hang on. At least now there is hope."

Kasege, who is HIV-positive, no longer worries about being denied entry back into the United States because of the human immunodeficiency virus. She is concerned about the money -- at least $2,000 -- needed to cover legal paperwork for a green card and at least $1,500 more for the round-trip flight.

The amount is steep for the single mother, who works only part time in a clothing store because of a sustained ankle injury. Kasege and her daughter bounced around two city shelters shortly after moving to New York City last summer. They now live in a sparse apartment in the Bronx that took her five months to furnish with two beds.

"Just a few months ago I had my own apartment in Texas and everything and then I am in a shelter. It's not easy with HIV. It just becomes another thing that you are dealing with," she said.

The January 2010 repeal of the HIV-travel ban has broadened the vision of a path forward for women like Kasege and Bianca Fung A Loi, 43, but it has not provided an automatic ticket back home for them and other HIV-positive immigrants in New York City, who must consider complicated legal, financial and medical dilemmas.

Wary About Leaving

Only one or two of the 138 HIV-positive clients Timothy Au assists as a care coordinator at APICHA Community Health Center in downtown Manhattan have returned to visit their countries of origin in East Asia since 2010, he said.

Many of Au's clients are undocumented. Yet those with documentation are also wary about leaving the United States since they aren't sure how to find treatment in homelands such as Indonesia and mainland China.

Fung A Loi, originally from Suriname, learned of her HIV status five years ago, shortly after her husband slipped into a coma and died from toxoplasmosis, a parasitic disease that can prove fatal for people with weakened immune systems. Fung A Loi was relieved at the surprise death of her husband, the father of her three children. He had abused her for the bulk of their relationship, and she fled South America 12 years ago to escape his torment.

But her diagnosis brought on new fears, since Fung A Loi associated HIV with a cousin in Suriname who had died of AIDS and was treated poorly in health clinics.

"Since then, nothing has really changed back home, in terms of stigma, and health care is not as accessible as it is here," Fung A Loi said in an interview in her Queens home. "As an undocumented person here, I was looking at a mountain of health care expenses and I was very concerned about that."

Fung A Loi is in the process of gaining legal residency through the Violence Against Women Act, which enables abused spouses of U.S. citizens and residents to gain legal status. She plans to visit her mother and brother in Suriname for a short visit sometime this year.

Widespread Misconceptions

The HIV-travel ban was adopted in 1987, amid the widespread misconception that HIV/AIDS could be transmitted through casual contact.

"There was sustained pressure from human rights and public health activists who showed that the ban had no basis in public health," said Kim Nichols, co-executive director at African Services Committee, which provides legal and support services to Kasege, Fung A Loi and about 12,000 HIV-positive immigrants a year in the New York City area. "It didn't keep people [with HIV] from coming into the country and it didn't prevent people who are immigrants or American citizens from getting infected with HIV."

The lifting of the ban allowed for the annual International AIDS Conference to take place in Washington, D.C., in 2012. It has also enabled some LGBT bi-national couples to stabilize their immigration status, without being tested for HIV, said Victoria Neilson, legal director of the New York City-based advocacy organization Immigration Equality.

But the aftermath of the repeal has also resulted in closer scrutiny of some immigration applicants in both consulates abroad and in the United States if the applicant's HIV status is known, said Iván Espinoza-Madrigal, legal director of the New York City-based legal advocacy group the Center for HIV Law and Policy.

The public advocacy movement that led to the ban's repeal deliberately centered on short-term travelers and not on the sensitive topic of immigrants, said Ronald Johnson, vice president of policy and advocacy at the Washington-based national nonprofit AIDS United.

That leaves some immigrants who are living with HIV/AIDS in limbo. While they can travel outside the country now, they're not sure how long they can stay.

A Catch-22

"The law has created an entire Catch-22 for people who are living with HIV and for a variety of reasons needed to leave their countries," said Bill McColl, policy director at AIDS United. "It would be nice if there were some kind of legislative fix as part of this immigration bill, but I don't think anyone is specifically looking at that."

However, Immigration Equality's Neilson said she doubts any HIV-related amendment in the immigration bill could do much to increase the rights of people living with HIV in the U.S.

Kasege is hopeful that she may gain a shot at citizenship through the bi-partisan immigration bill that passed through the Senate Judiciary Committee Tuesday. The full Senate is expected to debate the overhaul reform bill in June.

If not, she knows she can potentially qualify for other legal status options, since she suffered abuse during her marriage to her now ex-husband, who came to the United States with her in 1996 on a student visa.

Her husband began to ostracize and abuse Kasege as soon as she learned she was HIV-positive during her first prenatal exam at nearly five months pregnant, two weeks after she arrived in Houston as a university student at age 22. Their daughter, Florida, was born HIV-negative.

"The lifting of the ban is bittersweet," Kasege said. "I can't do anything on my own right now, but the door is open for me to adjust this status and go home. Every day I pray it will happen."