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Sign-on Letter: Advocacy to End Peace Corps HIV Dismissals


View the final letter with all organization and individual sign ons

Dr. Josephine K. Olsen
Director, Peace Corps
1111 20th Street NW
Washington, DC 20526

Re: Peace Corps’ Policies and Practices with Respect to Volunteers Newly Diagnosed with HIV

Dear Dr. Olsen,

The undersigned individuals and organizations are writing to express our dismay at the recent dismissal of two Peace Corps volunteers shortly after they tested positive and initiated treatment for HIV. Current Peace Corps protocols appear to create de facto automatic dismissal for any newly diagnosed volunteer. Given the relative ease with which HIV can now be treated and managed, this approach is out of date and misguided at best. The Peace Corps’s policies and practices pertaining to volunteers who are newly diagnosed with HIV need to be modified to reflect the current landscape of HIV treatment.

We are also alarmed at reports of volunteers being denied access to HIV pre-exposure prophylaxis (PrEP). Volunteers frequently serve in countries with a higher incidence of HIV compared with the United States, making access to comprehensive HIV prevention especially important. It is critical that the Peace Corps starts promoting and making PrEP readily available to any volunteer who is at a higher risk for HIV—per Centers for Disease Control and Prevention (CDC) guidelines—in a nonshaming, nonstigmatizing way.

Dismissals Based on Newly Diagnosed HIV
Romany Tin received media attention in March of this year after he was removed from service. Mr. Tin was serving in Cambodia, a country that is well on track to meet UNAIDS 90-90-90 targets, when he made the health-conscious decision to test for HIV. When his results came back positive, he was medically evacuated to Washington, D.C., and told that he would not be able to continue his service. Disagreeing with this decision, he contacted Treatment Action Group (TAG) for help, and we sent a letter to Peace Corps administration advocating for his immediate return to his existing assignment in Cambodia. The Peace Corps stood by its decision, stating in a letter to Mr. Tin that his health needs to “stabilize” before he can return to service. Considering that Mr. Tin reached an undetectable viral load before his dismissal, it is unclear what further improvement was required for Mr. Tin’s health to be considered stable. Since that time, a second volunteer in very similar circumstances has contacted TAG.

These current situations are not the first time that the Peace Corps has discriminated against an HIV-positive volunteer. Jeremiah Johnson, an HIV advocate at TAG and the author of this letter, was dismissed from his service in Ukraine in 2008 for testing positive for HIV. Just as in the present situations, Mr. Johnson was told that his request to finish his service would not be accommodated because his condition could not be managed in Ukraine, or in any country served by the Peace Corps.

However, the Peace Corps is well aware that it is required to make reasonable accommodations for volunteers living with HIV under the Rehabilitation Act. In 2008, the ACLU National LGBT and HIV Project reminded Peace Corps administration of their legal obligations in circumstances such as those in which Mr. Johnson found himself. In a letter dated July 15, 2008, General Counsel Tyler S. Posey reaffirmed the Peace Corps’s commitment to the Rehabilitation Act and its applicability to HIV-positive volunteers.1 A July 30, 2008, ACLU response further outlined expectations of how this commitment would be reflected in Peace Corps policy:2

1. In accordance with the Rehabilitation Act, the Peace Corps will make individualized assessments as to whether HIV positive volunteers and applicants will be able to volunteer or, if necessary, a reasonable accommodation will enable them to volunteer;

2. The Peace Corps will not automatically separate or disqualify any volunteer or applicant who tests positive for HIV;

3. The Peace Corps will make individualized assessments as to whether HIV positive volunteers may remain at their current assignment or be transferred to another assignment;

4. Peace Corps volunteers who test positive for HIV will be able to remain at their current assignment during the individualized assessment;  and

5. The Peace Corps will comply with the Rehabilitation Act to its fullest extent.

As this discriminatory history seems to be repeating itself, we are gravely concerned that Peace Corps administration has forgotten the commitment it made in 2008 or that it may be overestimating the complexity of HIV-related care. The Peace Corps, which plays a significant role in coordinating the U.S. government response to HIV through the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), should be aware that HIV is easily managed through routine blood work and daily medication.

Furthermore, the Peace Corps appears to have set up a ‘catch-22’ for any volunteer newly diagnosed with HIV who the Peace Corps believes cannot initiate treatment and stabilize in country.3 In correspondence with TAG regarding Romany Tin’s case, the Peace Corps has contended that after returning to the United States to initiate treatment, any newly diagnosed volunteer is individually assessed and may theoretically return to service if their condition “resolves” within the standard 45-day period allowed for volunteers who have been medically evacuated. However, in the same communication, the Peace Corps makes clear it believes that a newly diagnosed volunteer requires 3 to 6 months to “stabilize” on medication. Obviously, this 3- to 6-month demarcation falls outside of the standard 45 days allowed for a volunteer to resolve their condition, making it impossible for a newly diagnosed volunteer to return to service. As a result, there is a de facto automatic dismissal for any volunteer who is not allowed to initiate treatment and stabilize in country. In fact, when the second volunteer who recently contacted TAG asked their Peace Corps Health Coordinator if there is any way that a newly diagnosed volunteer might be able to return to service in any Peace Corps program in any country, the Health Coordinator replied that there is not.

We are concerned that the Peace Corps’s policy pertaining to volunteers diagnosed with HIV is arbitrary, is not grounded in evidence, and is being implemented without critical attention to the wellbeing of the volunteers. In practice, these policies mean that volunteers who make the health-conscious decision to get tested for HIV—a practice the Peace Corps should encourage—are, in effect, punished if they test positive.

Failure to Provide and Promote PrEP
The pattern of discrimination by the Peace Corps administration appears to extend beyond those newly diagnosed and living with HIV and into HIV prevention. We are aware of at least two volunteers who were repeatedly denied access to PrEP despite being placed in a country with an elevated HIV incidence. Even more alarming, the second volunteer facing dismissal for testing positive previously requested PrEP from their Peace Corps Medical Officer, who discouraged them from taking it. PrEP reduces the likelihood of sexual infection by up to 99 percent when taken daily,4 making it the most effective prevention tool currently available for HIV-negative volunteers at a higher risk for HIV.

The Peace Corps is the sole provider of medical services for volunteers, meaning that there are no alternative options for those who receive a denial of PrEP access from medical officers or the administration. Any failure to promote and provide PrEP for all volunteers who need it—certainly those who request it—is a denial of a U.S. Food and Drug Administration–approved and U.S. Centers for Disease Control and Prevention–recommended, scientifically validated HIV prevention modality, which makes Peace Corps staff and administration directly responsible for new cases of HIV among volunteers.

These actions not only represent an abject failure to protect the wellbeing of these volunteers, they are extremely disappointing coming from an agency—one of the eight primary implementing bodies for PEPFAR—that receives money specifically to increase access to HIV prevention and care and to prevent stigma and discrimination for people living with and vulnerable to HIV worldwide.

Collaboration Leading to a Solution
In recent years, the Peace Corps has made a number of grievous errors in protecting the sexual and reproductive health of its volunteers, making these present injustices part of a larger pattern that is worrisome. In 2013, the National Women’s Law Center and the ACLU had to pressure the Peace Corps to change a discriminatory policy that automatically prevented pregnant volunteers from continuing their service5 Years of allegations of mishandling sexual assault of volunteers ultimately forced Congress to intervene in 2011 and pass the Kate Puzey Peace Corps Volunteer Protection Act, which established a Sexual Assault Advisory Council.6 We would like to work with the Peace Corps to ensure the current failures around HIV are reliably and sustainably resolved without the need for legal or legislative action mandating external oversight.

In order to rectify the Peace Corps’s missteps on HIV and broader sexual health, we expect the Peace Corps to take the following urgent actions:

  1. Recognize that almost all newly diagnosed individuals whose HIV viral load drops precipitously after one month of treatment will achieve an undetectable viral load shortly thereafter if they continue to adhere to their medications.
  2. Immediately reevaluate the two recently diagnosed volunteers with the above in mind and return them to their original Peace Corps assignments under the condition that they otherwise remain in good health.
  3. Schedule a face-to-face meeting with leading HIV organizations, including the HIV Medicine Association, GMHC, AIDS United, the National Alliance of State and Territorial AIDS Directors (NASTAD), and TAG, to review current written policies and practices on recruiting/retaining HIV-positive volunteers and promoting/providing PrEP to volunteers.

We look forward to your prompt response regarding these urgent matters.

Sincerely,

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3 Though not entirely clear from our correspondence with administration, it appears that the Peace Corps believes that every volunteer newly diagnosed with HIV must be medically evacuated back to the United States to be evaluated and to initiate treatment.

4 Anderson PL. Emtricitabine-tenofovir concentrations and pre-exposure prophylaxis efficacy in men who have sex with men. Sci Transl Med. 2012 Sep 12;4(151):151ra125.