A new campaign aims to beat stigma and discrimination against HIV-positive Africans in New York by urging the wider population to show solidarity with them.
"For those living outside their home turf, the vulnerability that comes with being HIV-positive really exacerbates HIV stigma," explained Kim Nichols, co-executive director of the African Service Committee (ASC), an NGO that provides HIV and other health services to African immigrants in New York.
"There's a fear of deportation, a fear of being rejected by family and friends if they find out about their status that is just as real, if not more, because of the small community they are living in," she added.
According to the ASC, while effective treatment has dramatically changed the fight against AIDS, stigma and discrimination against HIV-positive people remain as strong as ever.
The "Choose to Stand Up" campaign calls on people to break the silence surrounding HIV stigma; share information by talking about experiences and concerns about HIV with friends and family; and to treat those with HIV with respect and compassion.
According to a 2008 study published by the US National Library of Medicine and conducted in several US states, up to 41 percent of diagnoses in women occurred among African-born individuals. Another study, published by Sociological Research Online in August 2010, found that Africans living with HIV in the US experienced "interpersonal, internalized and institutional" stigma.
Two countries, one stigma
When Ana* learned she was HIV-positive after moving to New York City, she wanted to return to her native Guinea, which she had left just four months before.
"I didn't want to stay here and die alone," the 29-year-old said. "But it was explained to me that if I stayed, I would get treatment, I could have children and I would have a better life."
The ASC helped Ana secure free HIV treatment. While her health has improved since she received her diagnosis in January, she still does not feel comfortable to "tell most people my secret".
"It's two countries but it's the same thing," she said. "People here talk to people there and then everybody knows."
The ASC, which works with approximately 4,500 HIV-positive clients, has tried to reduce stigma by integrating its HIV services into other health programmes.
According to ASC communications officer Stephanie Kaplan, taking a blood test that could be for HIV, or could just be for high blood sugar in a general testing facility, curbs client speculation about who is visiting the offices for what purpose.
The NGO tries to raise awareness of the availability of services to test and treat HIV. African immigrants often do not realize they are entitled to free HIV-related healthcare, regardless of their immigrant status.
"It's probably a barrier to learning one's HIV status, because if you don't know that there will be future coverage for your treatment, you are not likely to get tested," Nichols said.
It can take time to persuade some of the ASC's HIV-positive clients, of whom 80-90 percent are undocumented, to visit a health clinic or emergency room.
"People don't want to go to the hospital because there are fears of immigration [authorities catching them], yes, but it is also about fears of a disease that you don't want to share," said Rebekah*, 42, an HIV-positive Cameroonian ASC hospital escort, who helps immigrants navigate the health system.
Rebekah, who describes herself as "the luckiest person in the world" because of her immediate family's support, has another factor working in her favour - permanent residency.
In January, the Obama administration lifted a 22-year-old travel ban against people living with HIV/AIDS. According to Jim Alexander, a Washington DC-based immigration lawyer, the repeal signifies a more positive attitude towards HIV-positive individuals by the US government, but is unlikely to create new opportunities for HIV-positive illegal immigrants.
Alexander has represented African clients who gained asylum because of their fear of persecution resulting from their HIV status, homosexuality or transgender status.
"The number of people who actually go forward with cases is fairly small," he said. "We see people who are HIV-positive and decide not to pursue a case because the risk of coming forward for them is just too great."
The simplest option for many is to retreat and get on with a quiet life, as Ana has done, trying to send money home when she can and plan a future with her fiancé in Tunisia.
"I pray I can get my papers so I can travel so Tunisia to marry my fiancé," she said. "If somebody loves you even after you're sick, that's love."
* Not their real names
[ This report does not necessarily reflect the views of the United Nations ]