The Caribbean has the world’s highest HIV rate outside Africa, and the many HIV positive Caribbeans immigrating to the U.S. must confront a dauntingly unfamiliar health care system. They also face AIDS stigma among their fellow expats, which can discourage testing and treatment. So Brooklyn’s Caribbean Health Care Network (CHN) launched the Caribbean Access Initiative (CAI) in 2003. “We want to get people into the clinic right away,” says Steven Hemraj, CAI’s program director. “We don’t want them to wait until they get sick because they are afraid of getting caught by immigration or of the stigma.” The agency’s services include HIV meds and care, tips for getting additional health care, housing help, child care and free MetroCards to get people to their door.

Like most of the staff at CAI, Hemraj is Caribbean. He fled his native Guyana due to death threats for his politics and rumors about his sexuality and HIV status (he tested positive after arriving in the U.S.). “I would rather have killed myself than go back to Guyana,” he says, adding that he did not find adequate health care in the U.S. until he found the CHN.

CAI is one of four pilot programs for HIV positive Caribbean immigrants in New York funded by the U.S. Department of Health, with a fifth in Miami. Like most states, New York doesn’t punish illegal immigrants seeking care. However, a bill passed by the House of Representatives in December would make providing any aid to an illegal immigrant a criminal offense—undermining CAI’s mission. The bill was being considered by the Senate when POZ went to press. “I am worried about the future of these essential programs,” says Michelle Lopez, treatment administrator for CHN. “We want to go before Congress and show that these essential HIV programs save lives.”