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August 3, 2026
Quarterly Article
Jordan Herring
Carlos E. Rodriguez-Diaz
December 2025
Back to The Milbank Quarterly
Context: In 2018, proposed changes to the public charge rule—amid intensified anti-immigrant rhetoric and heterogeneous local immigration enforcement—were widely publicized. These changes have been linked to reduced health care access among Hispanic populations, potentially increasing human immunodeficiency virus (HIV) risk, yet little is known about how the local policy context shapes these health impacts. This study examined how shifts in immigration policy and rhetoric post-2018 affected Hispanic HIV incidence rates across antisanctuary and sanctuary counties in the United States.
Methods: County-level HIV incidence rates for 2010–2022 were obtained from AIDSVu.4 Counties were sorted into antisanctuary counties, sanctuary counties, and baseline counties using a county-level policy scoring system from the Immigrant Legal Resource Center. A triple difference-in-differences model estimated changes in the HIV incidence rates among Hispanic populations after 2018 by county type using the HIV incidence rates among White populations as a comparison. The HIV incidence rates among Black populations were included as placebo tests.
Findings: Triple difference-in-differences models estimated a statistically significant 16.8% increase in the HIV incidence rates among Hispanic populations in antisanctuary counties relative to baseline counties after 2018. Estimates for Black populations were not statistically significant, and point estimates were negative, opposite in direction to those for Hispanic populations, supporting the interpretation that post-2018 shifts in immigration policy uniquely affected Hispanic populations.
Conclusions: The results from this study indicate that immigration policy can work against public health policy to end the HIV epidemic. The HIV incidence rates among Hispanic populations may have increased because of fear and the chilling effects of the changes in immigration policy. The implications extend beyond HIV, indicating that anti-immigrant policies could lead to deterioration in a wide range of health outcomes.