Health Service Disruptions among Immigrants and Undocumented Individuals in 6 U.S. Fast-Track Cities, January–June 2025
1
Fast-Track Cities Institute, Washington, DC, United States
Popul. Med. 2026;8(Supplement Supplement 1):A2651
ABSTRACT
BACKGROUND:
Immigrants and undocumented individuals in U.S. cities face heightened barriers to health care, which can be exacerbated by political shifts, funding reductions, and administrative restrictions. Understanding the extent and nature of service disruptions is critical for protecting vulnerable populations.
METHODS:
This study documents recent disruptions in six Fast-Track Cities with significant immigrant populations: San Antonio (TX), Miami (FL), Oakland (CA), Atlanta (GA), Phoenix (AZ), and Chicago (IL). A mixed-methods assessment was conducted between January and June 2025, combining municipal health department data, service utilization reports from community-based organizations, and 48 key informant interviews with clinicians, advocates, and immigrant community leaders. Quantitative analyses tracked changes in HIV testing and treatment access, HIV pre-exposure prophylaxis (PrEP) uptake, vaccination coverage, and primary care visits. Qualitative data were thematically coded to identify barriers linked to policy environments, funding streams, and sociopolitical dynamics.
RESULTS:
All six cities experienced measurable health service disruptions for immigrants and undocumented residents. Miami and Phoenix reported sharp declines in HIV testing (−32% and −28%, respectively), linked to restrictive state-level health access policies. Atlanta and San Antonio saw disruptions in PrEP availability due to loss of federal/state support for safety-net programs. Chicago and Oakland maintained relatively higher service continuity, but still reported declines in vaccination uptake (−18% and −15%) attributed to mistrust and immigration enforcement fears. Across sites, undocumented individuals cited increased fear of deportation, reduced Medicaid and safety-net access, and overstretched community-based organizations as primary drivers.
CONCLUSIONS:
Immigrants and undocumented individuals in Fast-Track Cities face growing disruptions in essential health services. Policy-driven exclusions, funding instability, and heightened enforcement environments are key determinants. Strengthening city-level safety nets, protecting sanctuary policies, and expanding partnerships with trusted community-based providers are essential to safeguarding access to care for this population.
Immigrants and undocumented individuals in U.S. cities face heightened barriers to health care, which can be exacerbated by political shifts, funding reductions, and administrative restrictions. Understanding the extent and nature of service disruptions is critical for protecting vulnerable populations.
METHODS:
This study documents recent disruptions in six Fast-Track Cities with significant immigrant populations: San Antonio (TX), Miami (FL), Oakland (CA), Atlanta (GA), Phoenix (AZ), and Chicago (IL). A mixed-methods assessment was conducted between January and June 2025, combining municipal health department data, service utilization reports from community-based organizations, and 48 key informant interviews with clinicians, advocates, and immigrant community leaders. Quantitative analyses tracked changes in HIV testing and treatment access, HIV pre-exposure prophylaxis (PrEP) uptake, vaccination coverage, and primary care visits. Qualitative data were thematically coded to identify barriers linked to policy environments, funding streams, and sociopolitical dynamics.
RESULTS:
All six cities experienced measurable health service disruptions for immigrants and undocumented residents. Miami and Phoenix reported sharp declines in HIV testing (−32% and −28%, respectively), linked to restrictive state-level health access policies. Atlanta and San Antonio saw disruptions in PrEP availability due to loss of federal/state support for safety-net programs. Chicago and Oakland maintained relatively higher service continuity, but still reported declines in vaccination uptake (−18% and −15%) attributed to mistrust and immigration enforcement fears. Across sites, undocumented individuals cited increased fear of deportation, reduced Medicaid and safety-net access, and overstretched community-based organizations as primary drivers.
CONCLUSIONS:
Immigrants and undocumented individuals in Fast-Track Cities face growing disruptions in essential health services. Policy-driven exclusions, funding instability, and heightened enforcement environments are key determinants. Strengthening city-level safety nets, protecting sanctuary policies, and expanding partnerships with trusted community-based providers are essential to safeguarding access to care for this population.
| eISSN: | 2654-1459 |
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