Two uniformed policemen are drinking coffee in a nearby booth at a fast food outlet close to Penn Station in Manhattan, New York, forcing Samantha to speak in hushed tones, glancing anxiously over her shoulder.

Samantha is providing the Observer with a peek at life as an undocumented Jamaican living in the United States.

Her face, creased with worry lines, gives the appearance of a harsh life and today, like every other day for the past ten years, she wonders if the long arm of the immigration law will finally catch up with her.

The situation is quite grave for this 32-year-old who, in addition to being an illegal immigrant, is HIV-positive and has no medical insurance.

Samantha is her deceased grandmother’s name, but she uses it to shield herself from the stigma associated with HIV.

Disclosing her status to family and friends means that this petite, shy young woman may be immediately ostracised since the disease itself is shrouded in stigma and discrimination among Jamaicans.

“Most of my family in Jamaica don’t know that I am here, sick,” she says.

She may be the only one bold enough to share her story, but she is not the only HIV-positive undocumented Jamaican in the US who is going without proper medical care.

In fact, some persons have gone “underground” as they are of the notion, perceived or real, that if they continue accessing treatment through the public health care system their illegal status will be detected, resulting in instant deportation.

Dressed in an oversized coat and a baseball cap pulled down over her face, she stares through sad dark brown eyes as she recounts the experience of being with multiple sex partners before she was diagnosed with HIV, three years ago.

In-between slow sips of hot, black coffee, Samantha, her voice dropping to a whisper when the worker wiping the tables gets too close, speaks of waiting for more than a year, after feeling ill, before going to a hospital emergency room.

“It was only after I became so sick and could barely find the strength to walk that I begged a guy to drive me to the emergency room,” she says, twitching her fingers nervously.

After several tests, she got the dreaded news – she was HIV-positive.

“I don’t believe I would have continued to have several sexual partners if I knew I was positive all that time,” she says sadly.

But with no permanent home, no set income and no family support, Samantha still continues to have multiple sex partners, at times, to get a warm bed or food in her stomach when she is unable to find work providing home care for the elderly.

She, however, believes if medical care was readily available to illegal immigrants like herself she could have been diagnosed earlier and could have taken better precaution not to infect anyone else.

With no guaranteed medical care, Samantha will not go on antiretroviral (ARV) medication for fear that she may develop side effects, which will require her to see a doctor often.

While she receives treatment at the emergency room without anyone questioning her immigration status, the numerous questions she must respond to as an HIV-positive woman has made her fearful that her cover as an illegal immigrant could be blown wide open.

“It is hard,” she says, of not having the support of family members.

But even the thought, though dreaded, that she could die alone in a foreign country is not enough to persuade her to return home.

She has heard the stories of Jamaicans applying for asylum in the US on the basis that they are HIV-infected and she hopes to garner enough courage to do so at some point.

For many like Samantha, going without life-saving ARV and regular doctor check-ups is a lesser ill than being scooped up by Immigration and Customs Enforcement, placed in a detention centre and later sent back home under the label ‘deportee’.

Cheryl Hall, executive director of Caribbean Women’s Health Organisation (CWHO) based in New York, while not being able to provide specific figures, says there are scores of undocumented Jamaicans who later discover they are HIV-positive while living in the US.

Such persons, she said, often opt not to access medical attention until they get really sick.

“Undocumented and ill, they simply wait until they are really sick and then they go to the hospital emergency room,” explains Hall.

This, she says, does put a greater burden on the US health-care system as it will cost more in medication and other treatments when their condition deteriorates.

Although most government-funded programmes bar those who cannot prove their citizenship, states like California, which has a considerable Jamaican population, is projected to pay more than US$1 billion annually to cover the health-care costs of illegal residents.

According to the Federation for American Immigration Reform (FAIR), there are 9.4 million uninsured immigrants, the majority of whom are in the country illegally.

“Another problem is immigrants’ use of hospital and emergency services rather than preventative medical care. For example, utilisation rate of hospitals and clinics by illegal aliens (29 per cent) is more than twice the rate of the overall US population (11 per cent),” FAIR reports.

The main reason for undocumented Jamaicans staying away from accessing medical attention before they get gravely ill, according to Hall, is the fear that if their information is found to be in the health care system this might pose a problem for them if and when they later apply for a green card.

Hall explains that although hospitals will later bill these patients who seek treatment at the emergency room, they have an obligation to treat them regardless of their status.

Despite this, she says many illegal persons are afraid and will go only when their condition worsens.

But the problem does not end there as there is the big issue of how such persons continue to access much-needed health care once they are discharged from the hospital.

There are a few organisations that have access to grants which will allow for treatment of undocumented persons, but these are few and far between, and even where they exist, an illegal immigrant without the right connections will not know how to access them.

Hall says they are constantly challenged by this, and as such, try to ensure that educational materials are available and produced in a manner to which the Caribbean immigrant can relate.

She says Creole-speaking Haitians are still a disadvantaged group in this regard, as this material is still only being disseminated in English and Spanish.

Some persons, Hall says, may be able to access care at community health centres, but some even refuse to do that.

There are, however, some organisations that will collect unused ARV from persons who have died or don’t need them anymore, and these are doled out to persons like the illegal immigrants who cannot afford the treatment.

Meanwhile, Hall says that under recent immigration department law, some Jamaicans who are HIV-infected have been petitioning to remain in the US on the grounds that if they return to the island they will not have access to medication and appropriate health care.

In the US, there are, however, some programmes that provide free health care and medication to undocumented HIV-infected migrants, though not intentionally.

These programmes are said to help undocumented immigrants because the application does not enquire about the applicant’s immigration status.

Yvonne Graham, Brooklyn deputy borough president and a former Jamaican nurse who started the CWHO, says it is not clear how widespread the problem is, since there is a cloak of secrecy surrounding Jamaican immigrants who are HIV-infected.

Explaining how the CWHO was formed, Graham says that while working at a hospital she noticed that a lot of immigrants were coming to the emergency room when their health had severely deteriorated.

She says that when the organisation began, it facilitated those persons who were hesitant to access care for fear that their illegal status would be detected. Others were simply afraid that when they became legal, accessing public health service could jeopardise their chances of filing for another resident.

“They thought this may show they could not afford to sponsor a relative to the US and so they did not want to jeopardise that chance,” she says.

Now, she believes, the HIV-sensitisation message may not be reaching all the illegal immigrants, especially since immigrants arrive in the US at varied stages of the HIV education spectrum.

She says many of these illegal immigrants become infected while living in the US and this has grave implications as the Caribbean is considered to be the third border of the US.

“Some people live here in the US and maintain relationships back in Jamaica and that plays a role in the spread of the disease,” she says.

She agrees also that it will cost the US a higher health bill when these people become very ill.

“The earlier persons are diagnosed, the better chances they have of living healthy and productive lives, but the longer they wait to get medical attention, the worse their condition becomes and the greater the burden will be on the health-care system then,” she says.

Lorna Fairweather, a community consultant and health-care worker in New York, admits that accessing health care may have got more challenging for undocumented persons.

For Samantha, the future is uncertain and she must always hope for the best.

Gulping the last drop of coffee, she wraps her coat even tighter around her slender waist and with the first hint of a smile, she bids good-bye and walks briskly down the crowded street, blending in perfectly with the sea of New Yorkers.