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As Brendan Genaw read through the denial of SSI disability benefits, he was stunned. His client, who has suffered lifelong effects of perinatal HIV infection, had a solid case for reinstatement, including strong statements from her treating physician and case manager and medical documentation of ongoing physical and cognitive impairments.

But Genaw said the judge’s written ruling didn’t appear to acknowledge the client’s ongoing disabilities. 

“It was clear in the medical record that this client was born with HIV and has had issues from it since childhood,” said Genaw JD ’26, then a student-attorney in Duke Law’s Health Justice Clinic. 

“If you sit down with our client, she can have a conversation and she can function, but it's very clear within a short time that she cannot work a 40-hour job in terms how much assistance she needs.”

The client, who lost both of her parents to AIDS complications, is one of thousands of infants in the U.S. born with HIV before the use of antiretroviral drugs to prevent perinatal transmission. Early exposure to the virus and delayed treatment can create numerous complications in developing bodies and brains, with lifelong impacts that can affect a person’s ability to hold a job. 

That is the client’s situation. She had received Supplemental Security Income (SSI) starting in 2016, relying on that income — less than $1,000 a month — to meet basic needs, but her benefits were cut off in 2022 after a prior determination by SSA that she was no longer disabled. 

After clinic supervising attorney Hannah Demeritt JD ’04 was contacted by a case worker, the Health Justice Clinic began work on appealing the cessation of benefits. That meant compiling documentary evidence, including extensive medical records, and preparing a pre-hearing brief. In January 2024 Demeritt represented the client at an administrative law hearing during which she and her longtime social worker also testified. 

Such cases are the clinic’s primary focus, and most are resolved within the agency’s appeals system. But because of the factual and legal errors in the ruling issued after that hearing, Demeritt said, the clinic decided to escalate it. 

Demeritt and Genaw appealed to federal district court, arguing that the medical records and physician statements established that the client met the relevant criteria for disability on the basis of HIV-related complications. 

They also argued that the administrative law judge who denied SSI benefits made a determination not supported by the evidence and applied incorrect legal standards in doing so. 

Upon review, the attorney for Social Security Administration agreed to a voluntary remand and the case was sent back for another hearing in September before the same judge, where the client will be represented by Yasmine Abi-Hanna JD ’27. If the decision is reversed, the client will receive back pay for the years she was improperly denied.

“This case demonstrates how much the clinic relies on interdisciplinary collaboration and why our advocacy is so effective,” said clinic director Allison Korn, who called the case challenging both legally and emotionally and credited Demeritt's tireless advocacy.

“Clinic students work with healthcare providers, case managers, social workers, and even experts within our own clinical program. They apply administrative law; they apply case law. They translate medical records into legal arguments. And they work across different justice systems to get the outcomes our clients need.”

Overcoming bureaucratic roadblocks

Abi-Hanna and clinic partner Stephen Buys JD ’27, who picked up the case after it was remanded back to the SSA, ran into numerous bureaucratic hurdles. In 2025, the Social Security Administration cut 14% of its workforce and reassigned some staff to new roles, impacting customer service as the agency struggled to adapt. 

Abi-Hanna spent hours on the phone trying to untangle misfilings and mixups that caused delays in the case, even enlisting help from the offices of U.S. Senators Ted Budd and Thom Tillis. Eventually she learned the case had been closed mistakenly because of an internal issue — the federal judge’s order of remand hadn’t transferred to a new system in the hearing office.

“I was just glad she had representation. I don’t think that a lot of people realize that these government safety nets are actually incredibly hard to access,” Abi-Hanna said. 

“With Social Security, things take a really long time and clients have to deal with the financial stressors while they're waiting to get back on SSI. It’s just another layer of inaccessibility and barriers that low-income people who are disabled face.” 

The client’s long-term effects of HIV include repeated manifestations of HIV such as encephalopathy and recurring infections, and limitations in her ability to perform activities of daily living and complete tasks like adhering to medications and keeping appointments. 

She has relied on family members, a partner, and other federal and state government programs to make ends meet but lacks basic necessities like a phone. Yet Abi-Hanna describes her as “a joy to work for, a lovely person, very warm and funny.”

“The client has been very open with us about the things that are really challenging for her and the specific ways that this has made her life harder.” Abi-Hanna said. “For someone who's gone through all that she has, it's a testament to her resilience that she was still open to building relationships with her student-attorneys.” 

Abi-Hanna is preparing her client to appear at the remand hearing. She’s cautiously optimistic that benefits will be restored and back pay awarded for the years the client was improperly denied. 

“Because of the perinatal transmission, even if she was 100% compliant with her HIV medications for the rest of her life, there are impacts of the illness that are always going to impair her ability to work,” Abi-Hanna said. 

“She's a really special client and I look forward to continuing to fight for the money I believe she's owed. She’s waited a long time, and the sooner we can get to a happy ending for her, the better.”