New guidance on healthcare for HIV-positive asylum seekers in detention

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The National AIDS Trust (NAT) and the British HIV Association (BHIVA) have issued best practice guidance to support asylum seekers living with HIV while they are detained by the government. The document, which was developed in co-operation with healthcare managers at detention centres, outlines steps to ensure that migrants are not forced to interrupt antiretroviral treatment and can have access to healthcare and support while their application is decided, or while waiting to be removed from the country. It describes the roles and responsibilities both of detention centre staff and HIV clinicians.

While in the process of making a claim for asylum, applicants and their dependents are entitled to NHS treatment without charge.

Whereas the Court of Appeal recently decided that refused asylum seekers were not entitled to start new courses of medical treatment on the NHS, a 2005 Home Office policy established that a refused asylum seeker who had no further right of appeal, but who had begun a course of NHS treatment while his or her asylum claim was being considered, was entitled to continue that treatment for as long as he or she remained in the UK.

Glossary

clinician

A doctor, nurse or other healthcare professional who is active in looking after patients.

community setting

In the language of healthcare, something that happens in a “community setting” or in “the community” occurs outside of a hospital.

Moreover, anyone detained in prison or by immigration authorities is entitled to free NHS treatment.

These policies were not affected by the Court of Appeal judgement.

The UK Border Agency (part of the Home Office) oversees eleven Immigration Removal Centres (IRCs). They are prison-like structures, used for detaining those whose claim for asylum has been refused, as well as other undocumented migrants who the agency intends to remove from the country. These detainees usually stay in an IRC around three weeks.

In addition, some people have their asylum claim ‘fast-tracked’ which means that they are detained while their asylum claim is being decided. This process usually takes less than a week, and these individuals may stay in an IRC.

The IRCs are located near Heathrow Airport (two), near Gatwick Airport (two) and in Bedfordshire, Oxfordshire, Cambridgeshire, Kent, Hampshire, South Yorkshire and South Lanarkshire (Scotland). In each case, the local provider of HIV treatment is an outpatient GUM clinic.

The document notes that many people detained in IRCs are from Africa and, given the prevalence of HIV in the continent, “there is an urgent need to consider the HIV-related health and social care needs of asylum seekers and others in detention”.

More specifically, it recommends that detainees should have reception health screening within 24 hours of arriving at an IRC. At this stage a detainee may disclose that he or she is taking antiretroviral medication, and the guidance stresses that unbroken access to medication must be maintained. If a detainee arrives without his or her medication, the local HIV clinic should provide the necessary medication within 24 hours of the screening.

This will require local HIV clinicians to work closely with the IRC in order to establish an on-call system to facilitate prompt provision of medication, including outside clinic-hours and at weekends. Moreover, clinicians should be prepared to provide other forms of care and support to detainees, as necessary.

The guidance suggests that it is preferable for detainees to keep their own medication in their rooms. If this is not possible, it is the responsibility of IRC healthcare staff to ensure that detainees have the opportunity to take their medication – if a detainee does not attend the clinic when expected for this purpose, staff should proactively seek him or her out.

If the UK Border Agency is planning to remove a detainee from the country, the IRC general practitioner must first make a judgement on whether the person is medically stable and fit to travel. This should be made on a case-by-case basis, but having just started a new drug regime, waiting for important test results or having medical complications might indicate that travel was not appropriate.

Moreover, the general practitioner should seek advice on this issue from the HIV clinician. The document recommends that clinicians should give a high priority to providing a comprehensive response, including a medical history, details of all medical and support services used, and an opinion about the impact of travel on the detainee. Moreover, it should include input from the detainee’s previous clinician, who should also prioritise this issue. The guidance notes that: “Input from the HIV specialist who knows the patient well will ensure that appropriate medication is dispensed and may also influence the longer term outcome for that individual.”

Records of the advice given should be kept in the patient’s medical notes.

If a detainee is to be removed, he or she should be provided with:

  • Three months’ supply of medication.
  • Contact details of trusted HIV-support organisations in the destination country.
  • A sealed and confidential letter from the HIV clinician for the next doctor, describing HIV status, treatment regime and the clinician’s contact details. The detainee should be aware of its content and the importance of keeping it safe until he or she has a new clinician.

Similarly, if a detainee is to be transferred to another IRC in the UK, healthcare staff should make arrangements to ensure continuity of care, involving close consultation with HIV clinicians. The detainee should travel with enough medication to ensure unbroken access to treatment, and medical records should be transferred promptly.

The guidance also notes that the support of community-based organisations local to an IRC is a vital complement to medical care. It recommends that both IRC healthcare staff and community-based organisations should take steps to establish a relationship with each other.

Dr Ian Williams, chair of BHIVA, commented: “It is extremely important that asylum seekers with HIV infection detained at IRCs receive best care for their HIV infection. Failure to do so increases the risk of adverse consequences of HIV infection on their future health. It is important the IRCs recognise this and that HIV specialist clinicians are able to liaise effectively with the IRCs to ensure continuing best care for HIV infected detainees. This guide is an important and useful resource to enable this to happen.”