UK Conservatives announce policy of HIV/TB checks for immigrants

The opposition Conservative Party in the UK has announced that it will make an HIV and tuberculosis (TB) screening compulsory for immigrants wishing to live in Britain. Public health and costs to the NHS are cited by the party as the reasons for their proposed policy. Similar policies were considered, but rejected by the governing Labour Party last year, and an editorial published in the British Medical Journal exactly a year ago showed that there are very severe weakness in the case for mandatory HIV and TB tests for immigrants.

If returned to power at the general election, which is expected to be held in May, the Conservatives have said that they will introduce mandatory TB screening for all individuals from outside the European Union wishing to come and live in the UK for more than six months, though individuals staying in the country and working in healthcare, childcare or teaching would be required to undergo screening regardless of the length of their stay.

All migrants aged over 16 would also be tested for HIV and hepatitis under the Conservative’s plan. However, only individuals with tuberculosis would be excluded from entry, and all other cases would be considered on a case by case basis after considering likely costs to the NHS.

Similar immigration policies in Australia, Canada and New Zealand were highlighted by the Conservative leader Michael Howard when he launched the policy saying: “The British people deserve the best public standards of public health. We need to control who is coming into Britain to ensure that they are not a public health risk and to protect the NHS. It’s plain common sense. And it’s exactly what they do in New Zealand, Canada and Australia.”

Claims for asylum would not, however, be affected by the results of either HIV or TB tests.

In the spring of 2004 the governing Labour Party ordered civil servants to examine the feasibility of introducing tuberculosis and HIV tests for migrants, only to abandon the plans a few months later after they were told that compulsory testing would increase illegal immigration and drive individuals with tuberculosis and HIV underground.

An editorial in the British Medical Journal published almost exactly a year ago exposed serious flaws in the case for compulsory HIV and tuberculosis tests for migrants.

"For tuberculosis, the notion that screening immigrants detects those with disease and therefore benefits public health is not straightforward," argued the author, pointing out that there is no evidence that early detection of TB in immigrants has any public health benefit for citizens of the host country. Indeed, if there is a benefit from screening, it is likely to be for fellow immigrants, who live in close proximity to individuals with active TB disease.

Furthermore, very few cases of active TB, and even fewer cases of latent infection, have been detected by current TB screening programmes for asylum seekers, even though the prevalence of TB is elevated in this population. "Moreover, little correlation exists between the prevalence of disease in countries of origin and prevalence of active diseases in those screened."

The editorial explained that a significant practical problem for mandatory active TB screening is that the main screening tool, a chest X-ray, has a large number of false-positive results and involves "substantial human and capital costs".

The editorial went on to argue that significant practical and ethical difficulties would be involved in the compulsory HIV testing of immigrants. First, who would screening focus on? All migrants, immigrants from countries with a high HIV prevalence or asylum seekers? "Most asylum seekers are HIV-negative and most immigrants who are HIV-positive are not asylum seekers" stressed the author.

Furthermore, screening, (as initially proposed and abandoned by the Labour Party and now as suggested by the Conservatives), would not include individuals who have a right of free movement to the UK, such as citizens of the European Union. "Yet the future eastern border of the European Union," explained the editorial, "will be with countries that have the most rapidly escalating HIV epidemics in the world."

Compulsory screening would also encourage travel with false documentation, or illicit entry into the country, argued the author.

The UK’s "enviable reputation in international public health" has rested on "a humane public health policy response to HIV – where a position was taken early in the pandemic to protect human rights and provide care and succour to those in society most marginalised and stigmatised," argued the author, adding that this approach "also happened to be rational, coherent, and effective. It would be a shame if this reputation was tarnished through ill-considered conflation of immigration control and communicable disease control."