Dispersal of HIV-positive asylum seekers often medically inappropriate finds study

The overwhelming majority of doctors with experience of treating HIV-positive asylum seekers believe that the current policy of dispersing asylum seekers at short notice around the UK can have negative health implications, including the development of resistance to antiretrovirals, and mother-to-baby transmission of HIV, according to a paper published in the August 5^th edition of the British Medical Journal (published in advance online).

In April 2000 the UK started dispersing asylum seekers from London and the southeast to the rest of the UK. So far over 100,000 asylum seekers have been dispersed, and although it is not known how many are HIV-positive, many are from countries with a high HIV prevalence.

Asylum seekers receive only 48 hours notice of dispersal and if they refuse dispersal they face the immediate end to income, housing and legal support.

Decisions regarding the dispersal of HIV-positive asylum seekers should take into account medical advice about the potential for dispersal to adversely affect the health of the individual.

Investigators asked doctors working at 75 genitourinary medicine clinics around the UK offering HIV treatment about their experiences of dispersal on the health of HIV-positive asylum seekers, and about the ability of their clinics to cope with dispersal.

Questionnaires were mailed in December 2003 and were returned by 56 centres. A total of 34 of these centres were outside London and 20 had had an HIV-positive asylum seeker dispersed to them.

Short notice of dispersal was mentioned as a concern by 37 centres, and 43 said that dispersal had occurred without their prior agreement. Appropriate transfer of care was mentioned by only three centres. Other problems mentioned by clinics included a lack of community support (41 clinics), lack of facilities to support vulnerable asylum seekers with psychological problems (43 clinics), and 40 clinics said that they did not have the staff to cope with dispersed asylum seekers.

Some doctors added their own comments about the negative consequences of dispersal. Four doctors said that dispersal had led to the unplanned interruption of HAART, three clinicians blamed dispersal for mother-to-baby transmission of HIV, and two doctors said that dispersal had contributed to the death of patients under their care.

Dispersal was regarded as being particularly inappropriate during the initiation of HAART by 47 doctors. In addition, 43 doctors said that patients receiving salvage therapy should not be dispersed, 50 doctors believed that asylum seekers undergoing investigation should not be dispersed, a total of 52 clinicians said that it was inappropriate to disperse patients with multiple medical problems, and 45 doctors thought it was wrong to disperse individuals with AIDS.

“We identified several potential barriers to the safe dispersal of HIV infected asylum seekers. Of particular concern is that dispersal is done at short notice and often without appropriate medical details,” write the investigators.

They conclude, “inappropriate dispersal of an HIV infected patient could lead to HIV resistance, onward transmission of HIV infection, and avoidable morbidity and mortality in the asylum seeker…the National Asylum Seeker Support Service should seek specialist advice and consider the impact on the infrastructure and staffing of the receiving centre.”