Denying anti-HIV treatment to failed asylum seekers or individuals of doubtful immigration status has no sound economic, public health, or moral justifications, a panel of four leading UK HIV physicians said in a report published today. They recommend that HIV should be reclassified in government health care eligibility criteria as a sexually transmitted infection, therefore allowing individuals to access free treatment and care irrespective of their immigration status.
Under current UK regulations failed asylum seekers are ineligible for free NHS treatment and care for HIV, other than HIV testing and post test counselling. However, they are entitled to free treatment when an illness has public health implications, including all sexually transmitted infections (other than HIV) and tuberculosis.
The report, entitled Treat with respect: HIV public health and immigration also contains recommendations how to ensure the continuity of HIV care for asylum seekers facing dispersal.
HIV and immigration have already featured prominently in pre-election campaigning for the UK general election, expected to be held in early May. The opposition Conservatives saying that they would require mandatory HIV and tuberculosis tests for all migrants to the UK from outside the European Union.
Emphasising that early detection and treatment of HIV can substantially reduce the risk of onward transmission of HIV, Prof Brian Gazzard of London’s Chelsea and Westminster Hospital highlighted that the cost of anti-HIV therapy was £7,000 a year and clearly cost-effective when, according to the Department of Health’s figures, preventing a single case of onward HIV transmission would save the NHS between £500,000 - £1,000,000. The panel also emphasised that the early diagnosis and treatment of HIV was much more cost effective than emergency admission with an AIDS-defining illness.
According to government figures less than 900 HIV-positive asylum seekers entered the UK in 2003 – 04. Although the annual cost of HIV treatment for these individuals would be £13.5 million, not providing treatment and onward transmission would have an estimated cost of £500 - £1 billion per lifetime.
Report co-author Dr Jane Anderson, a consultant HIV physician in east London, drew attention to another of the report’s recommendations, that the National Asylum Support Service should not disperse an HIV-positive asylum seeker until the treating HIV doctor has been consulted and new treatment arrangements have been put in place. The panel also recommended that HIV-positive asylum seekers should only be dispersed to areas able to offer HIV care and services, and that individuals who are ill or pregnant should not be dispersed unless it is under the direction of a treating physician.
Sexual health on political agenda
Political attention in the UK focused on sexual health today. Conservative leader Michael Howard visited the Lighthouse, which provides HIV services and testing in west London, and pledged that a Conservative government would introduce a national sexual health education campaign aimed at young people and a Chlamydia screening campaign aimed at young people.
He accused the Labour government of deprioritising sexual health, and drew attention to recent increases in the incidence of HIV and other sexually transmitted infections. Howard also cited the HIV public education campaigns introduced in the 1980s as evidence of the Conservative’s good record on HIV and sexual health.
However, rates of gonorrhoea and Chlamydia were already increasing when the last Conservative government was voted out of office in 1997, and although the famous “AIDS Iceberg” awareness campaigns of the late 1980s brought HIV to the popular consciousness, they were heavily criticised at the time and subsequently for not addressing the HIV prevention needs of gay men, the group most affected by HIV at the time. The Labour government started work on a national HIV strategy soon after it was elected in 1997, is currently rolling out a national Chlamydia screening programme, and has pledged to reduce the incidence of sexually transmitted infections in its recent Public Health White Paper.