The British HIV Association (BHIVA) and the National AIDS Trust (NAT) have produced a booklet providing advice to healthcare staff and workers in the voluntary sector about the dispersal of HIV-positive asylum seekers in the United Kingdom.
Most asylum seekers are dispersed away from London and the south east by the Immigration and Nationality Directorate (IND). Dispersal usually involves considerable disruption for HIV-positive asylum seekers, including interruption of clinical care, medication adherence difficulties, and loss of support from the voluntary sector and informal support networks. Because of this, recommended standards for HIV services, produced by BHIVA, the Medical Foundation for AIDS and Sexual Health (MedFASH), and the National Association of NHS Providers of AIDS Care and Treatment (PACT) state: “facilitating continuity of care in terms of treatment and monitoring should be a central plank of service provision for asylum seekers with HIV.”
IND policy guidance for the dispersal of HIV-positive asylum seekers was issued in December 2005. It states that newly arrived asylum seekers who are known to be HIV-positive should be dispersed at the earliest opportunity so they can engage with clinical services in the area of dispersal. In all other cases, dispersal should only take place after discussion and advice from the treating HIV specialist; if the asylum seeker is medically stable and has no other health complications; and, only after the current clinical team has had time to ensure continuity of care at the dispersal location.
To ensure that this theory is put into practice, the new booklet, called The dispersal process for asylum seekers living with HIV: advice for healthcare and voluntary sector professionals, provides a number of recommendations.
Healthcare workers should “communicate appropriately with IND caseworkers”, and ensure that their patient who is facing dispersal should know what information has been provided to the IND about them and why.
Information provided by HIV specialists to the IND prior to dispersal is, the booklet stresses, “vitally important to the health of the patient and will be used to determine whether, when and how the patient is dispersed.” It is therefore recommended that the information should include a brief medical history, including details of current medication and past treatments; details of other medical services being used; details of voluntary sector support currently accessed; “an opinion about the impact that dispersal may have on medical and mental health”; accommodation requirements, for example is sole use of a fridge required for storage of medication; known areas where equivalent HIV care and support can be provided; and, a recommendation regarding whether dispersal can safely occur or should be delayed.
The booklet emphasises that continuity of care is particularly important in cases of pregnancy, and recommends, “should your patient receive notification of dispersal when pregnant you should, with their consent, get in touch with the IND caseworker to secure a delay in dispersal while the medical implications of the situation are considered.” Special efforts should also be made by the IND to ensure that suitable accommodation is found for families and children with HIV in an area with appropriate paediatric HIV services. Healthcare staff should contact the IND caseworker and request a delay in dispersal if they have not been contacted regarding these arrangements.
Situations have occurred when patients have been dispersed without healthcare staff first being contacted. Should this occur, doctors are encouraged to ask their patients if they have disclosed their HIV status to their IND caseworker. If not, patients should be “encouraged” to discuss their medical situation to make sure that the medical implications of dispersal are properly considered. If a patient still does not wish to disclose their HIV status to the IND, the current HIV clinical team should ensure that their patient has enough medication for the journey and arrival in the new area (a month is suggested), and is provided with a letter detailing their medication, blood test results, and useful contacts.
If, however, a patient has disclosed and the IND has not contacted the current HIV team, then the IND should be contacted to secure delay in dispersal until the relevant medical information is considered.
Once the IND has decided to disperse an individual, the current HIV team has a responsibility to identify and liaise with an HIV treatment centre in the new area. This treatment centre should be able to provide the same level of care that the patient is receiving prior to dispersal. The patient should be given a letter addressed to their new GP in the dispersal area detailing all relevant medical information. The contents of this letter should be discussed with the patient. The HIV team in the dispersal area should prepare for the reception of the dispersed patient. If a patient does not attend a pre-booked appointment, contact should be made with the local IND. If the patient has not disclosed their HIV status to the IND, medical staff must not mention HIV, and are recommended to say that the individual has missed a hospital appointment.
Voluntary sector organisations supporting an individual who is going to be dispersed should seek details of support organisations in the dispersal area and give these details to their client before dispersal.
British HIV Association and the National AIDS Trust. The dispersal process for asylum seekers living with HIV: advice for healthcare and voluntary sector professionals. December 2006.