Proposals to introduce mandatory HIV and TB screenings for immigrants to the UK are not based on adequate evidence and have practical and ethical problems, according to an editorial in the February 7th edition of the British Medical Journal.
Immigration and asylum-seeking have been hot political topics in the UK for a number of years, and sections of the UK media have recently taken to associating immigration with a threat to public health, particularly from communicable diseases such as TB and HIV.
The BMJ editorial, written by a senior faculty member from the Department of Public Health at the London School of Hygiene and Tropical Medicine, questions whether there is any evidence base to support compulsory TB and HIV checks for migrants.
"For tuberculosis, the notion that screening immigrants detects those with disease and therefore benefits public health is not straightforward," argues 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 explains 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 goes 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" stresses the author.
Furthermore, screening would not include individuals, such as citizens of the European Union, who have a right of free movement to the UK. "Yet the future eastern border of the European Union," explains 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, argues 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," points out the editorial, 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."
Further information on this website
Labour warned to think again on compulsory HIV tests for immigrants - news story
Coker R. Compulsory screening of immigrants for tuberculosis and HIV. BMJ 328: 298 – 300, 2004