Access to HIV treatment

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Access to HIV treatment
Issues of working with HIV positive refugees and
asylum seekers Linda McDonald MA MSc RN
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Background
Refugee A person who has a well-founded fear of
persecution for reasons of race, religion,
nationality, membership of a particular social
group or political opinion and who is outside
the country of his nationality or formal
habitual residence and is unable or, owing to
such fear, is unwilling to avail himself of the
protection of that country or return to it (
Refugee Convention article 1A)
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• Asylum seeker
• in the UK
• a refugee as defined by the refugee convention
• refusing the application would mean returning to
  a country
• where his life or freedom would be threatened.

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Article 3 of the Human Rights Convention An
asylum seeker who would suffer torture or inhuman
or degrading treatment or punishment if returned
to his/her country of origin, should not be
expelled from the UK.
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Economic impact on UK
There has been an increase in individuals seeking
asylum in the UK CDSC reports that most HIV
positive individuals in the UK contracted their
infection abroad The cost of HIV treatment and
care has escalated in the last few years More
and More HIV positive individuals are being
refused permission to remain in the UK on
compassionate grounds
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Who is eligible for NHS treatment
If individual has permanent residency in the
UK Students on a course longer than six
months Refugees/asylum seekers who have made an
application to remain in the UK If individual
has been detained by the immigration
authorities If individual has diplomatic
status If from a country with a reciprocal
agreement with the UK
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Who is not eligible for NHS treatment
Visitors Students on a course less than six
months Individuals who are intending to seek
Asylum or Refugee status in the UK, but who have
not yet submitted an application to the Home
Office Illegal immigrants
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Exceptions
AE treatment Diagnosis and treatment of some
communicable diseases (not HIV) Compulsory
treatment of psychiatric treatment District
Nursing, midwifery and health visiting
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VD V NHS regulations
National Health Service (1982) Access to
hospital treatments regulations HIV treatment
available only to eligible individuals HIV
testing is free, treatment is not (HIV is not
considered a communicable disease under the Act)
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Venereal Diseases 1976 Regulations Treatment of
STIs is free and patients are not required to
give names or addresses All HIV prescribing is
done under the auspices of GU clinics As
patients can remain anonymous, therefore no way
of checking who is eligible for HIV
treatment However, if patients are admitted to
hospital, they are out of the GU cocoon and will
be expected to pay
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Challenges for GU clinics
HIV positive individuals often assume that as
treatment is free in the GU clinic, it will be
in all other aspects of health care Different
interpretation of venereal disease regulations by
clinics Clinicians put under pressure to
commence patients on ARVs earlier than they
would wish to support asylum claims False
personal details cause great confusion when
responding to solicitors requests
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Ethical/ Medical considerations
Is it ethical/ good medical practice to commence
treatment, when the patient may be refused leave
to stay in the UK? HIV testing in pregnancy is
recommended to all pregnant women. Is it ethical
to test all individuals, when some may not have
access to treatment? Patients who are known to
be HIV positive come to the UK for treatment.
This has added considerable pressure on the NHS
to fund antiretroviral treatment, often at the
expense of other HIV services. How do we
respond?
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What level of HIV care is available to
individuals in detention centres? Will HIV
testing be initiated at ports of entry? Is this
ethically, legally or morally permissible?
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Conclusion
Diversity between NHS regulations/GU regulations
mean HIV positive individuals, who may not be
eligible, can access treatment and care through
GU clinics However, NHS services may not be
free outside the GU setting Interpretation of
regulations vary between clinics