Select Committee on Health Written Evidence


Memorandum by Positively Women (HA 12)

  In response to the enquiry into the consequences of the new and proposed charges for overseas patients with regard to access to HIV/AIDS services I wish to submit the following evidence. Positively Women would also be prepared to submit oral evidence.


Positively Women (PW)

  Positively Women is the only national charity working to improve the quality of life of women and families affected by HIV:

    —  Providing specialist support by women living with HIV.

    —  Enabling women to make informed choices.

    —  Challenging stigma and discrimination.

  Central to Positively Women's work is the ethos of "peer support", that is support for women living with HIV by women living with HIV. Services to women and families include:

    —  Immigration advice.

    —  One-to-one and group support.

    —  Treatment information.

    —  Drug and alcohol work.

    —  Volunteering and work opportunities.

    —  Specialist work with parents and young people.

    —  Outreach in clinics, hospitals and women's prison.

  Nationally, PW provides expertise to other organisations in developing services to meet the needs of women and families. The quarterly newsletter, written and edited by women living HIV, is a vital resource for those who are isolated. To ensure the voices of women living with HIV are heard, the Taking Part project trains women with HIV to lobby and inform policy at all levels.

  PW works collaboratively with a range of organisations including Asylum Aid, THT and The UK Coalition of People Living with HIV and AIDS, and is a founding and leading member of the Positive Futures Partnership.

  Positively Women (PW) recognises the issue of applying limited NHS resources accurately to improve health and treat disease and illness. This response results from direct contact with people living with HIV who use PW services.

  Positively Women believes the results of the charges to overseas visitors is to create a situation that endangers the health of individuals and will lead to the increase in onward transmission of HIV.

  The failure to include HIV in the exemptions for free treatment has serious consequences in causing individual hardship and constitutes a public health danger. As such this regulation is likely to have high cost implications.

  The widespread perception at grassroots level that treatment will be refused is preventing people with HIV from accessing health and support services.

  Anti-retrovirals act to suppress HIV, which breaks down an individual's immune system. Without this treatment HIV will resume the destruction of the immune system, opportunistic infections will then be able to take a hold, resulting in increased use of emergency services and long use of hospital beds. Failure to treat the cause of illness is not good clinical practice.

  The cost in health terms to women, who are still in the main the carers of the family's health, is particularly high.

  The ethos of the National Strategy for Sexual Health and HIV/AIDS is to promote testing in at risk communities, to identify early those with HIV, in order to treat, promote health and prevent transmission.

  There is evidence that many migrants have been diagnosed as HIV positive after entering the country for purposes other than health benefits. To refuse treatment for people in this situation is at odds with the commitment of the National Sexual and HIV/AIDS strategy to reduce transmission of HIV by 25%.

  Refusing treatment will further fuel the stigma of HIV, which the strategy is committed to reducing. It is also likely to lead to lower levels of diagnosis of other sexually transmitted infections and TB both of which have public health implications. A number of migrants with HIV have also proved to be co-infected with TB.

  In PW's experience, which is borne out by research by Sigma Research, most migrants with HIV do not have the means to pay for treatment, and HIV takes a back seat to housing and food needs.

  Since September 2004, PW's full-time team of HIV positive women peer mentors report the following:

    —  eight women reported that their doctors have asked them for proof of immigration status so they can be able to access ARV treatment;

    —  three women on treatment reported have been threatened with withdrawal of treatment if they do not confirm their immigration status; and

    —  one woman has been denied treatment.

  On a day-to-day basis this team is now seeing women who are facing withdrawal of life saving medication.


  PW recommends that treatment for HIV should be exempt from charges.

    —  The amendment to remove treatment rights for migrants who have been resident in the UK for more than 12 months will lead to increased onward transmission of HIV, including that from mother to child.

    —  The charges will ultimately be costly in personal health and emergency treatment terms.

    —  The amendment is contrary to the commitment of the National Sexual Health and HIV strategy

    —  HIV should be included with other STI's and TB for eligibility for NHS treatment on public health grounds.

20 December 2004

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