Select Committee on Health Written Evidence


Memorandum by Linda Grant (HA 35)


  I am writing with an important briefing for you as someone strategically involved in Health and Social Care Planning and Provision in Leicester, Leicestershire and Rutland.

  We have seen a sudden, dramatic and unpredicted increase in the number of new HIV+ people in this area since March 2002. Statistics and a graph showing the sudden upsurge are below.

  These statistics are not known amongst Planners and Policy Makers. Since the ring-fencing for HIV funding was removed several years ago, no-one locally has been collating statistics on new HIV+ diagnoses. The "sophid" statistics being used for planning are those up to the end of 2000, which as you can see from the graphs overleaf are woefully out-of-date.

  Up until March 2002, we were seeing new Service Users at a rate of less than six per month. Between March 2002 and September 2002 this jumped to 10 per month, since then it has accelerated to 13 per month. Our caseload has trebled in less than three years.

PeriodHIV+ AffectedTotal SUs Asylum
1 April 1999-31 March 2000115 491645 16
1 April 2000-31 March 2001165 673215 621
1 April 2001-31 March 2002219 8330224 630
1 April 2002-30 September 2002255 10636158 2179
-End Jan 2003305108 4139322 115

  Of particular concern is the number of Asylum Seekers, Refugees and people on Visas within this. Although 28% of the total, they represent 77% of all new Service Users. This has frightening implications for existing service provision (unable to cope) and for prevention work (the next "wave" of infections are likely to be those acquired locally, by heterosexual women, which potentially will not "show up" for 3-10 years and which may also be drug-resistant: see below).

  These people are presenting to us with acute and complex needs, which far outweigh those of the people we have traditionally seen previously. They are in acute poverty, have no recourse to "the public purse" or Social Services (since April 2002 when responsibility for housing, food and the £10 voucher per week were given to NASS). They have no Social Support, friends or family to assist them. The threat of violence from people from the Countries they are fleeing makes "Peer Support' anathema. They have serious housing needs (eg people living in rooms scarcely big enough for a mattress in Dickensian conditions) heating and clothing needs, and this coupled with stress regarding their immigration status contributes to rapid deterioration in health with obvious implications for costs to the Health Service. We are aware of people being kept on the Ward because the accommodation they have been assigned is "uninhabitable'. Language barriers and medical understandings are very difficult issues. Some people are being given Combination Therapies (expensive drugs designed to slow the progression of HIV) when they do not have the order, routine or resources (including food) to adhere to the necessary strict regimens. This has serious consequences for the individual, for Public Health, and for the optimal use of limited health care resources. Adherence below 95% typically leads to "Treatment Failure": faster disease progression for the individual, higher treatment costs, and drug-resistant HIV. This will result in an increase of transmission of resistant virus to the next wave of newly infected individuals.

  At Leicestershire AIDS Support Services we are unable to meet these increasing demands. Our Hardship Fund, Complementary Therapies Fund and most significantly The Foodbank, (which has supported adherence by supplying food for people on incomes below benefit level) have all run out of money. Up until March 2002 we raised on average £15k per year through donations and fundraising to maintain these services. At January 2003 due to the increase in destitute Service Users the forecast spending has risen to £52k per year and we simply cannot raise this amount locally.

  LASS Direct Services are reeling under the weight of new and complex demands. We are aware of other Service Providers also experiencing serious capacity issues.

  The new Asylum requirement brought into effect from 8 January 2003 will make this situation much worse. From that date any "in-country" applications will NOT be entitled to NASS support: food, shelter and clothing. (Refugee Council statistics 2001: almost 50,000 people applied "in-country")

  The likely result of this new policy will be to create tens of thousands of destitute Asylum Seekers who have no support from NASS, no food, shelter or clothing. Many of them will be HIV positive. They may or may not be aware of this.

  This has serious Crime and Disorder implications as well as Public Health issues. People who are destitute and unable to work are likely to turn to crime, particularly theft or prostitution, to live. Even without selling sex, recreational sex is likely to be one of the few pleasures available, and a human comfort.

  We suggest that it is highly unlikely that people in such situations will use condoms. We predict therefore, that the next "wave"of infections will be those being acquired locally now, through heterosexual sex. These are unlikely to "show up" for some years, until those individuals become ill.

  This of course leads to the importance of Prevention work. Given that this pattern of infection is completely predictable, we ought to be able to intervene. We have several major problems however:

    1.  Political and Public Complacency. Statistics for Sexually Transmitted Infections are soaring throughout the UK. There is no "condom culture". HIV and Sexual Health have dropped off the political and public agenda. "The public" do not perceive themselves to be at risk. The current epidemic of sexual ill health including soaring Chlamydia infections is evidence of this. Because it is not a "target", there is no investment or concern from funders.

    2.  Political unpalatability. It is very difficult to describe the structural and epidemiological problems related to HIV positive Asylum Seekers and Refugees without appearing to describe the individuals as "problems". No one (except perhaps far-right political groups) wants to do this.

    3.  Capacity. Current Service Providers such as ourselves are unable to cope as it is. More investment is needed for effective health promotion. The proposed devolution of the Health Promotion Agency and consequent loss of Sexual Health as a specialist function could not be more badly timed. "Generic" Health or Education workers—a vital resource which we must strategically tap into if we are to address this crisis—will not undertake sexual health work as it is unpopular, difficult and embarrassing. They must be properly informed, resourced and co-ordinated. Who will take responsibility for this?

  I urge you now that you have this information to please be mindful of it in any planning or financial forums in which you are involved. There are serious capacity issues to be addressed, and strategic long-term planning must be undertaken. Please use whatever influence you have to ensure that despite its unpopular nature, this crisis is not ignored or "left to someone else". Thank you for taking the time to read this briefing. Please contact us for any further information.


  We are unable to locate any body able to give an overall statistics on the numbers of new Asylum Seekers and Refugees coming into the area. Other Councils are buying up housing stock and placing their own Asylum Seekers and Refugees in these, and so not even Leicester City Council are able to give a clear estimate. What we do know is that many people are coming from countries such as Zimbabwe, which have 25% HIV prevalence rates. It is reasonable to assume that of every 100 people coming into the area daily from such countries, 25 will be HIV+ or have AIDS. These diagnoses are "turning up"from amongst women who are pregnant and routinely tested as part of antenatal procedures, or on the Infectious Diseases Ward where people are turning up extremely ill, with no other likely cause. Given that the vast majority of people with HIV will not show dramatic symptoms for some years after infection, the people that we are currently seeing can only form "the tip of the iceburg".

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