Memorandum by Linda Grant (HA 35)
LOCAL HIV HEALTH AND SOCIAL CARE CRISIS:
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as you can see from the graphs overleaf are woefully out-of-date.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.
INCREASING RATES OF NEW SERVICE USERS: LEICESTERSHIRE
AIDS SUPPORT SERVICES, APRIL 1999-JANUARY 2003
|1 April 1999-31 March 2000||115
|1 April 2000-31 March 2001||165
|1 April 2001-31 March 2002||219
|1 April 2002-30 September 2002||255
|-End Jan 2003||305||108
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
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
workersa vital resource which we must strategically tap
into if we are to address this crisiswill 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".