Annex
THE EMERGENCE OF AN UNDERCLASS OF DESTITUTE
PEOPLE WITH HIV/AIDS IN LEICESTER
At the end of September 2004, LASS analysed
our half-year Service User trends, outputs and outcomes:
— It has been a deeply disturbing six
months. In that time, 28 people with HIV surviving on nil income,
many on an ongoing basis have emerged.
— This is a direct result of Government
Policy (see previous briefing "Local HIV Health and Social
Care Crisis: January 2003").
— The results for our services have
been immediate. We have had to cut our Foodbank Voucher service
to a time-limited three-month only service, as it is simply
unsustainable for the increasing number of destitute people coming
to us. It is nothing short of shocking that we are having to cut
something designed to assist people with HIV to meet their basic
nutritional needs. After twelve weeks of giving people £7.50
per week for food we must now say "We are sorry, we cannot
give you any more food vouchers." We are left wondering how
such people will eat; and therefore how they have any hope of
adhering to their HIV medication presuming that they have any,
or maintain basic health.
— The focus of our other direct services
is shifting to work with other organisations, to try to help people
meet the most basic of survival needs; to producing information
about soup kitchens; looking for places for people to sleep and
for coats and shoes.
— If the current trends continue; then
40-60% of the new service users with HIV that we see each month
will end up destitute within 12-18 months of our first seeing
them. We now see 14 new people with HIV every month. 40-60%
of that is 6-8 people each month. This means that the dozens
of destitute people with HIV could become over a hundred in a
year.
— The impact of this will affect us
all as service providers, planners and commissioners.
— Our concerns are worsened by further
recent Government Policy changes. In April 2004, hospital charges
were introduced for overseas visitors requiring people to prove
they have a right to free treatment. Charges are now being proposed
for Primary Care, excluding emergency treatment. HIV drugs are
not excluded. This means that someone with HIV who cannot
produce evidence in a hospital to prove they have a right to free
treatment will not be given anti-retroviral HIV drugs (ARV). They
will only be treated in A&E if they become seriously ill and
require admission. The likely consequences of this include:
— People without HIV treatment will become
ill much faster, and for longer.
— "Treatment" would then occur
in cases of serious illness via A&E requiring hospitalisation,
at £500 bed-costs per day; as opposed to £800 a month
for the preventative ARV treatment.
— Healthcare resources are being diverted
to provide a surveillance system for the immigration services.
— It is unethical to wait for someone to
become critically ill before giving any treatment when the situation
could be cost-effectively averted by an earlier intervention.
— Like section 55 of the NIA Act last year;
these changes in National Policy are potentially disastrous for
our work.
These developments have profound implications
on all levels. For the individuals with HIV, their health and
survival needs are under serious threat. For local Service-Providers,
the acute needs of destitute people may overload capacity. There
are also 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, including 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 destitute people will be able
to prioritise obtaining condoms.
Further implications for forward transmission
include:
— To deter people from being tested
for HIV—if there is no treatment, what incentive is there
to test?
— To increase the number of undiagnosed
people.
— To in turn increase the number of
infections.
— People not on ARV are more infectious
due to higher levels of detectable virus.
This paper is not a comprehensive explanation
of all of the issues but is a very brief overview of some of the
most disturbing trends we have seen in the last six months. We
first mapped out our concerns in the briefing "Local HIV
Health and Social Care Crisis: January 2003", copies
still available. Prior to that point, we had worked with people
on nil income relatively rarely; and almost always in a transitional
situation whilst awaiting benefit decisions. The question was
about how much assistance the person might receive and when; not
about whether they would receive anything at all. Nevertheless,
our Foodbank expenditure rose from £4,827 in 2000-01 to £23,176
in 2003-04.
By April 2004, we were providing services to
seven people on nil income; of whom four were in a temporary nil-income
situation but three had no prospect of any further income. By
the end of September 2004 this had risen to 28 people on nil income,
of whom nine are in a temporary transitional situation (awaiting
benefits and likely to qualify) six are "uncertain"
(we do not yet know if they are likely to receive benefits due
to uncertain pending decisions) and 13 have no prospect of any
further income. We have extrapolated our predictions overleaf
directly from this.
We are flagging up what we are seeing as a direct
result of Government Policy changes and feel that we have a responsibility
to work together with our partner agencies in an attempt to avert
the growing crisis. This will require attention to service provision
and into planning for people in such dire straits; but also requires
lobbying at the highest levels. These developments run counter
to almost every aim, objective and target set out in the National
Strategy for Sexual Health and HIV.
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