Memorandum submitted by National AIDS
Trust
1. INTRODUCTION
The National AIDS Trust (NAT) welcomes the inquiry
of the International Development Committee into the provision
of anti-retrovirals. NAT is the UK's leading independent policy
and campaigning organisation on HIV and AIDS, working to prevent
the spread of HIV, to ensure equitable access for all those living
with HIV to treatment and care, and to eradicate HIV-related stigma
and discrimination.
In this submission, NAT wishes to focus on one element
of the Committee's terms of reference—"Policy coherence
on HIV/AIDS across Whitehall". Current domestic policy is
inconsistent with the policy and ambitions of DFID, undermines
DFID's moral authority internationally, and harms the fight against
HIV in the developing world.
Two policies in particular need to be addressed:
the denial of free HIV treatment in England to those who have
failed in their asylum application or are otherwise undocumented;
and the deportation of those living with HIV who have no right
to reside in the UK to places where ARV is not available.
2. ENTITLEMENT
TO FREE
HIV TREATMENT IN
ENGLAND
This issue is probably causing more distress and
concern at present than any other within the HIV sector in the
UK. Since April 2004 the Government has effectively denied free
HIV treatment in England to those who have failed in their asylum
application or are otherwise undocumented. All other STIs dealt
with in, or referred from, GUM clinics are exempt from treatment
charges—to single out HIV treatment for payment is itself
discriminatory and can only harm public health.
The HIV test remains free but without any treatment
available those affected lose one of the main incentives to test.
DFID in its HIV Treatment and Care Policy makes clear that the
provision of treatment is one of the most effective prevention
interventions. This fact seems lost on the Department of Health.
NAT has already uncovered many examples of treatment
being denied or interrupted as a result of these charges. The
results include:
— serious ill-health and eventually death
— additional costs to the NHS as people
denied ARVs instead access free services in A&E for increasingly
frequent and serious HIV-related illnesses
— increased onward transmission of HIV
in this country since those not on treatment are significantly
more infectious (and many may not test, get diagnosed and then
practice safer sex because the treatment incentive has been removed)
— increased risk of mother-to-child transmission
since mothers have to pay for the ante-natal care during which
HIV screening takes place and for the drugs to prevent HIV transmission
to the child.
Universal ARV provision is an international priority
because HIV is one of the greatest public health emergencies facing
our planet. It should not become a victim of immigration policy.
Whilst the Government's G8 commitments are to be commended, ARV
access policy in England does not appear to be based on public
health considerations or consistent with these G8 commitments.
If DFID is arguing that ARVs should only be provided
in developing countries to those who have clearly established
residency rights, then this would exclude many hundreds of thousands
and make a mockery of the phrase "universal ARV provision".
It would deny treatment to the displaced, marginalised and vulnerable,
to many victims of conflict, poverty and abuse, precisely the
groups who are at risk of HIV infection and where free treatment
is most needed.
But if DFID really means ARV provision to be universal
by 2010, what will it have to say when anyone can access ARVs
in Lusaka but people are being denied them in Lewisham?
Earlier this year the Commons Health Committee looked
into this question as part of its inquiry into New Developments
in Sexual Health and HIV/AIDS Policy [Third Report, Session
2004-05 HC 252]. NAT gave both oral and written evidence to the
Committee and our written submission to the Health Committee is
appended to this paper.[22]
We do not wish here to rehearse in detail all the arguments against
HIV treatment charges but would simply refer to the Health Committee
report and to that report's unequivocal conclusion that the Government
should exempt HIV from treatment charges. NAT would urge the International
Development Committee to demonstrate that Parliament can be joined
up where the Government fails to be, supporting the recommendation
of the Health Committee.
NAT recommends that the Government as a matter of
urgency exempt HIV treatment from NHS charges, taking forward
the international campaign for universal ARV provision by first
providing it throughout the UK.
3. DEPORTATION
The recent case of N in the House of Lords
made clear that at present the courts do not consider that the
deportation of someone living with HIV to a place where ARVs are
not available contravenes that person's human rights. This despite
the fact that without access to ARV treatment deportation will
mean serious illness and ultimately death for the person deported.
Although the courts have taken this view, this
does not dispose of the humanitarian and policy arguments against
such deportations, which the Government must consider.
The Government has succeeded in securing international
commitment to the goal of universal access to ARVs by 2010. It
seems inhumane in the extreme not to delay deportations until
this access has been achieved in the country to which the deportee
is to be returned, especially when such access is only up to five
years away. Such a small delay is the difference between life
and death for those concerned.
For those on ARVs who are deported to places
where they cannot access these drugs, in addition to the serious
deterioration in health which awaits them, there is an additional
problem of the possible development of a drug resistant strain
of HIV as a result of interrupting treatment. Furthermore, it
is possible for such a drug resistant strain to be passed on to
others. The impact of the Government's current policy on deportation
is thus effectively to export ill health to the developing world.
It will be very important in determining whether
ARVs are freely and universally available in a particular country
not simply to take the relevant Government's word for it, but
also to receive assurances from organisations in the country of
those living with HIV.
NAT recommends that the deportation of those
living with HIV who have no right to reside in the UK be delayed
until access to ARV can be provided in the country to which the
deportees are to be returned.
November 2005
22 Not printed. See HC 252, Session 2004-05, Ev 24. Back
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