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. 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