Memorandum submitted by the African HIV
Policy Network
1. THE AFRICAN
HIV POLICY NETWORK
1.1 The AHPN is an alliance of African community-based
organisations and their supporters working for fair policies for
people living with HIV/AIDS in the UK, providing training, support,
research and information. The AHPN is the only African organisation
in the UK whose work is dedicated to policy, advocacy and representation
at national level. Its major focus is on HIV and the sexual health
of Africans in the UK.
2. EXPERIENCES
AND NEEDS
OF AFRICAN
PEOPLE LIVING
WITH HIV IN
THE UK
2.1 There are estimated to be more than
11,000 African people living with diagnosed infection in the UK
(HPA, 2005). In addition several thousand more African people
living in the UK have undiagnosed HIV infection since studies
have shown that roughly two-thirds of African people in the UK
have never tested for HIV (Fenton et al, 2002). HIV prevalence
is many times higher among African people in the UK than among
the White British majority. Compared to UK born men and women
attending GUM clinics (each of whom have an HIV prevalence of
0.2%), 7.7% of African born women and 4.8% of African born men
who attend GUM clinics are infected with HIV.
2.2 A recent quantitative study (Weatherburn
et al, 2003) which included an analysis of the health and
social needs of African people with HIV shows that between a half
and three quarters of this group report significant ongoing difficulties
in the following areas: income, immigration status, housing and
living conditions, and access to training, skills and job opportunities.
Difficulties in meeting these basic needs clearly lead to reduced
quality of life. Similar percentages said they had significant
and ongoing difficulties associated with anxiety and depression,
their ability to sleep, their self-confidence and their personal
relationships. The same study compared the experiences of African
people with HIV to their White British counterparts. Compared
to other people with HIV in the UK, African people with HIV were
10 times more likely to report problems associated with their
income, seven times more likely to report problems with their
living conditions, three times more likely to report problems
with discrimination and twice as likely to report problems with
getting about (mobility) and personal relationships.
2.3 Thus, not only are African people with
HIV likely to experience more health and social care needs than
the general population, but they also experience more needs than
British people with HIV. Social exclusion is undoubtedly exacerbated
by factors associated with migrancy. It's likely that a significant
proportion of African people with HIV in the UK are (or have been
in the past) refugees or asylum seekers (Fortier, 2004), a group
already significantly socially excluded (refugee council, 2004a).
Exclusion associated with being HIV positive may be significantly
compounded by pre-existing social exclusion and social need associated
with being an African refugee or asylum seeker.
2.4 In order to survive and thrive, refugees
and asylum seekers need to draw on their own personal resources
(their ability to work for example) and need to draw on a supportive
social environment in their host country. This environment is
created first by the support of expatriate communities in the
host country as well as in their home country and second by the
provision of supportive enabling legislation policy and services
by the host country. African people with HIV are likely to have
all of these resources particularly curtailed.
3. TREATMENT
ACCESS
3.1 In July 2005, the UK played a significant
role in getting the G8 countries to pledge their support for universal
access to HIV treatment worldwide by 2010. This lofty goal was
later endorsed by all United Nations member states where they
obligated themselves to:
3.2 "Developing and implementing
a package for HIV prevention, treatment and care with the aim
of coming as close as possible to the goal of universal access
to treatment by 2010 for all those who need it".
3.3 In May-June 2006 this promise was again
ratified in the UNGASS Declaration of Commitment:
3.4 "[We commit] to pursue all necessary
efforts to scale up nationally driven, sustainable and comprehensive
responses to achieve broad multisectoral coverage for prevention,
treatment, care and support, with full and active participation
of people living with HIV, vulnerable groups, most affected communities,
civil society and the private sector, towards the goal of universal
access to comprehensive prevention programmes, treatment, care
and support by 2010."
3.5 The leaders also agreed to: "set
in 2006, through inclusive, transparent processes, ambitious national
targets, including interim targets for 2008... that reflect...
the urgent need to scale up significantly towards the goal of
universal access to comprehensive prevention programmes, treatment,
care and support by 2010."
3.6 Despite the UK government's very visible
leadership and commitment to universal access to HIV treatment,
it has not shown an equally brave face on its own front door.
3.7 In April 2004, in response to the tabloid
press claim of "treatment tourism", the Government introduced
changes to NHS policy concerning HIV treatment for overseas visitors
to the UK. Beforehand, NHS treatment for all conditions was free
for anyone who had lived in the UK for at least 12 months, including
anyone applying for asylum or the right to remain in the country;
which allowed the majority of overseas visitors who required HIV
medication to obtain it without charge. The new changes say that
anyone living in the UK without documentation, and anyone refused
asylum or leave to remain, but not removed from the UK, must pay
for HIV treatment except in emergencies.
3.8 This policy is inhumane and unethical,
as it targets those most vulnerable from the developing world.
These proposals would accentuate inequalities rather address them.
Charging undocumented migrants, failed asylum seekers, or visitors
with HIV/AIDS, runs counter to public health interests. Seeking
funds from those who are unlikely to possess them is neither cost
effective nor productive. Such measures also run the risk of driving
HIV underground, and increase the burden on NHS A and E services.
3.9 The legislation singles out HIV for
charges, while other communicable diseases and sexually transmitted
infections remain free to everyone, including accident and emergency
services.
3.10 HIV was singled out, because of the
fear that free treatment will bring a flood of people from countries
where none is available, putting the NHS under strain and public
health at risk. The existence of supposed "health tourism"
to which this measure is clearly a reaction to has not been proven
and is contradicted by a House of Commons Health Committee report
(2005). The report issued in response to the Department of Health's
policy, stated that the majority of overseas visitors infected
with HIV do not access NHS help until the later stages of their
condition when they are seriously ill. The same report they argued
that people with untreated HIV patients will make increasing visits
to A&E departments, costing the NHS more in emergency treatment
than it would to provide long-term medication.
3.11 There is a greater risk of HIV being
transmitted by untreated individuals. Free screening and counselling
is available to all those residing in the UK regardless of residency
status, evidence demonstrate that people are much more likely
to get themselves tested for HIV in countries where treatment
is available than those where there is no access to treatment.
The knowledge that they are not allowed treatment might stop immigrants
from getting screened for HIV, posing a further possible risk
to public health, as more cases of HIV are likely to go undiagnosed.
4. RECOMMENDATION
4.1 The UK government should exempt HIV
treatment from the NHS charges for overseas visitors rules.
5. DEPORTATION
5.1 On 5 May 2005 the House of Lords set
a very high threshold for those with HIV/AIDS in applying for
leave to remain under Article 3 of the European Convention on
Human Rights (ECHR). The decision authorized HIV-positive people
living in the UK, where they are receiving antiretroviral therapy,
to be deported to their home countries. A majority of the people
who could be deported are from African countries that have high
HIV prevalence and limited access to antiretroviral drugs.
5.2 Removal from the UK will be the equivalent
of turning off a life-support machine as HIV Treatment is not
readily available or affordable. The withdrawal of treatment increases
the body's vulnerability to opportunistic infection and will result
in drastically shortened life expectancy.
5.3 It seems incongruous for the Government
to strive to "make poverty history" in Africa through
granting aid and cancelling debt and yet, it is prepared to return
soon to be terminally ill Africans to their home countries where
scant or no resources for their care exists. HIV-positive people
should be allowed to stay in the United Kingdom, at least until
they might be able to return home when access to antiretroviral
treatments becomes more widespread in Africa.
6. RECOMMENDATION
6.1 A Humanitarian Protection Exercise should
be developed to allow certain categories of people currently on
HIV treatment to remain in the UK.
October 2006
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