Home Affairs Committee

1. NAT (National AIDS Trust) welcomes the opportunity to submit evidence to this Home Affairs Committee inquiry on asylum.

2. NAT is the UK’s policy and campaigning charity on HIV. We are active on a wide range of policy issues which affect the lives of people living with HIV in the UK and which impact upon the UK’s efforts to reduce onwards transmission of HIV. As the majority of heterosexual men and women living with HIV in the UK were born abroad135, asylum and immigration policies are particularly relevant.

3. The areas of investigation outlined in the Terms of Reference which NAT would particularly like to focus on are:

• — Whether the system of support to asylum applicants (including section 4 support) is sufficient and effective and possible improvements.
• — The prevalence of destitution amongst asylum applicants and refused asylum seekers.

4. For a broader range of evidence of how the asylum system impacts people living with HIV, covering all aspects of the Terms of Reference, we recommend the submission made by George House Trust (GHT), an HIV support organisation in Manchester. This submission contains recently gathered evidence from HIV positive service users who have experience of the asylum system.

Destitution amongst asylum seekers living with HIV and impact of the current support system.

5. NAT does not consider the current rate of asylum support sufficient to meet the essential living needs of destitute asylum seekers living with HIV. The experiences of asylum seekers living with HIV show that the current rates perpetuate already extreme levels of poverty in this group.

6. Asylum seekers are entitled to access HIV treatment and care while in the UK. With the high quality of clinical management available through the NHS, people living with HIV should be able to live long, healthy lives with minimal health impacts. However, the good work done by HIV clinics to help asylum seekers is often undermined by the effects of poverty.

7. In 2009, NAT analysed the applications received by the main UK-wide HIV Hardship Fund over the previous three years and found that 27% of all applications were from asylum seekers.136 Just under half of this group were accessing asylum support (the rest were reliant upon local authorities, charities and communities). For those on Section 95 the rate of cash support provided was insufficient. For those on Section 4 support the added restriction of only receiving support on a pre-paid card made it particularly difficult to access all their daily needs within the limited budget.

8. The application letters sent by referrers on behalf of asylum seekers who needed to access the Hardship Fund frequently explained that asylum support was insufficient for meeting their daily needs including clothes, bedding, nappies and other child needs, and enough to food to eat.

9. People with HIV are advised by their healthcare teams to eat fresh, nutritious foods to make treatment as effective as possible. Adequate nutrition is vital to supporting the immune system. HIV treatment can also affect the way the body metabolises food and people with HIV are at higher risk of metabolic complications such as osteoporosis, heart disease and diabetes. Access to enough high-quality food is always crucial to the wellbeing of people living with HIV and this is not possible on current support rates.

10. The recent focus group research by GHT found that people living with HIV who were reliant on section 95 asylum support talked about choosing between food and travel when spending their cash allowance. NAT has previously also heard of section 4 recipients missing clinic appointments because without any cash they have been unable to pay for travel.

11. When the link with HIV treatment and care is undermined in this way, the health of these asylum seekers will be severely compromised. HIV medication must be taken daily at the same time, and 95% adherence is needed to ensure the maximum benefit from the treatment. Poor adherence can also lead to the development of drug resistance. Without their treatment, people living with HIV will experience an increase in viral load, making them much more likely to pass on the virus to others in their community.

12. It is a waste of the effort and resources invested by the NHS in keeping asylum seekers with HIV well, if individual patients do not have adequate resources to meet their basic health needs such as food, shelter and warmth. HIV treatment is highly cost effective, but when patients are not able to adhere fully to their medication it is likely that many will need to be admitted to hospital with serious HIV-related illness.

13. The inability to work legally leaves asylum seekers particularly vulnerable. The GHT focus groups found that asylum seekers with HIV had considered sex work to support themselves.

Recommendations

14. NAT recommends that asylum support rates be set at a level equivalent to income support. While recipients of Section 95 or Section 4 are placed in asylum housing, it is also the case that British citizens who claim welfare benefits may also be assisted with housing—on top of their weekly rate of support.

15. NAT recommends that refused asylum seekers on Section 4 support are paid their support in cash, rather than on cards, to allow them to pay for essential needs including travel.

16. NAT recommends that asylum seekers are able to apply for permission to work if they have been waiting 6 months for a decision on their claim.

NAT

April 2013

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Prepared 11th October 2013