Examination of Witnesses (Questions 100-106)
DR ANGELA
BURNETT, MS
KAREN MCCOLL
AND DR
YUSEF AZAD
4 DECEMBER 2006
Q100 Lord Judd: Yusef Azad, in your
evidence you have referred to a woman whose HIV status was made
public because of a lack of privacy, and it is obviously true
that people on section 4 accommodation are not infrequently in
shared accommodation. Can you comment on the importance of Article
8 as you see it and the right to a private life for people with
HIV?
Dr Azad: It has been a frequent
problem in the dispersal process for asylum seekers that asylum
seekers living with HIV are sent to inappropriate accommodation,
and there are a couple of aspects to that. One is in terms of
the quality of the accommodation and in particular problems of
damp, for example, which for those living with HIV with a compromised
immune system can have severe respiratory implications, so there
is that basic health problem. The other is around privacy. Medication,
for example, often needs refrigeration, requires special diets
and there is quite a lot of it, and if you do not have the privacy
essential to take your medication people come to conclusions,
sadly, often very quickly. You have read one example; we have
plenty of others. We produced a report with Crusaid on World AIDS
Day last Friday on poverty and HIV, and this issue of accommodation
and the dispersal process and the undermining of privacy and family
life that came with that is certainly one of the main conclusions
that came out of the data from the Hardship Fund which Crusaid
administers to give special support to people in real need.
Q101 Lord Judd: You said in your
evidence that there is no evidence that people arriving in the
UK with HIV are "health tourists". Is there any evidence
to disprove this, such as evidence that HIV is diagnosed at a
later stage after they have arrived, and how do we establish this?
Dr Azad: One of the great problems
around HIV in the UK is the fact that one in three people living
with HIV do not know it; they are undiagnosed. Another serious
problem is the fact that people are getting diagnosed late, and
by "late" that means with a CD4 count below 200, which
is the point at which you should start treatment. 34% of people
diagnose late. The only bit of research that has been conducted
to our knowledge is that by the Terrence Higgins Trust and George
House Trust about migrants who were accessing HIV care as to the
point at which they were diagnosed. [2]They
tend to be diagnosed a significant time after they have arrived
in the country. If you were coming here cynically to exploit the
NHS the sensible thing would be to start accessing it pretty soon
after you arrive. It is certainly very odd to put in an asylum
claim, wait till the claim has failed and then access it when
you are no longer entitled to treatment, so in terms of when particularly
the people from sub-Saharan Africa are being diagnosed, often
late, often with an opportunistic infection which takes them into
A&E, and in terms of the logic of the claim they are health
tourists, the evidence simply does not stack up. If you look at
where people are coming from in the asylum and immigration statistics
from the Home Office, the epidemiology cannot explain it in terms
of any condition, nor can access to healthcare in the countries
of origin. We know why people move. It is because of conflict,
it is because of cataclysmic drops in living standards, it is
because of persecution, it is because of state failure. One of
the main countries of origin of people living with HIV in the
last three years has been Zimbabwe. I can think of a lot of reasons
why people would want to leave Zimbabwe other than or in addition
to the fact of HIV infection. We see no evidence for it and I
think this is a very important point. These charges have no relation
to why people come to the country, nor do they have any relation
to encouraging people to leave. The charges do not encourage people
to leave the country. People do not leave; they die or they become
ill. I think it is a very important opportunity for us to reassert
the fact that there is no evidence as to the value and impact
of these charges on immigration, either in terms of people arriving
or in terms of people leaving.
Q102 Dr Harris: I want to ask any
of you if you know of any instances where doctors or other care
workers were being co-opted by the authorities to aid either in
removal and being put under pressure to reveal information, or
indeed being put under pressure to provide information about non-legal
people as to where they might or when they might next be in or
divulge information that was obtained during the consultation.
Ms McColl: We do not have any
evidence of doctors being co-opted in that way but it is a real
issue of concern and it is one of the reasons why we do not think
there should be a link between immigration and entitlement to
healthcare because we do not think that health professionals should
be asked to do immigration checks on people.
Dr Burnett: I have been asked
for information in the past but not recently. What I would say
is that there is very clear guidance for all health workers about
issues of confidentiality and I think that most health workers
would feel that in this instance those issues of confidentiality
would be paramount.
Q103 Dr Harris: What about the overseas
patient accountant-type person in a hospital? They do not know,
or maybe they are supposed to or are permitted to divulge information
about who they have recently seen or billed. You do not know?
Dr Burnett: I would not be able
to speak on their behalf about what sort of information they are
being asked about.
Ms McColl: We have heard of administrative
staff making calls sometimes to report people because of their
immigration status and it is a great fear amongst the group that
we are working with.
Q104 Dr Harris: And it is inappropriate
in your view?
Ms McColl: Absolutely.
Dr Azad: We have one case of breached
confidentiality which we can certainly send to you, so it does
happen[3].
The other problem with these charges is that the vast majority
of healthcare workers act really professionally and well but the
charges are introducing a culture of permitted hostility to certain
categories of migrant and for those who may have that view it
is allowing some really quite tendentious and upsetting things
to be said to very vulnerable people. That is an issue.
Q105 Lord Plant of Highfield: Thank
you very much. Thank you, all of you, for the evidence and, since
I think most members of the previous group are still here, thank
you also. It has been very interesting and worthwhile from our
point of view and I hope from yours.
Dr Burnett: Are we able to make
any small additional summing up or not?
Q106 Lord Plant of Highfield: Because
we are scheduled to finish at six I do not want us to become inquorate.
If it is very brief please do.
Dr Burnett: I just wish to raise
two points. One is about mental health and to say that refugees
and asylum seekers are in a very high risk group for suicide,
particularly around the threat of deportation. The second is around
child protection issues because I think that pushing people out
of the system and underground raises very serious implications
for the protection of children.
Lord Plant of Highfield: I should say,
both to you and the previous group, that if there are further
bits of information you would like to convey to the Committee,
please do feel free to do so in writing. Thank you very much indeed.
2 Footnote from witness: "Recent Migrants
using HIV Services in England", Terrence Higgins Trust and
George House Trust, 2003. Back
3
Footnote from witness: The examples of breaches of confidentiality
have been provided by Terrence Higgins Trust (THT), as follows:
THT had a client (English regional centre
outside London) whose details of their debts and HIV status were
passed to debt collectors, who then took it upon themselves to
pursue the patient to Malawi and inform the High Commission there.
This subsequently led to refusal of a further visa to return to
the UK.
THT has had two clients (one in London,
one elsewhere in England) who were told that their details had
been faxed to the Home Office by the Payments Officer for confirmation
of their residency status, although they had never been asked
for permission to diclose anything.
THT has been informed recently by an
African community organisation of a client who tried to access
services at a London Hospital and was told that they would automatically
send all her details to the Home Office. It was unclear to THT
whether this was a genuine process, or whether the hospital was
trying to "weed out" ineligible patients by frightening
them off.
These breaches are not confined to immigration
issues; THT has recently dealt with a client who applied for DLA,
stating that both she and her son were living with HIV, only to
find that benefits staff had contacted her son's school for confirmation
of his details, including HIV status (the school had been unaware
of this).
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