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"Rachel Jacobson" |
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UK conference discusses disastrous impact of the myth of HIV health tourism
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Nov 4th, 2008 - 14:42:11 |
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UK conference discusses 'disastrous' impact of the myth of 'HIV health
tourism'
*Edwin J. Bernard*, Monday, October 20, 2008
The UK Government's policy of charging so-called 'health tourists' for HIV
treatment and care is a "public health disaster" based on myth not fact,
Yusef Azad, Director of Policy and Campaigns for the National AIDS Trust
(NAT) told last week's British HIV Association (BHIVA) Autumn Conference
during a session on treating migrant populations and their eligibility for
care.
HIV health tourism is one of the Government's main justifications for "a
harmful, costly and inhumane charging policy," according to a new NAT
report, *The myth of HIV health tourism*.
The results of that policy were highlighted at the conference by a panel
consisting of an HIV clinician, a human rights lawyer, a GP who has cared
for many asylum seekers with HIV, an HIV-positive migrant advocate, and Mr
Azad.
Since April 2004, overseas visitors, refused asylum seekers, undocumented
migrants and visa overstayers have no longer been entitled to HIV treatment
and care from the National Health Service (NHS) in
England,
although treatment for all other infectious diseases and sexually
transmitted infections continues to be free to everyone on public health
grounds irrespective of residency status. (The NHS in Scotland and Wales
have different policies.)
Earlier this year, a High Court
rulingresulted
in HIV-positive refused asylum seekers being entitled to free HIV
treatment and care for as long as they remained in the UK. But the judge
refused a claim that there was a human right to NHS treatment, saying that
any discrimination in the rules was justifiable so as to discourage 'health
tourism'.
Yet a new NAT report that "separates facts and evidence around migration
from fears and misinformation", argues that there is no evidence to
demonstrate that HIV health tourism to the UK exists. Allegations of 'HIV
health tourism', says the report, "make a serious charge against the
integrity and truthfulness of many HIV-positive migrants to the UK,
effectively alleging that stated reasons for migration to the UK are at best
a pretext and at worst totally untrue. Given the discrimination and
marginalisation experienced by many migrants we must question very carefully
any claim which might add to social hostility".
The report also notes, "the claim of health tourism has been central to the
Government's policy of charging refused asylum seekers and other migrants
without lawful residency status for healthcare. The Government argues that
free NHS care for those without what they deem to be a legitimate reason to
migrate to the UK acts as a 'pull factor', encouraging illegal immigration
and discouraging refused asylum seekers from leaving. Charges for NHS care
for certain categories of migrant were introduced to end the 'pull' of free
NHS care and address the so-called problem of 'health tourism'.
"Is there really evidence of HIV health tourism which would justify on
grounds of immigration policy the singling out of HIV for NHS charges alone
amongst all serious or sexually transmitted infections?" asks NAT. Over the
course of twelve pages, the paper robustly argues that there is no evidence
to demonstrate that 'HIV health tourism' is "a significant or real
motivation for migration to the UK" and considerable evidence to demonstrate
otherwise, "in particular the lower rates of HIV prevalence compared with
country of origin, the long average delays [an average of five years]
between arrival in the UK and accessing HIV testing and care, and the
evidence available on the actual motivations of migrants coming to the UK".
Dr Le Feuvre, a Kent GP, told the conference that NAT's conclusions match
his own experience. "We had tens of thousands of [refugees and asylum
seekers] coming through East Kent in the last ten years. I only personally
remember one person amongst those tens of thousands who seemed to be coming
here for medical treatment and the majority of people diagnosed with HIV,
and who left the [Dover Induction Centre], left with it being diagnosed
after their arrival and not before."
One of the paper's recommendations is that "since the provision of free HIV
treatment has no bearing on migration trends, the basis for the Government's
policy of charging for HIV treatment is wholly undermined. It has been
demonstrated
elsewherethat
the policy actually increases costs to the NHS and endangers public
health. The Government must review its policy on NHS charging so as to
exempt HIV treatment from charges."
The impact of this policy was brought into sharp focus at the BHIVA
conference by Professor Jane Anderson of Homerton University Hospital, east
London, who provided a case study to illustrate the desperation faced by
HIV-positive undocumented migrants in England. She told the conference about
a 35 year-old East African woman who was refused a prescription by a medical
team outside of London when she had only three days supply of
antiretrovirals left and no means to return to her country of origin. "We
gave her an immediate prescription for antiretroviral drugs...and gave her a
travelcard from our charitable fund so she could get food and support from
other charitable sources," she said.
She argued that HIV care in the UK should be for everyone. She noted that
the new UK HIV testing
guidelines,
which include a list of 'indicator diseases' prompting the offer of opt-out
testing "is only ethically acceptable if positive individuals are
immediately linked into appropriate HIV treatment and care. Yet," she asked,
"we are meant to send them to a place where they're going to get a big bill.
Is this appropriate practice?"
Adam Hundt, a human rights lawyer provided an overview of the complex rules
and regulations governing access to secondary NHS treatment and care, which
he described as "a bit of a minefield". He noted that there are situations,
people, and diseases exempted from the charging regulations including
treatment given at an emergency department, 34 infectious diseases
(including TB and viral hepatitis) and all sexually transmitted infections
apart from HIV which he said, "is a policy decision".
There is also an exemption for continuing a course of treatment, including
treatment for HIV, as long as someone has lawfully entered the UK.
"Unhelpfully," he noted, "there's no definition of what 'a course of
treatment' is." The Government recently clarified that 'treatment' does not
necessarily mean antiretroviral therapy, but in fact, can mean continued
monitoring of immune and clinical status due to an HIV diagnosis.
He noted that there is also much confusion amongst clinicians over what
constitutes 'immediately necessary treatment' which should be provided to
anyone regardless of their ability to pay. "It basically specifies that if
someone requires treatment because their condition is life threatening, or
because if treatment is not given immediately it will become life
threatening, or because permanent and serious damage would be caused by any
delay then they must be given treatment regardless of whether they can pay
or not and then be charged for it later," he said.
Dr Ian Williams, BHIVA's Chair, recently wrote to the Department of Health
to argue that HIV care should be considered immediately necessary in the
same way as maternity care. "I think the most important thing to remember,"
noted Mr Hundt, "is that it's a matter of clinical judgment which should not
be second-guessed by administrative staff."
In the discussion that followed, Prof. Anderson pointed out the paradox of
one Government department, the Department for International
Development, supporting
universal access to HIV treatment and care
overseas,
but another two Government departments, the Department of Health and the
Home Office "denying that care free here and also sending people back
through various legislation and legal decisions to places where there's no
care. Why can't we have domestic policies that are the same as foreign
policy?" she asked.
*References*
National AIDS Trust. *The myth of HIV health
tourism.*NAT,
October 2008.
BHIVA Plenary Session 2. *Treating migrant populations: eligibility for
care.* BHIVA Autumn Conference, London, 2008.
--
Rachel M Jacobson
Program Director
Global Youth Coalition on HIV/AIDS
www.iAIDS.org | www.youthaidscoalition.org
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