[UK] Fury at ban on HIV help for refugees

[Dreamer128]

· Doctors say no to 'morally repugnant' guidelines
· Cost-cutting scheme threatens unborn babies

Jo Revill, health editor
Sunday August 8, 2004
The Observer

Doctors are rebelling over plans that would lead to thousands of refugees being refused life-saving treatment for HIV on the National Health Service.
The Observer has learnt that specialists on a key health committee have refused to help draw up rules that would determine whether asylum seekers or other immigrants with the virus get antiretroviral drugs.

One said: 'It is morally repugnant for us to have to look at someone's immigration status before giving them the treatment they need. Let's be clear about this: if they don't get the treatment, it's a death sentence.'

The issue of how to care for refugees with HIV is growing increasingly controversial after the government introduced hospital guidelines last April aimed at cutting the number of patients receiving free drugs.

Officials are preparing a fresh set of guidelines for GPs, which would stipulate that people whose asylum cases have been rejected, or who have not yet submitted an application to the Home Office, must not be given 'routine' care, including drugs therapy. Refugees are allowed emergency treatment only if they fall ill with Aids symptoms and are sent to casualty departments.

The Observer has learnt that there have been several cases in the past three months of clinicians having to persuade hospital managers to allow them to treat pregnant women asylum seekers who have HIV.

Under the April guidelines, hospitals can refuse to give women the treatment if the Home Office has refused them leave to remain in Britain. But a decision not to give them the drugs would leave their unborn children with a 30 per cent chance of developing the disease.
Under government guidelines, people who are not eligible for full NHS treatment include illegal immigrants, students on courses lasting less than six months, those who have either not made an asylum or refugee application to the Home Office, or have had an application rejected.

One hospital trust has already rejected a request from a pregnant African woman with HIV to have a Caesarean delivery, which would cut the chances of her baby being born with the virus. However, she found another hospital prepared to overlook the rules, and had the procedure. Her daughter was born without the infection.

Doctors have told this newspaper that they know of several cases where such women have initially been turned down for antiretroviral treatment.

Dr Andrew Pollard, a senior lecturer in paediatric infectious diseases at John Radcliffe Hospital in Oxford, said: 'I am aware of cases here, where people have been prevented from treating the women, and then have been allowed to, after they have had discussions with managers and others, explaining what the risk is to the unborn child, and making the moral case for it. But the government guidelines are not to treat these mothers.

'A child who has the infection will be sick and very ill, and that would cost the NHS a great deal anyway, so there's a big economic case for treating it. But doctors are morally obliged to help people regardless of the colour of their skin or their race.'

A pregnant woman who is given the right drugs, told not to breastfeed and is allowed a Caesarean birth can expect the risk of the infection being transmitted to her baby to be less than 1 per cent, whereas in Africa it is around 30 per cent.

In London, where 75 per cent of the refugees with HIV live, members of the local NHS Specialised Commissioning Group have also refused to draw up rules which would set out which illegal immigrants or asylum seekers should be excluded from care.

A sub-committee, asked to look at the eligibility criteria, made its opposition clear but was told by health commissioners, the hospitals and primary care trusts which run NHS services, that they must do the work.

One member of the sub-committee said: 'We said the plan is not workable because how are you going to turn away someone who is infected, who is likely to be seriously ill, and who remains highly infectious while he or she is not put on the right therapy?

'This is an outrageous policy, and to me it seems racist and profoundly unethical.'

A spokesman for the group, which investigates what services the NHS needs, said the issue was not about refusing patients access to drugs and treatment because of their asylum status, but about clarifying the guidelines. 'This issue is government policy, so people have to address it.'

Dr Barry Peters, an honorary consultant and senior lecturer on HIV at Guy's and St Thomas's Hospital in south London, said there was a growing danger that asylum seekers would not come forward for testing because they believed it would affect their immigration status.

He is also worried about the guidelines. 'It seems ludicrous to wait until someone has a life-threatening illness before you treat them. These people are not a huge burden on the NHS, and it's odd that such a wealthy country as ours has over-reacted to this problem in such a way.'

There were 7,000 new cases of HIV in the UK last year. It is estimated that there are around 17,000 people who have the disease but who have not yet been diagnosed.

There are concerns about how fast it may be spreading within African communities in Britain, and also fears that the policy of dispersing immigrants may be fuelling the spread of the disease.

The National Aids Trust will publish a report tomorrow identifying the government's failures to tackle effectively the increasing problems of HIV. It warns that unless the government acts quickly, HIV will continue to rise, resulting in many more thousands of cases each year.

Its chief executive, Deborah Jack, said: 'We know that doctors are ignoring these guidelines over eligibility because they feel they are wrong, but we don't know for how much longer they will be able to do so.

'For these people it is a death sentence if you end their treatment, and then deport them back to a country which has no Aids drugs. How can the UK try to do so much internationally, and then fail to deliver humane care in its own backyard?'

'Every day I wake in despair'

Angela, a mother of two from Tanzania who works as an office administrator, is HIV-positive and has been refused leave to stay in the UK.

'Every day I wake up with this feeling of complete despair. It's hard to describe it to you because it's a mixture of sadness and fear. It lifts a bit during the day but comes back at night.

'I left Tanzania five years ago when the politics of the time made it difficult for me to stay there. I lost everything when I moved and had to leave my children behind but they were able to follow me two years later.

'I put in an immediate application for asylum but I didn't hear anything for years. I didn't know then that I was HIV-positive - I found that out two years later. By then I had got a job as an office administrator.

'My doctor has been great, he found the right drugs for me and on them I've felt quite healthy. But now I feel very depressed and very unhappy. Honestly, my children have kept me alive, otherwise I'm sure I would have killed myself.

'My children are now 13 and eight, and they go to the local school. We have a one-bedroomed flat above a shop, and there are only two beds so I sleep on the floor.

'It really hurts me that people here think that asylum-seekers have an easy life, and take all the money in benefits. I've never claimed any benefits at all. I work as an office administrator and every penny I get goes into paying the bills and paying for the children's food.

'Right now, I'm trying to block the future from my mind. Back in February, I had a meeting with the officials and the person from the Home Office who was very nice. But the others were not so kind. One person said, "well, we've listened to your story", as if it was just a story which I had made up.

'Then I was turned down for the right to have leave to remain here, so now I'm appealing. Every time a letter comes through the door I have to run and get it first because I don't want my children opening it. They don't know I'm HIV, how could I tell them? They don't understand why we are here, why we have to share one room. It's really hard for them now.'

'If I lose my appeal I might have to go back to Tanzania. Obviously, I would die there, because there are just no drugs for Aids. Just having a simple blood test there costs you lots of money.

'I'm not a criminal and I don't want to take what is not mine. I'm in a full-time job and I pay tax and I want to carry on working. If people could just see that, maybe they would understand.'

(Source: The Guardian)

[Timber Loftis]

This is basically a non-issue in this country. You either have health insurance or you don't. And even if you have health insurance, the majority of the best AIDS drugs would not be included. Also, most insurers will drop you ASAP if you are found to have AIDS. In fact, many policies these days require that you get AIDS tested before they'll take you.

So, basically, you either have the money or you don't. That's how we do it in the Land of Free. [img]graemlins/heee.gif[/img]