Rejected asylum seekers and illegal immigrants should get HIV treatment free on the National Health Service

Mar 23 2005

MPs on the Commons health select committee say, in a strongly worded report, that rejected asylum seekers and illegal immigrants should get HIV treatment free on the National Health Service (NHS) like everybody else, to avoid the risk of a further spread of Aids; they say the government's withdrawal of free treatment from these groups as a measure against "health tourism" was ill-advised.

David Hinchliffe, the committee's chairman, says that while it was vital that the UK did not become a magnet for HIV positive people seeking free treatment, there is no evidence that this is happening.

Under new government rules, treatment with the antiretroviral drugs that can prevent infection from the virus progressing to Aids, is no longer available to people found to be illegal entrants or those who have had an asylum application turned down. The treatment can cost between £10,000 and £14,000 a year. The committee says that although there has been controversy about people allegedly entering the UK to get free treatment, the government has no idea of their number, or how much they cost the NHS.

However there is some threat to the public, according to the government's public health advisory body, the Health Protection Agency, who say that if individuals with HIV enter the country and are not treated, if they remain sexually active, transmission of the virus will rise.

Migrants with HIV generally do not seek treatment until they have been here for some time and their disease is well advanced, the committee says, which is not the behaviour of a health tourist. The MPs say there is an anomaly, in that people with tuberculosis are exempted and can be treated for their TB even if they are here illegally, yet people with HIV often have TB as well. If their underlying HIV is not treated because of cost, they may then default from care and as a consequence transmit TB to as many as 15 people a year.

The committee is very concerned that neither the department nor the public health minister appear to have considered or understood the public health implications of refusing HIV treatment to people who, although not legally resident, continue to live in the UK.

The new rules will deter them from being tested, and if they do not know they have HIV they are more likely to infect others. Taking the appropriate drugs lessens the likelihood that people with HIV will pass the virus on by up to 60%.

The Health Protection Agency says there are 53,000 cases of HIV in the UK, and the number diagnosed is rising by about 20% a year. In 2003, 6,606 new infections were diagnosed.The report paints a poor picture of sexual health services in the UK. A crisis two years ago resulted in clinics being overwhelmed and forced to operate in portable buildings; people with sexually transmitted infections had to wait weeks for an appointment.

A follow-up report says cases have continued to rise, waiting times are still bad and the services "are more overstretched than ever". While they welcome the government's recent announcement of a campaign to educate about sexually transmitted diseases, they say the current services will not be able to cope with the inevitable increase in demand. They recommend the government to postpone it.

The committee welcomes the new money the government has given to the sexual health services, but says it is not enough. It calls for an audit to establish how much is getting through and how much is diverted by primary care trusts to other parts of the health service.