Migration to the UK has significantly changed the nature of the HIV epidemic since many people have come from countries with high HIV prevalence. The immigration process is complex and raises a number of issues for people living with HIV.
Access to HIV treatment for migrants and asylum seekers
In England and Scotland, the NHS provides HIV treatment free to everyone who needs it. This follows years of campaigning by NAT and other HIV and migrant organisations. NAT is now calling on Wales and Northern Ireland to make the same formal commitment - although in practice migrants in these nations are also able to access HIV treatment without charge.
Treatment has only been free since 1 October 2012 in England and 1 May 2014 in Scotland.
Although HIV and other sexual health treatment is always free, some migrants and refused asylum seekers may be charged for other secondary care (the treatment and care you get in a hospital). The rules for NHS charges are outlined in our factsheet Will I have to pay?.
The Immigration Bill and access to NHS treatment
The Government has recently consulted on proposals to require migrants to make a financial contribution to the NHS. Read NAT's response to this consultation. Some of these proposals now form part of the Immigration Bill and others will be introduced in regulations next year.
HIV treatment will remain free under these proposals. However, we are still very concerned about the impact of these proposals on HIV prevention, testing and treatment. Find out more about why we think you should challenge these restrictions on migrant access to the NHS.
One new proposal is to extend charging rules to apply to primary care (GP) services, which are currently free for all. NAT believes that this will be disastrous for current efforts to improve uptake of HIV testing and are campaigning against this change. For more details read our policy briefing Universal access to primary care: A gateway for HIV testing, treatment and prevention.
We thought it vital that these concerns were raised in the Public Bill Committee on the Immigration Bill, so coordinated this evidence submission on behalf of a group of health, refugee and migrant charities.
The myth of HIV health tourism
Over the last few years, numerous allegations have been made about health tourism to the UK both in general and in relation to HIV. These claims have affected media and popular perception, as well as Government policy, particularly on entitlement to NHS care. But as our report clearly demonstrates there is no evidence that HIV health tourism to the UK exists. Migration has been one of the most seriously debated issues in UK politics recently. It is therefore vitally important to separate the facts and evidence around migration from the fears and misinformation. Read our report The Myth of Health Tourism.
Asylum seekers who need help with housing must usually accept accommodation whereever it is available in the UK. This policy of 'dispersing' asylum seekers has resulted in people living with HIV being moved at short notice without proper arrangements for continuity of care and treatment, causing serious ill health and possible drug resistance.
Our advocacy on issue helped influence UK Border Agency procedures for dispersal of asylum seekers with healthcare needs, so that asylum seekers with HIV will no longer routinely be dispersed away from their local HIV clinic.
To find out more read NAT's briefing on the new healthcare guidance for dispersed asylum seekers.
Detention and Removal
We have also worked with BHIVA to develop a resource that provides best practice guidance to support high-quality care for detainees living with HIV in IRCs. This followed a survey of HIV care in immigration removal centres (IRCs) which found significant inconsistencies and gaps in provision. Read the booklet Detention, Removal and People Living with HIV.
Refugees and people who have been granted humanitarian protection to stay in the UK have the right to access the same benefits and housing entitlement as the general population. However, refugees are only given 28 days to make the transition from asylum support to mainstream benefits. Many refugees living with HIV are not able to successfully make this transition before losing their asylum support, and are left in poverty as a result. We have developed a Factsheet on Benefits and Housing in the UK for refugees living with HIV which sets out entitlement and how to make this transition. It is intended as a resource for refugees and organisations who support them.
People with no resource to public funds (NRPF)
When most non-EU migrants apply to come to the UK they are told they will have 'no resource to public funds' or NRPF. NRPF means you are not able to access welfare benefits or social housing while in the UK. This means that if people with NRPF lose their income or housing they won't have any safety net. Local authorities are not always legally allowed to support people with NRPF, who have to rely on charity for basic subsistence.
Destitute migrants with NRPF are some of the most vulnerable people living with HIV. We have produced a policy briefing explaining the rules of NRPF.
A number of national, local and regional campaigns are challenging the policies which prevent local authorities from supporting vulnerable people with NRPF. NAT is a member of Still Human Still Here, the campaign to end destitution of refused asylum seekers. Local HIV organisations should also consider getting involved with Regional Asylum Activism and City of Sanctury projects, which run local and regional campaigns for fairer support systems for refused asylum seekers.
To share your thoughts and experiences on migration policy please contact firstname.lastname@example.org
Download hereThe Myth of HIV Health Tourism (2008)
Download hereHIV & the AsylumPathway (2008)
Download hereWill I Have to Pay? Advice on getting NHS sexual health and HIV services for asylum seekers and migrants (2012)
Download hereDetention, Removal and People Living with HIV: Advice for healthcare and voluntary sector professionals (2009)