By Tamara Manuel

At National AIDS Trust we have long drawn attention to the barriers that migrants face accessing HIV-related healthcare. Hostile environment policies deter migrants from accessing the care they need and will continue to do so during the coronavirus pandemic unless significant changes are made. This blog will look at the parallels between access to HIV and coronavirus treatment and highlight how some migrants living with HIV are particularly vulnerable.

Testing and treatment for coronavirus, like HIV, is free for everyone, irrespective of immigration status. However, should a migrant test negative for COVID-19 and require treatment they will be charged 150% of the cost of the care they receive. Many migrants are worried about how accessing and being charged for healthcare will affect ongoing or future visa and asylum applications. This is because NHS bodies must notify the Home Office of patients with debts of £500 or more if they have been outstanding for over two months.

Migrants living with HIV may be particularly susceptible to developing severe symptoms of COVID-19. A significant proportion of migrants living with HIV are diagnosed late, meaning the virus has already had the opportunity to damage their immune system. And, due in part to the barriers mentioned above, some migrants are not accessing HIV treatment. Without knowing their CD4 count, it is impossible to know whether they are immunocompromised and therefore considered a vulnerable group to COVID-19.

Despite this increased risk, some migrants will find it harder to adhere to the Government’s guidance aimed at slowing the spread of coronavirus. The guidance and policies are confusing, and it’s hard to know what migrants are entitled to. To help us understand, a collective of migrants’ rights organisations has compiled this useful resource with more information about how we can support migrants in our community during the coronavirus pandemic through Mutual Aid groups. Doctors of the World UK has published coronavirus guidance in over 40 languages, giving migrants the best opportunity to keep themselves, and others, safe.

However, for some migrants it will not be possible to adhere to the guidance. Some will be in precarious employment and have no recourse to public funds. This means they are not eligible to apply for the Coronavirus Job Retention Scheme or Universal Credit. They might feel unable to tell their employer that they are living with HIV due to the stigma that still surrounds the condition and will have no choice but to continue to work, putting themselves and others at risk. While the country is in lockdown, they have less access to the migrant/HIV services that they relied on before. Migrants with no recourse to public funds are less likely to be provided with suitable housing in which to isolate.

Further, those currently detained in Immigration Removal Centres are particularly vulnerable. They are in an environment where coronavirus can spread quickly, with many people in close proximity and limited measures to prevent the spread. Some people held in immigration detention have received letters instructing them to stay in their cells for the next three months, despite the Home Office only  supposed to detain people where there is a realistic prospect of removing them from the UK.

The support offered by the Government does not go far enough to ensure that migrants, and particularly those living with HIV, are protected from coronavirus. They, and the community, are being put at risk.

• The Government must recognise that charging migrants for healthcare and sharing data between the NHS and the Home Office, is detrimental to the effort to stop the spread of coronavirus.
   
• The Government should provide assurance that no migrants will be charged for healthcare until at least the end of the coronavirus pandemic. Likewise, data-sharing between the NHS and Home Office must be suspended.
   
• Government schemes to support people during the coronavirus pandemic should be extended to those with no recourse to public funds and irregular immigration status.
   
• While there is no prospect of removing people in immigration detention from the UK, no one should be detained.

Only if we dismantle the hostile environment policies towards migrants can we prevent the spread of coronavirus. 

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Tamara Manuel is Policy and Campaigns Officer at National AIDS Trust