HIV & COVID-19
Stay informed with the latest facts on COVID-19 for people living with HIV in the UK
I am living with HIV. Am I at increased risk?
HIV if left untreated damages the immune system by reducing a person’s CD4 count (the white blood cells affected by HIV). Treatment stops this from happening, so people living with HIV on treatment often have good immune systems.
BHIVA is the British HIV Association for HIV clinicians. It said on 5 August 2020 in a joint statement with clinical bodies across Europe that there is "no clear evidence for a higher COVID-19 infection rate or different disease course in people with and without HIV".
However, if you have a low CD4 count (below 200) or a detectable viral load, BHIVA says you "may be at higher risk of severe illness.”
How can I get a vaccine?
The COVID-19 vaccine is mostly being distributed via GP patient lists. You need to be registered with a GP for access to the vaccine. GP care is free to anyone no matter what your immigration or housing status. You can find a GP here.
No matter their age, people living with HIV can be vaccinated now because they will belong in one of two priority groups. You can see these groups here.
Some people living with HIV can be vaccinated as part of group four. This is only the case if you are clinically extremely vulnerable. You are considered clinically extremely vulnerable if you have a CD4 count of below 50, or have had an opportunistic illness in the past six months. (This is not to mention other reasons beyond HIV that may make you clinically vulnerable.)
Most people living with HIV will be offered a vaccine as part of group six (the 'at-risk group'). If your GP is not aware that you are living with HIV, and there is no other reason why you would be in the at risk-group, then you may not be offered a vaccine until it reaches your age group. You can either choose to tell your GP about your HIV status, or HIV clinics can refer you directly to vaccine centres.
There are other advantages to your GP being aware of your HIV status. It can support them to provide better overall care to you in the future and to prescribe the right medications.
Vaccine prioritisation: on 30 March the Joint Council for Vaccinations and Immunisations (JCVI) advised the Department for Health and Social Care that over-16s who are living with adults who are severely immunosuppressed should be prioritised for the COVID-19 vaccine. This explicitly includes those living with people living with HIV. All such people will be offered a vaccine by mid-April. We will be contacting the Department for Health and Social Care to ensure that the confidentiality of people living with HIV is protected.
Antibody testing on Gov.uk: Following a joint letter from National AIDS Trust, BHIVA, BASHH, the HIV CRG, HIV Scotland, THT, UK-CAB & HIV i-Base, the Department for Health & Social Care (DHSC) has agreed with our position that there is no clinical reason to exclude people living with HIV from the COVID-19 antibody testing offer for people in specific professions.
Moving forward people living with HIV will be able to access an antibody test through Gov.uk.
We welcome this immediate change, which will go beyond people living with HIV – to everyone living with an immunosuppressive condition. This rightly gives people the power to make their own decisions about testing. We thank the DHSC for their constructive engagement on this matter, and swift action.
Am I 'extremely vulnerable'?
All of the below applies to people who have no symptoms of, and have not tested positive for, COVID-19 (coronavirus). If you or someone you live with has tested positive or has possible symptoms, you need to check this website for advice.
- Your CD4 count is below 50; and/or
- You have had an opportunistic illness in the last six months; or
- You were advised to shield for another reason, for example, because you have another condition covered by the guidance for complex conditions.
From 4 January 2021 England has entered national lockdown.
As part of this national lockdown, those who are clinically extremely vulnerable are advised to shield until at least 31 March 2021. You should have received a letter from your GP or NHS England explaining this.
This means that you are advised to stay at home as much as possible. You can still go outdoors carefully to exercise or to attend health appointments. You should work from home if you can, and not attend work if you cannot. You may be eligible for furlough from your employer and/or local authority support.
This is all advice for your health. It is not unlawful not to shield.
This new guidance is for England only. You can find advice on shielding in Scotland, Wales or Northern Ireland via the links provided.
There is a Shielded Patient List (SPL) held by NHS Digital. If you are on this list you might be able to access extra services such as food or prescription delivery or a free supply of vitamin D. Your doctor can add you to this list if you are not already on it but need to be. There is guidance for HIV clinicians on how to do this here.
Shielding is currently paused. Everyone will follow the same guidance nationally, but you are encouraged to exercise caution.
I think I was told to shield when I don't need to
Your GP or NHS England may have been in contact with you (by text, email or letter) telling you that you should consider shielding. Many people were told for the first time to shield in the week of 15 February 2021. In the past some people with HIV were added to the Shielded Patient List (SPL) in error - we are looking into whether this is happening again.
The NHS explained that this occurred in April 2020 because some people living with HIV are coded as “immunosuppressed” on some GP records. This code does not always mean you need to shield, but was one of the codes on GP records that was used by NHS Digital to put people on the SPL. This means that some people living with HIV with this code on their record were added to the SPL and told to shield (usually by text) by mistake.
A new risk calculator for serious illness from COVID-19, called QCovid, identified 1.7 million more people to be added to the shielding list in February 2021. Many people living with HIV have been added after this. It is currently unclear whether this is to do with their HIV status, and we have written to the relevant bodies for clarification.
In each case, GPs can override this code and update the list so that the person is removed if they have a CD4 count above 50, have had no opportunistic infections in the last six months, and have no other reason to shield. If you think you are affected by this then talk to your GP or your HIV clinician and direct them to this guidance.
The British HIV Association (BHIVA) and Terrence Higgins Trust (THT) have reiterated that "there is no evidence, nor guidance, that people with well-controlled HIV should shield."
What are my rights at work?
We have sought legal advice from Leigh Day on the employment rights of people living with HIV in the context of the COVID-19 pandemic, which we outline below.
What is the advice from the Government?
The present advice of the Government (as of 23 March 2020) is that people with HIV “who are at increased risk of severe illness from coronavirus [‘COVID-19’] be particularly stringent in following social distancing measures.”
In addition, the British HIV Association and Terence Higgins Trust have advised that:
- Those with a CD4 of less than 50, or who have had an opportunistic illness in the last 6 months, class themselves as extremely vulnerable and take appropriate precautions. This means staying at home and avoiding face to face contact for 12 weeks.
- Those with a CD4 of less than 200 or not on ART follow social distancing advice stringently.
- Those with a CD4 of greater than 200 and undetectable on ART follow general advice on social distancing
It is also worth considering if you have other health conditions which may increase your risk of severe illness from COVID-19.
This will particularly impact those whose jobs necessarily involve a degree of social contact. People who need to stay at home, as result of the increased risk to them, ought to be eligible for Statutory Sick Pay [‘SSP’] even if they are not personally unwell. SSP is paid at a rate of £94.25 per week. You may also request that you are given a temporary leave of absence covered by a new government scheme (see ‘what should my employer be doing for me?’ below).
Should I speak to my employer?
If you are concerned that you are at particular risk, in particular, if your immune system is presently weakened, you may wish to inform or remind your employer of your HIV status and request that they put procedures in place to mitigate any risk to you.
Your employer should not subject you to any detriment for making such a request nor should they subject you to any detriment merely because you have HIV.
What if I don’t want to tell my employer I am living with HIV?
The best way to ensure that you have the full protection of the law is to tell your employer you are living with HIV. You can request that such information is kept confidential, under GDPR rules, and that it is shared amongst the minimum number of people necessary for you to be assisted to carry out your role.
If you feel unable to disclose the exact nature of your condition you may wish to seek a fit note from your GP.* This may simply be a recommendation that you self-isolate for a period of time given the functional impact of your condition. Ideally, it should also state that this condition has lasted or will last for more than 12 months in order to assist in framing your condition as a disability under the Equality Act 2010 [‘EA 2010’]. In addition or alternatively, since HIV is automatically classed as a disability under the Equality Act you could ask your GP or HIV clinician to state in the letter that you have a condition protected under the Equality Act 2010.
Your employer should comply with the recommendations of a registered medical professional however ideally the letter would disclose your condition to ensure that you will benefit from protection under EA 2010.
What should my employer be doing for me?
Your employer should be ensuring that you are able to work as safely as anyone else and have access to the same job opportunities as your colleagues unless there are very good reasons why this is not possible.
In response to COVID-19 this may include:
- Allowing you to work from home
- Allowing you to temporarily work in a role that minimises your contact with the public
- Providing you with access to personal protective equipment
- Allowing you to socially distance yourself from colleagues and the general public
- Allowing you to self-isolate
- Giving you a temporary leave of absence (‘furlough’) deploying payments of 80% of your salary (up to £2,500) available from the government.
What legal protections are available to me?
There are various legal protections available to assist you in ensuring that you are able to work in a healthy manner and to protect you from exploitation by your employer.
It is important to remember that given the present situation enforcing rights may become difficult. There are pressures on businesses that may see them cease operations and there are likely to be delays in progressing matters in the Courts for some time. If you think you have experienced discrimination from your employer, do get in touch with NAT and we can provide you with advice and signpost you to further sources of support.
Latest Government Guidance
While not being a specific legal protection the guidance issued by the government should be complied with by your employer. If they fail to comply with this guidance then the Courts are likely to take a dim view if their failure leads to a claim under specific legal protection that is available to employees and/or workers.
The latest ‘Stay at Home’ guidance from the government states as follows:
- People may only leave home if they cannot reasonably work from home.
- Employers should provide suitable IT and equipment to allow their staff to work from home
- Where people cannot work form home employers should take steps to help employees avoid busy times and routes on public transport
- Examples given of sectors that may still require people to attend work are:
- Critical national infrastructure
- Essential public services
The shielding guidance was updated on 7 January 2021 and applies until 21 February 2021. Those who are in the clinically extremely vulnerable category ought to have received a letter from the government giving advice on how to protect yourself and access support. In particular, the advice for people in the clinically extremely vulnerable group is:
- Work from home if you can
- Your employer ought to try and offer you an alternative role or change your working patterns and can seek support from Access to Work to accommodate you
- You should not attend work
- Members of your household should continue to attend work as normal
The letter from the government ought to be sufficient evidence for your employer to show that you cannot work, which may result in the entitlement to furlough or Statutory Sick Pay. If you have not received this letter you should enquire with your GP and/or HIV clinician to check whether you have been classed as clinically extremely vulnerable and, if appropriate, seek confirmation of their decision in writing to provide to your employer.
Equality Act 2010
If your work is in England, Scotland or Wales your employer is bound to follow EA 2010. According to the Equality Act, HIV is defined as a disability from the point of diagnosis. You do not need to view your HIV as a disability in order to be protected by this law.
The following protections are available under EA 2010 if your employer knows, or could reasonably be expected to know, that you are living with HIV:
- Direct Discrimination – the right to not to be treated less favourably because you have a disability. For example, your employer dismisses you because you tell them that you have HIV
- Discrimination arising out of a disability – where a person is treated less favourably as a result of something that has happened because of their disability. For example, your employer disciplines you for taking time off work due to a requirement to self-isolate.
- Failure to make reasonable adjustments – where an employer fails to amend policies that put disabled people at a disadvantage. For example, you request to work from home but your employer refuses to allow you to do so.
- Harassment – subjecting disabled people to a hostile, degrading or intimidating working environment. For example, you ask to work from home due to your HIV status and your manager tells you to stop being soft.
- Victimisation – subjecting disabled people to negative treatment because they have tried to assert their rights under EA 2010. For example, you are disciplined for not being a team-player after making a request to work from home.
You are also protected from indirect discrimination even if your employer doesn’t know you are living with HIV. Indirect discrimination is where your employer has a policy that puts disabled people at a disadvantage. For example, your employer refuses to let people work from home despite the fact this would have a minimal impact on productivity.
A failure to comply with EA 2010 could give rise to a legal claim worth thousands of pounds so this can be an important tool to ensure that you are treated fairly by your employer.
Health & Safety at Work Act 1977 & Management of Health & Safety at Work Regulations 1999
Under Health and Safety legislation you are required to take reasonable care for the health and safety of yourself and other people. At present, this may be interpreted as a requirement to share your HIV status to your employer if it puts you at an increased risk.
Your employer is under a duty to do everything that is reasonably practicable to ensure that you are safeguarded while you work. Your employer ought to be proactive in minimising any risks to you.
Risk assessments should be carried out to ensure the safety of your employer’s staff and service users and these risk assessments should be kept under review. Clearly, the issues thrown up by COVID-19 would indicate that risk assessments should be updated to ensure your safety as an employee.
There is specific guidance available on working safely during coronavirus for various sectors. If you are concerned that your employer is not following this guidance and will not take steps to do so you may wish to report any concerns to your Local Authority and the Health and Safety Executive.
Employment Rights Act 1996
Sections 44 and 100 of the Employment Rights Act 1996 (ERA) provide protection for employees (but not workers) against both detriment and dismissal in cases involving health and safety issues in the workplace.
If you are so concerned about health and safety at work that you do not attend or choose to leave/cut short shifts, you could be protected under this legislation. Your employer is under a duty to ensure that your workplace is safe, if they fail to do so you are entitled to raise any issues with them without the fear of being treated badly as a result. If you refuse to subject yourself to a situation you genuinely and reasonably consider to be dangerous you should review the circumstances before doing so, this would include your own knowledge of the situation, the facilities available to you and any authoritative advice. You must be careful to ensure that any action you take is not negligent in the circumstances.
If you are briefed regularly on the dangers you face at work, are provided with all the necessary equipment (face masks, gloves, other protective clothing) and allowed proper breaks and rest periods it would be – from an objective point of view – a mitigated risk. However, if you are regularly working without proper protection, are unaware of what measures are in place to keep you safe and are genuinely afraid for health and safety you could fall under the scope of this law.
As our understanding of Covid-19, and the associated risks, is rapidly changing issues such as an appropriate level of protection, and what constitutes ‘circumstances of danger’ will be contentious issues.
*If you have not shared with your GP that you are living with HIV, speak to your HIV clinician to see if they can help. Please note that in Scotland, only GPs can issue fit notes. If you have symptoms of COVID-19, or are living with someone with symptoms, you can get an isolation note from the online 111 service.
HIV COVID-19 Network Briefings
National AIDS Trust, with support from partners in the HIV sector, is producing a fortnightly briefing on the impact of COVID-19 on people living with HIV and communities affected by HIV.
We want to ensure this is a valuable resource that provides a snapshot of the key issues, highlighting the emerging data and analysis from those on the ground that can inform and improve the Government and sector's COVID-19 response.
Read all released briefings here.
Where can I get more information?
- Information about COVID-19 for people living with HIV from Terrence Higgins Trust
- Comment from BHIVA and THT on UK Government Guidance on Coronavirus (COVID-19), Social Distancing to Protect Vulnerable Adults and Shielding to Protect Extremely Vulnerable Adults
- i-Base Q&As on COVID-19 for people living with HIV
- General information on COVID-19 from NHS
- UK government advice about COVID-19
- Full guidance on staying at home and away from others
- Information on COVID-19 from Department of Health and Social Care.
- HIV Scotland's advice on coronavirus.
- PrEPster have put together a COVID-19 tips & tricks section for people using PrEP
- Doctors of the World has translated NHS guidelines on COVID-19 into 43 languages
- NAM has put together a number of useful pages on sharing your HIV status with facts on whether you have to disclose your status, pros and cons of sharing your status and information on telling your health workers.
- The Faculty of Sexual & Reproductive Healthcare has put together a leaflet outlining advice for women on access to contraception, abortion and other sexual and reproductive healthcare during the COVID-19 pandemic
- Mind has put together a resource on mental health and support available during this time
National AIDS Trust’s Looped in tool can help you produce and download information to share with your employer. You might find this particularly helpful if you are speaking to your employer about your HIV for the first time. Looped in now includes a specific topic addressing issues related to HIV and COVID-19.