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Dangerous failures in HIV care in the UK’s Immigration Removal Centres.

Monday, December 23, 2013

A new report from NAT (National AIDS Trust) shows worrying gaps in HIV treatment and care within the UK’s Immigration Removal Centres (IRCs). 

 With detainees living with HIV being as likely to remain in the UK as face deportation when leaving an IRC, this is a public health as well as human rights failing.

 The research found HIV doctors being kept in the dark about their patient’s whereabouts, and rarely notified before detainees with HIV are allowed to leave.  This means that extremely vulnerable people living with a serious communicable disease are left without any onwards care pathway.  Without unbroken access to HIV treatment, their health will deteriorate severely.  Consistent access to HIV treatment is also an important part of public health efforts to reduce onward transmission of HIV to sexual partners.

 Detainees living with HIV who are removed from the UK continue to leave the country without enough medication to support them until they can access care in their destination country.

Deborah Jack, Chief Executive of NAT, says:

 “It seems that with healthcare in immigration removal centres there is often a sense of ‘out of sight, out of mind’.  Detention is seen as half-way to deportation, so we no longer have to meet the urgent health needs of these vulnerable people.  But our research shows that as well as upholding the human rights of people living with HIV who will be removed from the UK, we must think about the onwards care of an equally large group who will return to our community.

 In 2014, NHS England will take responsibility for healthcare in the detention estate.  One of their first priorities should be to implement effective care pathways for HIV treatment and care.”

More information on the research:

 This is the first review of HIV care in the detention estate to be conducted since 2005/6.  Healthcare teams from all 10 IRCs responded to NAT’s survey, which asked about their care of detainees with HIV between July 2011 and June 2012.  A parallel survey was also completed by seven of the eight local NHS HIV clinics who regularly see patients from the IRCs.   NAT was supported by Public Health England and the British HIV Association (BHIVA) in disseminating the surveys. 

 NAT’s research found:

  • There were between 60 and 70 detainees living with HIV in IRCs in the UK - 67% of these cases were in the three largest Harmondsworth, Yarl’s Wood and Colnbrook. 
  • Patients from some IRCs are missing appointments because the IRC decides to use their booked transport for another purpose (such as removing other detainees). They are also being forced to attend HIV clinics in handcuffs and accompanied by more than one security escort. In at least one location these restraints are kept on and security escorts are present during consultations. 
  • People living with HIV who go into detention are about as likely to be allowed back into the community or transferred to another IRC, as they are to be removed from the UK.  But there are serious failures to plan for their healthcare needs on release, with their specialist doctors routinely not being told until their patients have already left the IRC. 
  • People with HIV also continue to be removed from the UK without the three month's medication recommended by expert advice, to help them maintain their treatment whilst seeking care in their home countries (where HIV care is often hard to access).
  • Around 10% of detainees with diagnosed HIV arrive at the IRC without a supply of their antiretroviral drugs, essential to keeping them well. This is normally the result of being brought into detention without the opportunity to collect their medication. Of this group, only one patient received a supply of the necessary medication within the 24 hours recommended by expert advice.
  • There were at least four (and possibly as many as 12) cases of treatment interruption while people living with HIV were in detention.  In order to be successful and reduce levels of infectiousness, HIV treatment must be adhered to strictly, and taken at the same time every day. 
  • There is significant variation in how IRC healthcare teams approach HIV treatment and care, even where two IRCs are co-located and share the same local HIV clinic. This shows that the challenges of the IRC setting can be overcome and patients can receive their right to an equivalent level of HIV care as the NHS provides to the general public.  

Notes to the editor:

People who are held in immigration detention are entitled to the same range and quality of services which the NHS provides to the general population.

NAT Topic