A big cheer for all those HIV doctors making a valiant stand against obscene
attempts to charge some refugees with HIV in the UK for vital life-saving
treatments. But how long can this thin white line hold firm in the face of
cut-hungry NHS managers? Already, bailiffs are chasing patients co-infected
with HIV and TB with unpaid care bills (see PN news pages) while doctors are
locked in battles with NHS managers, trying to persuade them to give free
treatment to pregnant women living with HIV. Since April, hospitals have been
under orders to deny free 'routine' care (including antiretrovirals) to asylum
seekers with rejected claims, or asylum seekers who have not yet submitted
their claim to the Home Office. These people are only entitled to free 'emergency'
treatment for HIV, testing and counselling, but not HIV drugs. Before long,
extremely sick people with Aids-defining illnesses like recurrent PCP and
TB, people who can't afford the HIV drugs, will start filling Aids wards in
a scary re-run of the early 1980s. You don't have to be a rocket scientist
to figure out that this strategy is as uneconomic as it is unethical. With
their underlying HIV infection untreated, these patients step onto a 'revolving
door' of costly NHS care; yo-yoing in and out of hospital, and running up
huge bills for 'sticking plaster' care and tea and sympathy, until they either
die here or are deported to certain death. If this is a deliberate strategy
to deter immigrants, it is callous and ill-conceived. Our Bangkok conference
coverage this month highlights how the roll-out of antiretroviral drugs in
Africa is still painfully slow. The World Health Organisation has also strongly
hinted it is unlikely to meet its global target of three million on treatment
by 2005. So going home is just not an option for most asylum seekers with
HIV.
A Canadian study recently found that patients hospitalised with sub-200 CD4
counts cost up to three time more than patients who present earlier. It would
make far more sense to give these patients free HIV drugs and encourage others
to come forward for testing. Once well enough, they should be allowed to work,
so they can contribute to the economy and 'pay' for their treatment that way.
If cost-cutting is not the real reason behind this shameful strategy, then
vote-catching must be. Is Blunkett really prepared to sacrifice lives just
to dodge the wrath of the tabloids and their unhealthy, middle-England obsession
with 'health tourism'? If you feel strongly about this, please pledge support
for asylum seekers by signing the Medical Practitioners Union petition at
www.mpunion.org.uk Meanwhile, men women and children living with HIV can only
hope that doctors can continue to resist this policy until humanity and sense
prevails.
Amanda Elliot, managing editor
