The tabloids claim that the UK is being invaded by ‘therapeutic tourists’ seeking treatment for HIV, and the Government is promising that it will deny them free treatment. Gus Cairns investigates the truth behind the scare stories
Soldiers came to Victoria’s house and threw her in prison for six months until an uncle bribed someone to release her. She was expelled from Uganda and told she’d be killed if she ever came back. She had to abandon her four children and has no idea if her husband is alive. When her sister met her in London, she said: “You look ill. Go for an HIV test.” It was positive. But Victoria is so terrified of approaching the UK authorities that she won’t go back to the clinic for treatment or seek out a solicitor to make an asylum claim.
Ama fled from Zimbabwe and Mugabe’s troops - who were killing Movement for Democratic Change supporters in her town - to the UK with her son, applying for asylum on the basis of persecution. But then ‘illness’ came. She went to get her HIV test with her only confidant, her teenage son, who was so distraught at the positive result he tried to hang himself. She got HIV drugs from a second GP after the first one refused because her asylum application hadn’t gone through. “You can only get treatment in Zimbabwe if you know people,” she says. “I’d be killing myself if I went back.”
These are the people (their stories true, the names and details disguised) who according to The Sun are the “freeloaders - many from Africa where HIV and TB are rife - who often land at Heathrow and demand taxis for hospital.” Who, according to The Telegraph, are the reason “your granny won’t get her hip replacement.”
The government has become so concerned about foreign, non-taxpaying citizens helping themselves to free NHS treatment that on 29 July, Health Minister John Hutton told hospitals that the immigration status of ‘suspicious’ patients must be checked. If they were failed asylum seekers or overstayers of visas - ‘illegals’ - they could get treatment for emergencies but not chronic conditions. Even then they’d be issued with a bill. He was announcing a consultation on how NHS rules might be tightened up, due to report at the end of October (see http://www.doh.gov.uk/overseasvisitors/nhschargesconsult.htm for details).
Much of the furore is probably political spin aimed at reassuring Labour’s working class voters. In practice, this tightening up will mean little immediate change to existing NHS guidelines on who gets HIV treatment. But it will put incalculably greater pressure on doctors and NHS managers to act as ‘health police’ and inform on patients; a role most doctors, whose ethic is to put the health needs of the patient first, will strongly resist.
When it comes to HIV, enforcing the guidelines has already turned out to mean people not getting proper treatment for HIV-related illnesses, including in one case known to the Terrence Higgins Trust, expensive treatment for cancer - but then denied the anti-HIV drugs that could keep that infection under control.
“My experience is that most are fleeing persecution, war and so on,” says the clinical director of one of the UK’s largest HIV clinics. “HIV is fourth or fifth on a list of pressing priorities. They present later, when they get sick.”
Neil Gerrard MP is chair of the All-Party Parliamentary Group on Aids (APPG-Aids), who recently issued a report on improving the lives of migrants with HIV. He agrees.
“People talk about the ‘pull factors’ being the most important ones for seeking asylum. It’s the ‘streets of London paved with gold’ argument, how most asylum seekers are ‘bogus’ economic migrants.
Three of the top four applicant nationalities in 2002 were from war zones, not HIV hotspots: Iraqis (13,405 asylum claimants), Somalians (5,895) and Afghans (5,600).
But fourth on the list were Zimbabweans (2,270), where the HIV incidence is 30 per cent. So it is not surprising that nearly half (46 per cent) of the 3,225 Africans newly diagnosed with HIV in the UK last year were from this one country.
It is, however, a mistake to equate ‘HIV positive immigrants’ with ‘asylum seekers’ anyway. The number of asylum seekers is dwarfed by the number of students entering the UK on study visas (about a quarter of a million last year), and the number recruited to fill the never-ending demand for health workers and teachers to cater for Europe’s ageing population.
An interesting perspective is given on this by a piece in the Financial Gazette of Zimbabwe. Under the headline ‘Brain drain reaches unacceptable level’ the paper says, “At last 500,000 professionals have slipped out of Zimbabwe because of the worsening political situation and biting economic recession.” A total of 176,000 were now living in the UK. Of the ones with HIV, 90 per cent will have left Zimbabwe unaware of their HIV status. So much for ‘health tourism’.
It also reveals that nearly two-thirds of the departing professionals were qualified health workers.
One of the panics about immigrants with HIV has been the assumption that they must inevitably introduce a new wave of HIV into the UK resident population. Similar assumptions have been made about TB.
There’s not a lot of evidence that this is, so far, the case, despite recent press. Ninety per cent of all heterosexuals diagnosed with HIV in the UK actually caught their HIV abroad. The number of heterosexual infections where both partners caught their HIV in the UK has run at 35-50 a year for the last decade with little sign of an increase.
The same applies to TB. Whereas in southern Africa, HIV and TB co-infection run hand-in-hand, and TB is the most common Aids-defining illness, so far only three per cent of people with HIV in the UK also have TB.
What this means is that - so far - the HIV positive immigrant communities have done a remarkably good job at not passing on their infections.
Reasons include better healthcare and the provision of HIV treatment resulting in lower viral loads.
The other argument for restricting the flow of immigrants with HIV into the country is the cost of treating it. This is a tougher one to refute. People with HIV are expensive propositions.
The average person with HIV costs the NHS about £15,000 a year to treat, of which over half is the drugs bill. This means that a taxpayer with HIV would have to earn £45,000 before even covering the cost of their own healthcare - and of course the immigration debate is about non-taxpayers. The total treatment and care bill for people with HIV currently stands at £250m a year, and the current rate of increase is rising by £90m a year.
However, this has to be placed in the context of other NHS costs. The total spent on chronic diseases is about £37.5bn. Caring for diabetes (another disease which is largely preventable, but increasing) costs £5bn. Kidney disease takes up £2bn.
But then remarkably, what is missing from the whole debate, and yet which lies behind the Labour government’s ambiguity on immigration, is that study after study has shown that countries that allow quite high (though not necessarily overwhelming) rates of immigration benefit economically and culturally compared with ones that do not.
One of the rumoured changes is some kind of testing for HIV and other communicable diseases at ports of entry. However, this would be impractical to arrange for all six million visitors to the UK each year.
What is more likely to happen is ‘opt out’ testing (ie you can refuse, but woe betide you) for relatively manageable categories like people seeking permanent resident status and ones seeking work permits. In addition, the climate of inquisition surrounding patients at HIV clinics is likely to get tougher. Far fewer asylum applications will be allowed on the basis of HIV status alone (see page 24 for details on the law and immigration).
Derek Bodell, Chief Executive of the National Aids Trust, says: “The movement of people around the world has always involved complex factors, but overwhelmingly, it is based on the desire to secure a better, safer life. Any debate on HIV and migration warrants careful consideration of the facts.”
In the end, will the entire furore do anything other than add to a climate of fear? BBC News presenter George Alagiah addressed the presentation of the APPG-Aids report saying: “I come from an immigrant family. In a world of porous boundaries and global inequality, where people want to better themselves, immigration is as natural - and unstoppable - as water flowing downhill.”
