Is it legitimate to worry about the cost to the NHS of the increasing number of non-UK taxpayers with HIV? At £15,000 per person per year, each positive person would have to earn £180,000 in order to pay the National Insurance to cover their own healthcare. And since over a third of the people newly diagnosed in Britain last year were not in a position to pay any NI - because they aren’t allowed to work - it’s fair to ask where the money is coming from.
It’s simple, says Tories’ Dr Liam Fox. All you need to do is test would-be immigrants in their home country for contagious diseases such as TB and HIV. And then what? All that would happen would be the institution of a discriminatory policy against perfectly able would-be settlers with HIV - such as is already in place in Canada and Australia.
However most of the 4,000 new arrivals with HIV fall into two other categories. The first are the asylum seekers. Realistically, they aren’t going to present themselves for HIV testing before fleeing the country. They’re going to get here, then claim asylum.
So you test them for HIV or TB as part of processing their asylum claim. And then what? The international laws that support asylum status say infections make no jot of difference to whether someone has a genuine claim. If the UK started specifically turning away its sickest asylum claimants it would soon be challenged in the European Court of Human Rights.
The other category is people who come here to work and study. Here you could in theory test for HIV and TB pre-entry. And then, again, what? Well, you’d have to turn away a lot of workers from African countries who help to keep some of the public services in the UK afloat. Forty six per cent of nurses in the NHS were born abroad (many African emigrants).
In the end one has to seek far more wide-ranging solutions. Immigration is an inevitable, almost physical process in a world of greater freedom of travel but undiminished inequality. So part of the answer is to campaign for better treatment in the home countries, as this magazine does unceasingly.
The other part may be to ask whether a universal free-on-demand healthcare system can work in this century. Should we be moving towards an insurance-based pay-now-reclaim-later system - such as applies in France, the country with the world’s best heathcare system?
But that’s probably the last thing that will happen. What will happen is that health checks for the entrants that need them least will be instituted; HIV status will no longer be grounds in itself for asylum; and some curbs will be made on the number of foreign students. And the tabloids will continue to stir up fear and hatred.
Despite rants from journalist Anthony Browne about all these new people with HIV being a heath menace to native Britons, the real HIV and public health story is that the UK already has its own expanding home-grown epidemic, represented by the 2,000 gay men diagnosed with HIV last year.
As we’ve always said here at PN, it is HIV positive people who spread the virus, and HIV prevention in its broadest sense has to target people with HIV. So it was disconcerting, to say the least, when a recent review by the Health Development Agency about the effectiveness of interventions to reduce sexual transmission of HIV concluded: “We found no review-level evidence either to support or discount the effectiveness of any [our italics] interventions with people with HIV. We are therefore unable to make any recommendations for policy and practice.”
This shocking and complacent conclusion comes as the number of people with HIV in this country tops 50,000. Out of the millions of pounds spent on HIV prevention research and campaigns, still virtually nothing is aimed at the people who actually carry the virus.
Gus Cairns, Editor in Chief
