UK News

Doctors face dilemma on treating asylum seekers

British HIV doctors are facing a dilemma of whether to treat failed asylum seekers in this country, it became clear this month.An Abbott Pharmaceuticals debate at this autumn’s BHIVA conference found that HIV specialists are divided about whether they should treat HIV positive asylum seekers, where to go for help and whether they would be breaking the law.

Dr Mervyn Tyrer, of the Royal Free Hospital London, chaired a BHIVA debate with an expert panel discussing case studies involving HIV patients facing deportation from the UK.The first case study was of a 38 year old Zimbabwean single mother of 2 children who had been living in the UK for 9 years but who was facing imminent deportation. She had both HIV and TB.

A big majority of delegates voted that she should be treated for both conditions but existing NHS rules say she is eligible for TB treatments but not for HIV treatments.

Dr Surinder Singh, of the Royal Free and University College Hospitals, said the patient should be treated for both conditions.

Ms Josephine Namusisi, of Positive East, said clinicians should do what is in the best interests of the patient. Miss Nicky Perry, of Brighton and Sussex University Hospitals, said: “We would want her to feel safe and secure. Treat her TB and HIV, give her adherence support and involve the whole clinics’ team.”

Miss Jennifer Swan, of Newham University Hospital, said hospitals are now following up treated Africans and trying to get money from patients for HIV treatments.

Ms Namusisi said that public health was an issue in this case but also she is a mother of two young children and what about their future if she is deported?

Dr Tyrer said that nationwide a staggering 40 per cent of new HIV patients are late presenters, with a CD4 count of less than 200 and asked what GPs could do to improve this?

Dr Singh said that in his borough, Barnet, only 2 GPs on the whole local list tested for HIV and he felt GPs should do more.

Ms Perry said we shouldn’t bash GPs too much but encourage them with education and HIV training.“This is everyone’s problem,” she said.

Dr Tyrer asked whether we should be dispersing HIV out into primary care and asked if our GPs are competent enough to treat HIV?“I fear not,” Dr Singh replied.

The delegates then voted on what the Zimbabwean lady should be treated with and the voting was split.

Some felt she should be given the best possible treatments here but others felt treatment decisions should be made on what drugs could be available for the woman when she was sent back to Zimbabwe.

Ms Namusisi said the woman had no hope of decent treatments at home in Zimbabwe as it was only available to a few thousand people there. Dr Tyrer then asked delegates if UK doctors felt they were confident in addressing immigration issues among their HIV patients? A big majority voted no. And few knew where to send such patients for advice. Nicki Perry said we should involve community groups and advocates more in such cases. And Josephine Namusisi said that the worry of being deported meant that for many Africans with HIV in the UK, immigration issues are more important for many patients than their own health. Dr Tyrer said doctors have a duty to advocate on their patients’ behalf.

A fascinating session brought up many ethical and legal dilemmas for HIV doctors.

Should they ignore NHS rules and treat people the government says they shouldn’t? Should hospitals be chasing up patients for the money to pay for HIV drugs?

And could doctors face disciplinary or even legal action for acting on their conscience and in the best interests of their patients instead of strictly obeying NHS rules?