A proposed immigration law currently under discussion in the UK parliament could be devastating for asylum seekers living with HIV, deterring them from accessing primary care.
As national borders become increasingly open, and conflict escalates in many parts of the world, numbers of people seeking asylum in Western countries continue to rise. And asylum seekers living with HIV already face many challenges when accessing high quality, necessary care in the UK, which will be amplified if proposed legislative changes are introduced.
The number of people seeking sanctuary in the UK in 2011 was 26,430 (Eurostat). While the press and the potent narrative of nationalist parties, such as UKIP, may suggest otherwise, the UK is not the most popular European country for refugees. France (57,335), Germany (53, 255), and Belgium (31,915) are among the six European countries receiving more asylum seekers than the UK.
UK asylum seekers and HIV
Many asylum seekers and refugees who arrive in the UK come from countries with a high HIV prevalence, including Zimbabwe, Nigeria, and Uganda.
According to the UK Health Protection Agency, 65% of people newly diagnosed with HIV between 2001 and 2010, with country of birth known, were born abroad. Africa was reported as the region of birth for 87% of heterosexual diagnoses, with nearly half from south eastern Africa.
Asylum seekers are particularly vulnerable to HIV. Their migration may have been triggered by detention, torture, rape, sexual assault or harassment, or they may have been exposed to high-risk situations for HIV. In the UK the experience of being an asylum seeker may involve poor living conditions, malnutrition, lack of protection and depression, all leaving them vulnerable to sexual exploitation. Female asylum seekers are the most at risk.
Stress and asylum
Asylum seekers face many sources of stress. These can be difficulties experienced in their home country prior to leaving, during their flight and when they arrive in the UK. Fears of being sent home, problems accessing health care, separation from family and social support, difficult interviews with immigration officials, detention, and unemployment can all generate high levels of personal stress.
For asylum seekers living with HIV, their HIV positive status compounds and adds to these problems. Differences between the UK’s health system, compared to that of their home country where health is often paid for and difficult to access, complicates the situation.
According to a study published by Biomed Central in 2012, levels of resilience among asylum seekers living with HIV in the UK can vary.
People find ways to cope by tapping into personal resources, such as drawing on a personal faith, seeking support from HIV care providers, and staying busy. But when local policies attempt to segregate asylum seekers (as proposed during 2013 in Switzerland), the stress they are under increases.
Access to quality services
For asylum seekers living with HIV access to, and retention in, the health system is vital. According to Estelle Worthington, from the Regional Asylum Activism Project: “People seeking asylum in the UK already experience restrictions in entitlement to accessing secondary care. This has led to the shocking reality that asylum seeking women are three times more likely to die in child-birth in the UK than the average British woman.”
Since 2012 all people in the UK affected by HIV, regardless of immigration status, have unrestricted access to primary care. However, asylum seekers still require information and support when seeking access; going to the wrong place (for example specialised hospital care instead of a local general practitioner) can lead to them incurring charges.
Contrary to populist media reports there is no evidence of ‘health tourism.’ Health Protection Agency figures suggest an average of five years between arrival in the UK and an HIV diagnosis.
Diminished service for asylum seekers
According to Sarah Radcliffe, writing in ‘Migration Pulse’ (2013) “Universal primary care systems are vital for individual and public health,” and ensuring asylum seekers gain access should be a prime aim of government policy. It is also vital that all public and health systems appreciate the lived experience of illness and disease, and how they are constructed by different cultures.
The proposed immigration bill, currently under discussion in the UK parliament, threatens to further diminish asylum seekers’ limited health service access.
“The overall health situation for people seeking asylum is set to get far worse if the government’s proposals to introduce charging for primary and emergency healthcare for anybody who does not have indefinite leave to remain in the UK are implemented,” says Estelle Worthington.
In the context of HIV, though testing and treatment remain free, charging for other conditions may deter asylum seekers and refugees wanting to consult a GP about a possible HIV-related issue.
For asylum seekers, perhaps the worst thing is being alone – away from their country, extended family, and culture. Ensuring access to health care will address at least one of their concerns, at the same time enhancing personal and public health. Sounds good to me.
BBC (2013). Outrage as Swiss move to segregate asylum-seekers. Online at: http://www.bbc.co.uk/news/world-europe-23599502
Health Protection Agency (2011). Migrant Health: Infectious diseases in non-UK born populations in the UK. London: HPA
Migration Pulse (2013). Five points which must not be lost in the debate on NHS access. Migration Pulse, 2nd July. Available online at: www.migrantsrights.org.uk/migration-pulse/2013/five-points-which-must-not-be-lost-debate-nhs-access
Orton, L., Griffiths, J., Green, M. & Waterman, H. (2012). Resilience among asylum seekers living with HIV. BMC Public Health, 12, 926.
Ian Hodgson is a member of the Key Correspondents network which focuses on marginalised groups affected by HIV, to report the health and human rights stories that matter to them. The network is supported by the International HIV/AIDS Alliance.continue reading