The UK government’s immigration strategy is a risk to public health as the “hostile environment” it has created makes migrants less likely to get treatment for infectious diseases, The Independent reports experts have warned. Migrants living in the UK legally are also affected by a raft of policies which work to deter them from seeking early testing or care for complications, the National Aids Trust (NAT) said.
“Migration is the major issue for anyone working on HIV and sexual health,” the charity’s director of strategy, Yusef Azad said. “One cannot underestimate the degree to which the hostile environment creates an atmosphere of fear and suspicion and distance for many migrant communities from health care.”
The result of these barriers “is that we fail to diagnose people with infectious diseases early and it spreads to the general population”, he said, adding that with HIV “the key problem is getting people diagnosed”.
The report says the warning comes as UK Prime Minister Theresa May and the Home Office are embroiled in a scandal over the status of the Windrush generation who emigrated from the West Indies to Britain in 1948. The crisis has its roots in policies the prime minister enacted as Home Secretary in 2012, pledging to create a “really hostile environment” for illegal immigrants – a move described as “almost reminiscent of Nazi Germany” by some in government, former civil service chief Lord Kerslake has claimed.
Treatment for HIV and other sexually transmitted or infectious diseases is provided by the National Health Service (NHS) regardless of residency status and clinics. Often run by charities they are still seen as safe spaces by patients. But, the report says, even people who have legal residency are aware their status can change and on the heels of the hostile environment a health tourism crackdown means a visit to hospital now requires foreign nationals to undergo residency checks which can result in a hefty bill for those ineligible for care. This can result in secondary illnesses, such as cancer or respiratory diseases, which are more common in people with HIV, only coming to the NHS when they are already an emergency – at much greater cost to the NHS.
In a deal with the Home Office, the NHS has also agreed to hand over patient names and addresses to immigration officials looking to trace immigration offenders – a move charities have warned has already led to the death of one woman too afraid to seek prompt medical help.
The report says stricter requirements on GP surgeries to seek proof of UK residency from new patients have created another barrier to early testing and detection.
Dr Richard Ma, a GP in Islington and a research fellow at Imperial College London, who specialises in sexual health, is quoted in the report as saying that GPs can register patients with the minimum of residency information and are resisting pushes to share information with Home Office officials, but the climate is having an impact. “Building trust and a relationship takes time, and access to the GP appointment. I agree there is a very pervasive air around migrants, and it’s very disruptive. I think it really can deter people from accessing care and divulging some bits of their history which may be very relevant to their care.”
People diagnosed late are 10 times more likely to die within a year of diagnosis, but late diagnosis also means more chance of other people being infected and their care is far more costly to the NHS. While 42% of all HIV cases are diagnosed late, typically meaning they have already had the disease for three or four years, the NAT said that among heterosexual migrants late diagnoses account for 53% of cases.
“Late diagnosis means greater morbidity, greater mortality, further onward transmission and extra costs to the NHS,” Yusef said. “Far from a deterrent policy the government need to have a proactive engagement policy with these groups, not just to improve migrant health but also public health in general.” He added that a “very significant proportion” of those diagnosed late would have been infected after arriving in the UK.
The report says this shows another failure in the government health strategy which has seen public health and sexual health budgets cut since 2010 and means there are even fewer schemes for already hard-to-reach groups that could keep them HIV negative.
“Pushing back on the hostile environment and promoting good health in these communities in the face of it, becomes even more difficult when the services to do so are being cut.”
A government spokesperson is quoted in the report as saying: “The diagnosis and treatment of STIs and infectious diseases like HIV is free of charge for everyone, including overseas visitors. Urgent and emergency care is always available from the NHS regardless of immigration status. Non-clinical, demographic information is shared on occasion between health agencies and the Home Office to locate individuals suspected of committing immigration offences – this data is strictly controlled and only shared if there is a legal basis to do so.”The Independent report