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Free ARVs for all in England

The number of people receiving ARVs in developing countries has more than doubled from 400,000 in December 2003 to about 1 million in June 2005, according to a report released by the World Health Organization (WHO) and UNAIDS.
Working in the dark (Georgina Cranston/IRIN)

On the first day of October, a law change enabled everyone in England, regardless of their immigration status, to obtain free treatment for HIV and AIDS. This marks a victory for advocacy groups that have long argued that the health system restricted access to HIV treatment for some of the country's most vulnerable people.

Every resident in Britain contributes to the National Health Service (NHS) through their taxes, and gets free treatment. People without residency have to pay for treatment, with two exceptions: Cases of accidents or emergencies, where everyone receives free treatment from hospitals, and cases where serious infectious disease could be passed on to members of the public. But while treatment for STIs like syphilis and gonorrhoea fell under this latter category, treatment for HIV and AIDs did not.

This has changed, and HIV is now eligible for free treatment. "We have been campaigning on this for something like seven years," Eleanor Briggs, of the National AIDS Trust (NAT) policy and campaigns team, told IRIN/PlusNews. "So we are very pleased, and see it as a very positive development. It really was an anomaly that treatment for HIV was chargeable when other infectious conditions and STIs were not. Tests were always free but we know some people were put off taking the test because they were afraid of the cost of treatment, and so could have been infected and spreading the virus."

Those benefitting most from the change will not be short-term visitors to the UK, experts say, but people living there without proper documentation, including illegal migrants, those who have overstayed their visas, and asylum seekers whose claims have been turned down but who haven't left the country. Many are members of the African diaspora, a community with a relatively high rate of HIV infection and a lot of issues over visas.

Jacqui Stevenson of the African Health Policy Network says the previous policy was inhibiting treatment even among people who could have received free treatment, either because they met NHS criteria but didn't realize it, or because, in practice, health workers often don't demand fees from people they know will have difficulty paying.

''It really was an anomaly that treatment for HIV was chargeable when other infectious conditions and STIs were not.''

"This is a much simpler policy, and it should have a real impact in terms of people being likely to test," Stevenson said.

Fear unfounded

The change was slow in coming, partly because of fears about 'HIV health tourism' - people coming to the UK illegally to benefit from free treatment - and partly because of the perception that HIV-positive people, even on treatment, can still spread the virus to others. However, recent research shows that HIV treatment can vastly diminish the risk of transmission.

Meanwhile, another study showed that, among heterosexual adults born abroad but diagnosed with HIV in Britain, a third likely acquired the infection since their arrival in the UK - three times higher than previous estimates. The lead author of the study, Brian Rice, principal HIV scientist at the Health Protection Agency, says the new figures will have an impact on the understanding of prevention. "If you focus on heterosexuals, as we did, the majority are in African communities, and there are implications for prevention policy because it means that transmission in these communities is much higher than we thought."

He, too, welcomes the new policy. "It's important for prevention that everyone who needs treatment gets that treatment and gets it promptly; thankfully this change in the law helps that."

NAT investigated fears of 'health tourism', and its study concluded that the concerns were unfounded. It point out that, on average, migrants in Britain diagnosed as HIV-positive had already been in the country for five years.

When the change in the law allowing free treatment was introduced, British authorities promised what they called 'tough guidance' to prevent the abuse of the system. But Eleanor Briggs, of NAT, sees that as primarily a political gesture. "I think they just wanted to make clear their concerns around health tourism [being a problem], but there is lots of evidence to show that this is simply not the case."

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This article was produced by IRIN News while it was part of the United Nations Office for the Coordination of Humanitarian Affairs. Please send queries on copyright or liability to the UN. For more information: https://shop.un.org/rights-permissions

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