HIV and Migration: Understanding the barriers faced by people born abroad living with HIV in the UK

This report from the National Aids Trust, funded by Trust for London, interviewed migrants living with HIV in the UK and found migrants are being left behind in the UK’s response to HIV, despite being disproportionately affected by HIV.

The report identified a number of major barriers for migrants trying to access HIV testing and treatment, including:

• lack of access to appropriate information about healthcare entitlements;
• migrants’ poor understanding of healthcare entitlements and fear and confusion over possible charging for NHS services;
• ‘hostile environment’ policies – such as data sharing between the NHS and Home Office – deterred people born abroad from accessing care and contributed to their late HIV diagnoses;
• restrictions on being able to work or claim financial support for some migrants  forced some migrants into destitution, unable to afford food or travel to appointments.

For the Home Office

• The Home Office should end the No Recourse to Public Funds policy which provides inadequate protection from destitution.
• Healthcare staff should not be responsible for upholding ‘hostile environment’ policies.
• Charging migrants for access to healthcare should be ended as a practice that does more harm than good and the Government should not consider any further expansion of charging as this will only do further harm to public health.
• End all data sharing between the NHS and the Home Office. This practice should end in all circumstances and should be communicated to migrants so that they regain trust in the health system.
• The Home Office and Department of Health and Social Care should proactively provide information on HIV testing and treatment entitlements to all migrants applying for a visa, asylum or reporting to the Home Office. This should include information on how the healthcare system works and how to register with a GP.
• Information provided by the Home Office and the Department of Health and Social Care to migrants about their healthcare entitlements should be available in key languages and include information about interpretation services. This must state clearly that NHS services are required to provide interpreters where needed and that interpretation services are free and confidential.
• The Home Office should implement the guidance recommending that people with diagnosed HIV are not routinely dispersed away from the area they are receiving treatment.
• The Home Office must replace confiscated mobile phones and provide mobile data so people in initial and contingency accommodation can access GPs and HIV clinics.
• The Home Office should urgently work to ensure that the standards set out
  in the guidance ‘Immigration detention and HIV: Advice for healthcare and operational staff’ are met and that staff are provided the necessary information and training to implement the guidance. This should include, but not be limited to, a pilot that is used for learning.
• The Government must reconsider how detention is used for immigration purposes and review the Adults at Risk policy to ensure that detention of all vulnerable people ends.

For the UK Health Security Agency

• The UK Health Security Agency should consider migrants a key population and collect and publish more granular data on specific groups, including reporting in the published HIV data tables and annual report on all communities with over 500 cases of new transmissions in the last five years.

For the Department of Health and Social Care

• The Government must ensure GPs are funded and supported to offer HIV testing to new registrants and those known to be from a country of high HIV prevalence, in line with NICE guidelines.
• The Department of Health and Social Care should outline actions for HIV prevention and increasing testing in migrant populations as part of the HIV Action Plan.
• The national, regional and local HIV prevention campaigns should target prevention campaigns at migrant populations, with messaging outlining that HIV prevention, testing and treatment is always free irrespective of immigration status.

For Clinical Commissioning Groups

• Clinical Commissioning Groups and new Integrated Care Systems should ensure that there is access to mental health services that can meet the specific needs of migrants living with HIV. This should include psychological support based within HIV clinical services and simple referral pathways and co-working between HIV services, local voluntary sector services, and mental health services in the area.

For support services

• Tailored mental health, housing, welfare and financial support services should be prioritised for migrants living with HIV and support services should consider how they can remove barriers to access for migrants.
• Tailored services for migrants should be culturally specific and include paid participation by migrants where possible (this may be difficult due to restrictions on right to work for many migrants).

For the Health and Social Care Committee

• The Health and Social Care Committee should investigate the health and economic impacts of the current lack of permission to work and No Recourse to Public Funds policy on individual and public health.

For NHS bodies

• The NHS must review GP registration models and practice to understand why migrants face difficulties registering and accessing care at the GP.
• The NHS must support Primary Care Networks (or equivalents) to ensure GPs have access to specialist HIV advice from HIV clinics where needed. The Royal College of General Practitioners and British HIV Association should be involved in developing these processes.
• Health Education England, The Northern Ireland Medical and Dental Training Agency, NHS Education for Scotland and Health Education and Improvement Wales must work with Local Education and Training Boards (LETBs) or deaneries to ensure GPs receive sufficient training to enable them to deliver primary care that complements specialist HIV care.
• When patients (including those born abroad) register with a GP, present at A&E or when the NHS takes blood samples across all kinds of healthcare settings, there must be opt-out, not opt-in, HIV testing.
• Opt-out HIV testing should be included in the initial accommodation service specification across the UK.
• HIV support services have previously been funded by Local Authorities as a legacy of the AIDS Support Grant which no longer exists. NHS England, Clinical Commissioning Groups and local authorities should work together through new Integrated Care System (ICS) structures to ensure that HIV support services are funded and available to all people living with HIV as a key component of HIV care.
• NHS England and NHS Improvement should revise the service specification for primary care in immigration removal centres to incorporate recommendations contained in guidance published by National AIDS Trust and BHIVA: ‘Immigration detention and HIV: Advice for healthcare and operational staff’.

For the Department of Culture, Media and Sport

• The UK Government must expedite actions to address digital exclusion that are being led by the Department of Culture, Media and Sport in partnership with other departments and with the backing of HM Treasury. Access to key services such as healthcare for particularly excluded groups, such as migrants, must be prioritised so that no one is left without digital access.

For HIV clinics and clinicians

• HIV clinics and support services must maintain a mix of online and face-to- face services after the pandemic to ensure marginalised populations including migrants are able to access testing, treatment and support.

For Commissioners

• Commissioners and providers should work with local community-led organisations to ensure better co-delivery of services that can effectively address HIV stigma.