The United Kingdom Department of Health has announced that it will soon
make HIV treatment free for all who need it, regardless of citizenship or
immigration status. While the change may be politically controversial,
ministers are justifying it on the grounds of public health.
For a number of years, treatment of other sexually
transmitted infections, tuberculosis and malaria has been free to all,
regardless of normal rules on entitlement to NHS services. HIV treatment will now
be provided in the same way, as long as the person seeking treatment has been
in the UK for at least six months.
This is a significant victory for HIV advocates, led by the National AIDS Trust,
which has persuaded government officials that charging for HIV care discourages
migrants from testing for HIV, leads to undiagnosed individuals unwittingly
passing their infection on, and means that when people are eventually diagnosed,
the treatment they need is unusually expensive.
HPTN 052 study, the chief medical officer, Professor Dame Sally Davies, noted
that effective HIV treatment reduces the risk of transmission by 96%.
However, immigration is a sensitive political issue, and this has led successive
governments to tighten restrictions on free-of-charge NHS treatment for people
subject to immigration control.
individuals who are in the process of claiming asylum and people who have
refugee status are entitled to NHS care, this is not generally the case for
people who have been refused asylum, people who have overstayed a visa or
illegal entrants. Moreover, people who have a visa for studies or for a short
visit are not usually entitled to healthcare.
the rules do allow doctors discretion in some areas and there are no charges
for treatment of a number of serious communicable diseases.
Last year, a select committee of the House of Lords, chaired
by the former Conservative health minister Lord Fowler, recommended that anyone
who is resident in England should have access to free HIV treatment if they
As part of the Lords debate on the highly controversial Health and Social Care Bill, Lord Fowler
introduced an amendment to that effect. In response, government ministers yesterday
said that Fowler’s amendment was unnecessary as the government would itself
introduce changes to the Charges
to Overseas Visitors Regulations in the next few months which would
have the same effect as his amendment.
Milton, the public health minister and a former nurse, said: “This measure will
protect the public and brings HIV treatment into line with all other infectious
diseases. Treating people with HIV means they are very unlikely to pass the
infection on to others.” However she added: “Tough guidance will ensure this
measure is not abused.”
government believes that early diagnosis of people with HIV will ultimately
help cut costs.
Jane Anderson, chair of the British HIV Association said: “I am delighted that
Lord Fowler has finally won the argument on this point. It's a decision that
will certainly save lives and improve the quality of life of many who were
previously shut out from appropriate treatment.”
Deborah Jack, chief executive of the National AIDS Trust (NAT), commented:
"NAT has been
campaigning for HIV treatment to be free for all those who need it in England
for many years - and we regard the Government's commitment on this to be a huge
achievement. Free HIV treatment for all is a victory for public health and
for the NHS.”
rules are likely to come into force in October – until then, charges may be
made for treatment. The changes will initially apply only to the regulations in
England. However, the Welsh and Scottish health services have rarely charged
individuals for HIV treatment in the past. It’s not clear whether Northern
Ireland will follow suit.