HIV treatment to be free for undocumented migrants and non-UK citizens

Roger Pebody
Published: 28 February 2012

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.

Citing the 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.

While 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.

Nonetheless, 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 need it.

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.

Anne 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.”

The government believes that early diagnosis of people with HIV will ultimately help cut costs.

Professor 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.”

The new 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.