Significant failings in HIV care for some immigration detainees in the UK

Many HIV-positive people held in immigration detention in the UK receive substandard healthcare, involving forced treatment interruptions, inadequate clinical investigation and breaches of confidentiality. Moreover, people are removed from the UK with inadequate supplies of antiretroviral medication or against medical advice.

In a report released yesterday, the charity Medical Justice catalogued significant failings in the treatment of 35 people whose cases were brought to their attention. However as 29 of the 35 cases relate to one particular facility (Yarl’s Wood in Bedfordshire), it is possible that problems are localised rather than consistently experienced by immigration detainees.

The UK Border Agency (part of the Home Office) oversees ten Immigration Removal Centres (IRCs). They are prison-like structures, used for detaining people whose asylum claim is being considered, those whose claim for asylum has been refused and migrants who the agency intends to remove from the country.

Like prisoners, immigration detainees are entitled to receive healthcare that is ‘equivalent’ to that normally available through the NHS; this is an ‘operating standard’ for the private companies that run IRCs on behalf of the government.

Primary healthcare is provided within an IRC by private contractors. They should facilitate access to HIV treatment and other secondary care which is provided by local hospitals.

In 2009, the British HIV Association (BHIVA) and National AIDS Trust (NAT) produced advice on providing HIV care in immigration detention. They aimed to outline steps that should be taken to ensure that care is indeed equivalent to NHS provision.

However the UK Border Agency does not accept that their advice is policy which it must comply with. Moreover Medical Justice (a charity focusing on healthcare for immigration detention) is concerned that the BHIVA / NAT advice is not being consistently implemented. Their report describes numerous breaches of the advice.

Twenty one of 35 detainees referred to Medical Justice had experienced interruptions in their access to medication. Drugs were confiscated from people arriving at an IRC and individuals were not always given a sufficient supply of drugs.

Some detainees were not taken to their medical appointments, leading to treatment interruptions. The authors obtained a document outlining the IRC’s priorities for transporting detainees and found that journeys to medical appointments were considered a low priority.

Medical Justice points out that forced treatment interruptions risk the development of drug resistance, necessitating the use of more complex drug regimens which may be unavailable in the country a person is deported to.

Driven to desperation by the threat of forced return to their country of origin, a number of detainees attempted suicide. In three cases, they hoarded their antiretrovirals until they had a quantity that they believed would be fatal if taken as an overdose.

Twenty three of the 35 detainees experienced incidents (other than interruption of medication) which the researchers believe amount to healthcare below NHS standards. People were obliged to share cells with people with TB and other infections, or forced to attend medical appointments chained to guards. The HIV status of five individuals was revealed to others. This included an incident in which a member of IRC staff informed two children that their parents were HIV positive - a revelation that the father says “broke their hearts”.

Some people were seriously ill, but their symptoms were not adequately investigated. This includes individuals whose HIV was undiagnosed for an extended period of time. Eight people suffered from failures by clinicians to carry out necessary tests (for example, resistance tests) or to obtain test results. One man was told by the IRC doctor that he could not receive his test results himself - they could only be given to the UK Border Agency.

The largest group of problems (affecting 26 people) concern breaches of the advice around deporting people. Although the BHIVA / NAT advice states that people who are to be deported must be fit to travel and medically stable, a number of individuals who had just started a new drug regime or who were waiting for important test results were removed or would have been removed had lawyers not intervened.

Moreover the recommendations that, in order to avoid treatment interruptions, those being deported should be given a three months supply of medication, contact details of support organisations in the country and a letter for the next HIV clinician were widely ignored.

Twenty people supported by Medical Justice either were removed or faced removal with less than three months supply of drugs. This was sometimes due to HIV clinicians not being kept informed by the IRC of an impending removal, but in other cases HIV clinicians wrote prescriptions for 28 days rather than three months (the normal duration for NHS patients at the same clinic). The authors note that this discrepancy may amount to illegal discrimination. Moreover, there is a very real risk of treatment interruptions, considering the challenges in accessing HIV care in many African countries.

Medical Justice believes that given these failures to provide adequate clinical care, people with diagnosed HIV should not be detained at all. NAT believe that a wider audit of health care for people with HIV at the full range of Immigration Removal Centres needs to be conducted.

One of the detainees whose case is included in the report commented: “The research highlights the way people like me are not treated like human beings in detention… I was scared that I was going to die in Yarl’s Wood when they refused to give my medication. It was as if they were turning off my life support machine.”

Burnett J et al. Detained and Denied: the clinical care of immigration detainees living with HIV. Medical Justice, 2011.