UK government policies restricting the entitlement of foreign nationals to healthcare are adversely affecting both individuals' health and public health, researchers report in the journal AIDS Care. People with HIV report delaying HIV testing, only accessing healthcare when they were sick enough to be admitted to an Accident & Emergency department, using alternative therapies and sending for medication from abroad.
The provision of healthcare to people subject to immigration control has been restricted in recent years. While current asylum seekers and those with leave to remain are entitled to free care in NHS hospitals, refused asylum seekers and undocumented migrants are sometimes issued with large bills for medical treatment.
Felicity Thomas and colleagues conducted in-depth qualitative research with HIV-positive migrants from Zimbabwe, Zambia and South Africa living in London. A total of 70 people took part in eleven focus group discussions.
Although there is no legislation to restrict access to primary care on the basis of immigration status, respondents reported problems registering with a GP. A particular challenge was that they were usually asked to provide documents that they were unable to supply (for example, a passport which was being held by the Home Office).
Under the legislation, care provided in an Accident & Emergency department is free-of-charge to all. Many respondents were well aware of this, and reported delaying seeking healthcare until their condition was so serious that an ambulance could be called. One man commented:
“You would rather wait for a situation where you get taken to hospital by ambulance because even if you walk in they want to know who is your GP. And if you don’t have one they become very suspicious.”
Accident & Emergency treatment is extremely expensive to provide. Moreover, in most cases, the patient then required immediate HIV treatment and a lengthy stay in hospital.
Some people had received bills for several thousand pounds for hospital admissions, surgery and treatment. The researchers found that these experiences often affected people’s feelings toward health providers.
People who were entitled to free NHS care could still be subject to intrusive visits from immigration and hospital officials. For example one woman who had been recently diagnosed with HIV received a bill for hospital treatment:
“I was worried how am I going to pay this £4000? So what kills you first is the stress and worry . . . I found myself thinking if I did not have indefinite leave to remain in this country then what would I do?... You’d just try to go away, you’d remove the drip and run away from there before immigration got there.”
People also reported relying on self-medication. Individuals sent for drugs in their home countries, but acknowledged that drugs were often used at sub-optimal doses or in other inappropriate ways. Furthermore, a number of participants had used herbal remedies and other alternative treatments, in some cases delaying HIV testing until such treatment had clearly failed. One woman commented:
"There are some people who do not have papers in this country, who can’t have access to a GP or a hospital and they have to rely a lot on the traditional medicines."
Although HIV testing is free for all (on public health grounds), HIV treatment is not. Respondents said that this served as a disincentive to others in the community to test:
“If I cannot access services, then there is no reason for me to test. If I test and I know I’m HIV-positive, I know it will be very difficult to access [treatment].”
Concluding, the authors note that current policies may appease a part of the UK electorate but act as a barrier to the uptake of HIV testing and treatment. Moreover, the policies can result in people resorting to other forms of treatment that may be costly, harmful or ineffective. As well as having implications for the health of individuals, the policies are likely to have an impact on the onward transmission of HIV.
Thomas F et al. ‘‘If I cannot access services, then there is no reason for me to test’’: the impacts of health service charges on HIV testing and treatment amongst migrants in England. AIDS Care 22: 526-531, 2010.