Tuesday, 5 April 2011

Report: medical care denied to UK immigration detainees with HIV/Aids

Source: Medical Justice

Most HIV+ immigration detainees helped by Medical Justice have been denied life-saving medication in detention according to our new research.

'Detained and Denied', based on the first ever comprehensive analysis of treatment of HIV+ immigration detainees in the UK draws on medical evidence from eight independent clinicians who assessed the detainees. Many of the 35 men, women and children studied are torture survivors from countries where rape is used as a weapon of war.

As a result of denial of medication some detainees have developed drug resistance, necessitating more complex drug combinations which are inaccessible to many in the country they are being deported to.  Without these drugs they may die within a few years, leaving their children orphans in a country some of them have never been to before.

More than three-quarters of the people in our study who were deported, had little or no medication. The UK Border Agency (UKBA) tried to deport an HIV+ pregnant mother who had been given less than a month's medication even though it is critical that treatment is not interrupted during pregnancy, to avoid a newborn child becoming infected.

Medical Justice has been granted permission by the Court of Appeal to intervene in the case of three HIV-positive (ex)detainees it has assisted who seek to have their detention ruled unlawful because of failure to treat them properly.  The 'Detained and Denied' report will form part of Medical Justice’s evidence that will be submitted.

Medical Justice calls for UK Border Agency to immediately stop detaining people who are HIV+ for immigration purposes.

"The UK Border Agency claims that healthcare in its centres is equivalent to that in the NHS, but the report shows that being in detention leads to a situation in which these patients cannot access proper medical care. In the case of HIV, this is a threat to the patients' lives. HIV-positive people should therefore be released and properly cared for."
Dr Indrajit Ghosh, a GP and HIV specialist who visited a number of detainees included in the study

“NAT welcomes the important report from Medical Justice, 'Detained and Denied', on the treatment of people with HIV in immigration detention, and deplores the continuing failures in care.  The NAT/BHIVA best practice Advice is there to assist those responsible to provide equivalent high quality care to that available in the community - not to do so is inexcusable.”
Deborah Jack, Chief Executive of the National AIDS Trust (NAT)

"Terrence Higgins Trust has supported many people with HIV whose health, physical and mental, has suffered while in detention. Given the clarity and quality of the BHIVA/NAT guidelines, there can be no excuse for this."
Lisa Power, Policy Director, Terrence Higgins Trust

“The clinical care in detention centres is currently so poor that it is a dangerous place for someone with HIV. Health and wellbeing is affected and lives are even being shortened.  That is unacceptable.”
Jenny Willott MP

“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.”
“Mary”, HIV+ ex-detainee (name changed to preserve anonymity)

"We provide primary healthcare facilities in all immigration removal centres which are equivalent to those available in the community.”
Director of detention services, UK Border Agency – 20/03/11

"Nobody is denied access to necessary treatment or medication whilst detained".
Lord Attlee - 2 March 2011


About the 35 HIV+ detainees’ cases that Medical Justice handled:
  • 28 are women and three are children, mostly from African countries.
  • Five had been detained for over a year, and some for several years – immigration detention in the UK is indefinite
  • 80% discovered their HIV infection after their arrival in the UK

Many have fled their own countries seeking safety and refuge and fear being deported back to face further persecution. Many are unlikely to be able to access treatment in the country they are being deported to and fear they may only live a few years without treatment. Some UK-born children may be orphaned in a country they have never been to and where they have no family.

All of the detainees were being detained indefinitely for immigration purposes, despite not being accused of any crime, yet some were forced to undergo medical examinations while handcuffed to guards, even though UKBA Detention Service Order 08/2008 states “handcuffs should be removed during hospital treatment and if requested by a treating clinician.”

British government treats HIV+ detainees’ health beneath contempt in UK immigration removal centres:
  • 60% suffered disruptions in their medication due to their detention and many developed resistance to their drugs
  • 77% were deported with little or no medication
  • 66% were subjected to harmful practices, so dangerous that they may have led to permanent harm, including:
  • Denial of access to hospital for appointments with HIV specialists
  • A failure to carry out or pass on the results of tests to determine resistance to particular medications
  • Putting detainees at risk of contracting opportunistic infections
  • Despite typical symptoms of HIV infection, a detainee was not given a test for over a year – she is HIV+
  • One detainee was given a significant overdose of her medication by the detention centre’s healthcare staff
  • One woman was given the wrong drugs
  • Detention centre staff failed to respect the confidentiality of detainees
  • Some detainees were forced to undergo consultations whilst handcuffed to escorts
  • Less than half were deported, begging the question why they were locked up in the first place
  • Some detainees attempted suicide due to fear of deportation
The Medical Justice study tracked breaches of the National AIDS Trust and the British HIV Association guidelines.

Guidelines for the treatment of HIV+ detainees have been set out by the National AIDS Trust and the British HIV Association (BHIVA). The BHIVA guidelines simply call for NHS-equivalent for HIV+ detainees, nothing more. UKBA policy is that healthcare in its detention centres is NHS-equivalent all detainees anyway. However, when challenging failures to provide care in line with BHIVA guidelines (i.e. NHS-equivalent), UKBA claims that it is neither willing nor able to enforce the guidelines within detention centres. It’s a classic Catch-22, with potentially lethal consequences.

The British government is willing to deport people who they know will die within a few years as a consequence.

UKBA has deported HIV+ children who are unlikely to have consistent access to treatment where they are deported to. 46% of the detainees were removed, despite in some cases former treating clinicians writing letters explaining, explicitly, that deporting particular detainees would be likely to lead to death. In one case, a judge recommended that the UKBA either find a woman who had been removed with insufficient ARV drugs and bring her back to the UK, or arrange to have three months supply of medication flown out to her. Neither happened.

The British government may have shortened detainee’s lives and prematurely orphaned children.

Through its private company sub-contractors who provide healthcare in detention centres, the government has denied HIV medication to detainees in our study for days, and in some cases - weeks. One person reportedly went without some of the drugs that he was supposed to be taking for nearly 3 months.  Furthermore, the government has denied blood tests to investigate resistance and/or withheld results. Missing just one dose of HIV medication can be serious and increases the propensity to HIV related (and non HIV related) illness. Ultimately, this can be fatal.

The process of detaining people who are HIV positive inherently puts them at risk.

Medical Justice calls for and end to the immigration detention of anyone who is HIV+, not least because our findings indicate that the process of detaining people who are HIV positive inherently puts them at risk and has caused significant harm. Common problems included interruptions to medication and treatment due to the process of arrest, being temporarily held in various places, removal attempts and administrative errors.  Some hospital appointments are missed as another private company providing transportation has set priorities for transport ; hospital appointments are quite far down the priority list. Furthermore, detainees have been put at serious risk of contracting dangerous – potentially fatal – infections or viruses when made to share rooms with people with TB, Swine Flu and chickenpox.

Case-studies of the contemptible treatment of HIV+ detainees:
A husband and wife, both HIV+, were arrested in a dawn raid with their two children. The parents were denied their HIV and other medication for a period of time.  The parents had kept their HIV status secret from their children but the detention centre staff told the children. The family were then separated when the father was put in isolation for a short time. Even though a doctor who had treated the parents prior to detention wrote that without access to continued medication in the country they were being returned to, the life expectancy of both parents was likely to be only a few years, the government tried to deport the family with less than 3 months medication. Describing the effect of detention on his children, the father said; “… they think that they are not human beings anymore, they have no future and they think that we are criminals.”

Failure to treat HIV - Four people exhibited symptoms which could have been indicative of a development of their HIV infection which, according to our records, were not sufficiently investigated. One woman was coughing yellow spit, had signs of TB infection, and was at risk of numerous life-threatening opportunistic infections. Little, however, appeared to have been done to investigate these symptoms. Another woman had lost approximately 20kg in weight, had abdominal pains, and watery diarrhoea; yet she had not seen a HIV specialist in over a month. 

Denial of test results - one man in an unstable medical condition claimed that clinicians in detention refused to give him the results of blood tests and instead would only give them to the UKBA.   

Attempt to deport a baby untested for HIV - There was an attempt to deport an HIV+ mother with her baby despite the fact that the baby was too young to test to ensure he had not been infected with HIV, The baby had not been offered malaria prophylaxis and, given that he was born in the UK, would be extremely vulnerable to this disease.

Discrepancy in medication supplies – The NHS norm is to supply patients with three months’ supply of medication, yet immigration detainees are normally given 28 days supply, even though they are being deported to countries where it is known that access to medication is at best patchy.

About Medical Justice - Medical Justice is a small charity with four staff and acts as a network of volunteer medics, solicitors, barristers, ex-detainees, and detainee visitors who arrange for independent doctors to men, women, children, including torture victims, in 11 immigration removal centres around the UK. In response to medical abuse we have exposed, and with evidence from our case-work, we seek policy changes to secure lasting improvements for immigration detainees.

A meeting on the medical care detainees with HIV/Aids receive while in immigration detention

Monday 9 May, 1-2pm, at the Institute of Race Relations, 2-6 Leeke Street, London WC1X 9HS

  • Theresa Schleicher - Medical Justice
  • Jon Burnett - author of 'Detained and Denied: the clinical care of immigration detainees living with HIV'
This meeting is aimed at lawyers, campaigners, ex-detainees, individuals and organisations interested in how asylum seekers with HIV/Aids are treated in detention. As places are limited it is essential to reserve a seat. Please RSVP to events@irr.org.uk. And note that meetings start promptly at 1 o'clock.

Medical Justice: Detained and denied
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