By Sarah Boseley
The law that stops visitors to the UK and asylum seekers from getting NHS Aids drugs must be changed, a senior HIV doctor says, not just in the interests of humanity, but because the drugs now reduce the chance that they will infect other people.
Jane Anderson, the new chair of the British HIV Association, which represents doctors in the field, says there is no sense in leaving people without treatment, following studies that this year showed the drugs prevented transmission as well as keeping people alive.
"The legislation raises complications about getting the right treatment into the right people. It deters people from coming to services and it is very confusing," said Professor Anderson.The rules were drawn up under the last government in response to tabloid fears of waves of illegal immigrants heading for the UK for free Aids treatment. That, says Anderson, is a nonsense.
"The majority of people do not present for HIV care before nine to 18 months after arriving in the country, when they are ill or pregnant. We've never seen people getting off planes and rushing to HIV clinics," she said. Labour's stance was at odds with its policy to the developing world, she added. "The previous administration was very committed to ensuring adequate HIV care happened outside the UK, but at the same time as having barriers within our own borders."Lord Fowler, the former Tory health secretary behind the "Don't Die of Ignorance" Aids campaign of the mid-80s, also called for the rules to be changed in his report on HIV earlier this year.
Many of those with HIV in the UK are in marginalised groups. HIV infection has not stopped rising in the UK, particularly among men who have sex with men and in the African-Caribbean community.
Infection still carries a heavy stigma. Among the patients at the Homerton hospital in east London, were she works, Anderson says about 30% "haven't really told anybody much" that they have HIV. Many of those who do face discrimination and rejection by their community, families and friends.
Anderson and her colleagues are also concerned about new commissioning arrangements in the NHS. While specialist care will be organised by the National Commissioning Board, testing and prevention are likely to be localised and the long-term needs of patients who are living longer will probably be managed by GPs.
"We have some of the best outcomes in the world and the best surveillance and we're not doing a bad job," said Anderson. "We're being asked to change the way in which we do that very good job with financial pressures and a structural re-organisation, neither of which are really designed to deliver joined-up care to a group of people who are already in a complicated place in society."The stigmatised and marginalised people living with HIV infection may not get as good care as the middle-class "worried well" who know how to demand attention, she said.