Health Quango Cuts and HIV

posted: 27/07/2010

Eighteen health quangos will be cut to between eight and 10 over the next four years. The Health Protection Agency (HPA), which deals with HIV and infectious diseases, is one that will disappear within the next two years.
 

The Health Secretary Andrew Lansley justifies the quango cuts on the grounds that it would produce savings of more than £180m over the next four years by streamlining their functions and cutting their bureaucracy. Although the Department of Health's overall budget is being "ring-fenced", the growing demands on the NHS each year mean that significant savings need to be found.
 

Expert Criticism

Experts in infectious diseases criticised the plan to abolish the HPA as a statutory organisation and transfer its functions to the Secretary of State’s new Public Health Service. "It's a very bad idea because the HPA is an absolutely essential national resource," said Hugh Pennington, emeritus professor of bacteriology at Aberdeen University. "There is no merit in making changes to the HPA other than those that strengthen it. It's quasi-independent and a degree of separation between it and the rest of government gives it more scientific freedom and independence," Professor Pennington said.
 

The HPA plays an important role in monitoring and preventing HIV and other sexually transmitted infections in the UK. At the recent International Conference in Vienna it presented important research results and recommendations. Transfering its work to the Secretary of State’s new Public Health Service means its valuable independence disappears.

NAT concern

Deborah Jack, Chief Executive of NAT (National AIDS Trust) wrote to the Independent to say "We read with concern of the Government's plans to abolish the Health Protection Agency and merge it within a new Public Health Service directly accountable to the Secretary of State. As the UK's HIV policy organisation, for years we have benefited from the HPA's surveillance of HIV and other sexually transmitted infections. This information is vital in assessing the needs of the population and allowing effective targeting of resources, more important than ever in the present climate. We call on the Government to promise that public health surveillance and analysis will remain independent of ministerial interference to ensure impartiality, and that there is no deterioration in the quality and scope of the HPA's key public health functions, so essential to an evidence-based response to HIV."

The HPA in the Department's Quango Review

Here is what the Department of Health Review reports says about abolishing the HPA and setting up a Public Health Service within the Department of Health under the Secretary of State.
 

"3.42 We propose to support the cross-government public health strategy through the creation of a new Public Health Service directly accountable to the Secretary of State, to integrate and streamline existing health improvement and protection bodies and functions, with an increased emphasis on research, analysis and evaluation. As a part of that development we intend to abolish the Health Protection Agency and the National Treatment Agency for Substance Misuse as statutory organisations and transfer their functions to the Secretary of State as part of the Public Health Service.
[3.43 a paragraph about absorbing the National Treatment Agency for Substance Misuse into the Public Health Service.]
 

3.44 Our programme for public health will be set out later this year and more detail on what it means for these two organisations, and dedicated public health ring-fenced funding to support delivery of local services, will be set out in the context of the new Public Health Service. We will engage with the Health Protection Agency and the National Treatment Agency for Substance Misuse to ensure a smooth and orderly transition.
....

Legislative Changes
5.7 Many of the changes outlined in this document will require primary and secondary legislation. The Queen’s speech included a major Health Bill and a Public Bodies Bill for the first legislative programme. The Government will introduce these bills this autumn and the changes, where appropriate, will be enacted through one of these bills: our intention is that the majority of changes will be in place during 2012/13.
.....

The Public Health Service will in place by April 2012. (Annex C)"
 

NAT letter of concern to The Independent   

DH Arms Length Body Review report

Source

Department of Health press release

HIV Stigma and Harassment Action

posted: 24/03/2010

Ending HIV stigma and harassment has edged a little closer. An official inquiry is about to begin into progress by public authorities on eliminating disability harassment – and this includes HIV stigma. The Inquiry is called because of recent cases of severe disability harassment neglected by public authorities. Councils and the NHS, among other public bodies, are simply not doing what the law tells them to - eliminate disability harassment.

Last week George House Trust met with the Equalities and Human Rights Commission in Manchester at a consultation into exactly what the disability harassment inquiry should look into.
 

• We made it plain that the official Inquiry must include HIV and not just people with learning difficulties or mental health problems.
• We said that people with invisible but highly stigmatised conditions like HIV face considerable disability harassment and stigma, and many barriers to complaining.
• We said that public bodies, with rare exceptions, ignore their duty to eliminate HIV disability harassment and stigma.

Over the next year the Equality and Human Rights Commission will investigate and we have offered to help gather HIV evidence. We are working with NAT to make this a nationwide effort.
 

What will happen?
The Commission has considerable powers to force public bodies to act if they are not doing their job. We have a right to expect things to improve and the least we expect is public campaigns to make HIV stigma and harassment socially unacceptable everywhere, a bit like the Kick Racism out of Football campaign.
 

The powers the EHRC has to force public bodies to eliminate HIV stigma and harassment means HIV stigma and harassment could really start to fade away. We think the Commission should start using its powers - this is one of the best hopes we have for ending HIV stigma and harassment.
 

We’ll keep you updated on the Inquiry and how you can give evidence confidentially.
Disability Harassment Inquiry
 

HIV Prosecutions Focus

posted: 11/01/2010

HIV prosecutions and criminalisation in different countries is the focus of the latest issue of 'Reproductive Health Matters'.
 

One article looks at how gay men living with HIV in England and Wales have responded to prosecutions. This follows work by Sigma Research in its 2009 report ‘Relative Safety 2'. 
 

Does prosecution in an epidemic make public health better or worse?
 

42 HIV positive gay men, including some men using services at George House Trust, were asked what they knew about HIV prosecutions and how it may have changed their behaviour.
 

Only one in three are right about the law
There is considerable confusion among these gay men about the law and mistakes about whether their behaviour is legal or not. 1 in 3 of the men living with HIV were broadly right about how the law affects them. Most of the men were mistaken about the law.
 

Some of the men have changed their behaviour because of the law and reduced the risk of transmission, by telling partners their HIV status before sex, or in other ways.
 

Prosecutions have made HIV transmission more likely for most HIV positive men
But for most of the men, the law has made transmission more likely. Some of the men have felt pushed towards more anonymous sex, and are now less likely to tell partners they have HIV: HIV stigma is reinforced by prosecutions.
 

Other men felt that they were already being safe and so the law would not really matter because they wouldn’t pass on HIV anyway. But many of the men are making mistakes in their judgements about the risks so the likelihood of transmission rises.
 

A small number of other men are not able or willing to reduce their transmission risks despite the possibility of prosecution.
 

Public health harm outweighs the good
The aim of the criminal justice system is to provide justice, not to improve public health. But using the criminal law in an epidemic has few public health benefits and these are outweighed by the public health harms. Most of the men believe they are doing enough to prevent HIV transmission and that they are on the right side of the law. Most of them are mistaken about both.
 

The law is complicated and it doesn't fit the complex reality of living with HIV - the strong force of HIV stigma, the difficulties of accurately judging transmission risks in different situations, the impossibility of providing plain and simple advice, and the complexities of some men's lives, all make HIV transmission more likely.
 

Involving the law has bad unintended public health consequences. George House Trust has always argued that prosecutions for HIV transmission do more public health harm than good. The evidence is here.

 

Source Responses to criminal prosecutions for HIV transmission among gay men with HIV in England and Wales Catherine Dodds, Adam Bourne, Matthew Weait

This is based on research for Relative Safety 2 - Sigma Research 2009
 

Reproductive Health Matters Volume 17, Issue 34, Pages 4-224 (November 2009) €21 / US$28 for the single issue

Articles on HIV criminalisation in this journal

• Criminalising HIV transmission: punishment without protection
• Protecting HIV-positive women's human rights: recommendations for the United States National HIV/AIDS Strategy
• Responses to criminal prosecutions for HIV transmission among gay men with HIV in England and Wales
• Advocating prevention over punishment: the risks of HIV criminalization in Burkina Faso
• Vertical HIV transmission should be excluded from criminal prosecution
• Ten reasons to oppose the criminalization of HIV exposure or transmission
• International consultation on the criminalization of HIV transmission: 31 October – 2 November 2007, Geneva, Switzerland Joint United Nations Programme on HIV/AIDS (UNAIDS),
• Round Up: HIV and AIDS

Training for Councils - No Recourse to Public Funds

posted: 21/12/2009

A full day's training for councils on their legal duties to support people and families with ‘no recourse to public funds’ (NRPF) is provided by the NRPF Network along with London’s Islington Council. A significant number of migrants with HIV in NW England are subject to the No Recourse to Public Funds rules. Some NW England councils apply the rules very harshly or refuse to even accept they have any legal duty to assess people or help. Other councils do their duty well.

The training

• focuses on good practice in assessing and supporting people with NRPF
• provides an overview of relevant legislation and case-law and
• invites participants to explore other factors to be considered where immigration status impacts on entitlements to services in the UK.

Since April 2009, there have been 17 of these sessions for councils and voluntary sector organisations across the UK and the feedback is very positive.

The full details of the training days are on the NRPF microsite and any requests or enquiries can be made by email

In NW England councils vary widely in how well they perform meet their legal duties towards people with HIV under these rules.  
 

HIV Harassment Investigation

posted: 08/12/2009

Public bodies in England, Scotland and Wales face an inquiry into how they deal with disability-related harassment by the Commission for Equality and Human Rights, the watchdog announced.
 

The commission promises that bodies that do not adequately uphold the rights of people with disabilities, including everyone living with HIV, could face legal action.

Public bodies have a legal duty to take steps to eliminate disability-related harassment – part of their disability equality duties.
 

The inquiry, which will publish its final report in early 2011, follows the inquest into the deaths of Fiona Pilkington and her disabled daughter Francesca. Their deaths followed years of harassment and exposed weak public responses to tackling this.
 

EHRC commissioner Mike Smith said: "Disabled people experiencing harassment can become conditioned to hostile treatment, or are sometimes told to ignore it by those around them - including by public authorities. They may also go to enormous lengths to avoid putting themselves at risk which can limit their freedom and opportunities. These are unacceptable outcomes for anyone in our society."
 

Evidence exists
The commission said it already had evidence that harassment of disabled people was widespread throughout Britain and that people with learning disabilities and mental health problems were at a particularly high risk. People living with HIV similarly may experience significant harassment and violence because of stigma.
 

What are Councils and Health Bodies actually doing?
The Inquiry will look at what public bodies are doing to end disability-related harassment and to deal with its causes, including prejudice and negative attitudes; and how public authorities have involved people with disabilities in eliminating harassment and its causes – for example by effective joined-up reporting procedures.
 

Ruth Scott, director of policy and campaigns at disability Scope, said: "We would like to see the inquiry focus on how public authorities are raising awareness of disability related harassment among disabled people, to increase their confidence in reporting such cases, and supporting and training frontline staff across public authorities to ensure they respond appropriately and promptly."
A document outlining the terms of reference will be published shortly for consultation and the terms will be finalised early next year. The whole review will be completed within the year.
 

Have you evidence?

The Inquiry will collect evidence from people with HIV and other disabilities and from people affected by disability-related harassment (such as HIV negative partners and family) and from public authorities on what they are doing to tackle the issue.
 

George House Trust will work with other HIV bodies to collect and submit evidence of HIV harassment. Few cases are ever reported, mainly because of HIV stigma and the belief that complaining won’t change things for the better. This investigation, linked to the use (or not) of public powers to deal with HIV stigma, is the best opportunity to make councils, police and health bodies take real action to cut HIV harassment in society.

If people have information on HIV harassment in NW England please contact HIV Policy worker Chris at George House Trust.
 

The investigation follows the recent publication of the UK HIV Stigma Index - information in our recent report and also here. 
 

Good practice too
The Inquiry may also aim to identify examples of good practice in eliminating disability related harassment and addressing its causes.
 

The Commission will consider how public authorities have complied with their obligations in relation to the Disability Equality Duty set out in the Disability Discrimination Act 1995, the Human Rights Act, and the UN Convention on the Rights of Persons with Disabilities.
 

Useful Information and Guidance

Public Bodies Duties Guidance 
ECHR report – Promoting the safety and security of disabled people 

Sources          The ECHR press release              Community Care