HIV and Africans in the UK

posted: 11/05/2011

HIV & UK African Communities is a brand new guide to the key issues affecting black African communities in the UK. It contains personal stories and a directory of services as well as sections dealing with the key issues.

Produced by NAM it is available free online or as a book for just under £25.
 

It covers the key topics

• facts and figures about black Africans living in the UK
• about HIV among Africans here
• the needs of Africans living with HIV
• mental health
• faith
• stigma and discrimination
• telling others
• HIV prevention, testing, diagnosis and treatment
• women
• men
• men who have sex with men
• children and families
• young people
• carers
• older adults
• gender-based violence
• rights to healthcare
• immigration and asylum
• prosecutions.

HIV & UK African Communities: the key issues
 

HIV Patients made Prisoners

posted: 03/05/2011

NHS consultants say that security measures imposed by the UK Border Agency have turned Hillingdon hospital’s HIV clinic into a prison.
Hillingdon hospital in west London, is the nearest to Heathrow airport, and some of the people with HIV that it treats are detained at nearby immigration removal centres, who are brought to the hospital for treatment.
 

Patient cuffed to guard

The problems began when an immigration guard who had handcuffed a patient to him refused to remove the handcuffs so the man could be treated in privacy. When the guard refused to uncuff the man the doctors refused to treat him and made a formal incident report to the hospital’s medical director. That’s a serious formal complaint, and it concerns inhuman and degrading treatment.
 

Clinic windows barred - a prison for all
Officials from the UK Border Agency then fitted restraints on the windows at the hospital's sexual health clinic to ensure that detainees could not escape.
HIV specialist Ben Holden, a consultant at the hospital, said: "The unit is now a prison for us all. Our windows only open two inches but UKBA have installed chunky locks on them. We were told they would bring removable window restraints but these are permanent.
 

No attempts to escape
"No detainee has ever absconded or attempted to abscond. As doctors we believe that to keep immigration detainees restrained or locked in is discriminatory. I don't want to be part of a process that treats people in a less than human way."
Doctors are angry that immigration detainees who have committed no crime, approximately half of whom are later released, are treated in this way.
 

Deported without needed HIV drugs
An audit conducted at Hillingdon hospital also revealed that none of the detainees removed from the UK were dispatched from the UK with a full three month supply of anti-retroviral drugs (in accordance with British HIV Association / National Aids Trust guidelines). They left without an adequate tide-them-over drug supply because in many cases doctors at the hospital are not told by UKBA before people are removed from the UK. UKBA frequently cancel clinic appointments and some HIV-positive patients were removed before they were even seen at the hospital.
 

British HIV Association 'disappointed'

Professor Jane Anderson, chair of the British HIV Association, said: "BHIVA and the National Aids Trust have developed advice on appropriate HIV treatment and care for people in the immigration removal system, and we are disappointed to hear that this advice is not always being followed. We want to see the highest standards of care for everyone with HIV in the UK. Any factors that make the provision of high quality clinical care difficult give us cause for concern."
 

Emma Ginn, co-ordinator of the charity Medical Justice – which recently published Detained and Denied, a report cataloguing examples of poor medical treatment of HIV-positive detainees in the UK – said: "Along with the potentially lethal medical abuse they suffer in detention centres, detainees are suffering sub-human conditions in hospital."
 

Window bars excused
The UK Border Agency said: "We have agreed the installation of window locks for detainee treatment with Hillingdon hospital and are working with them to address the concerns now raised. Detainees are only handcuffed when absolutely necessary and they are not handcuffed during treatment.”
"The welfare of detainees is important but this must always be balanced with the security of the detainees and the public. Detainees have round-the-clock access to healthcare services to discuss their medication needs."
 

Hospital’s story
A spokesman for the Hillingdon hospitals NHS foundation trust said: "The UK Border Agency has told us that they do not believe our open ward environment is suitable for the treatment of individuals who may be failed asylum seekers and under restraint. However, a large proportion of the patients who are brought to our sexual health department by the agency are later discharged into the community and are not subject to the criminal law.
"We have agreed a temporary measure with the Border Agency to put discreet bars on windows in the unit, but we are continuing to negotiate an agreement with the agency that will offer a solution that allows us to treat all our patients with respect."
 

George House Trust would point out that Hillingdon hospital has allowed the UKBA to fit restriction devices onto its hospital clinic windows. It was under no legal obligation to treat all its sexual health clinic patients and staff in this way. And handcuffing patients is very rarely justifiable and hospitals must always consider alternatives or risk legal action under the Human Rights Act.

The NHS Constitution seems to have been ignored by the hospital - it says 

"You should always be treated with dignity and respect, in accordance with your human rights. This means, for example, that your right to privacy should be respected."

Complaining is far more difficult for people using Foundation Trusts like Hillingdon Hospital – there is no independent body to represent patients and help with complaints, Hillingdon’s website won’t even let you download its complaints leaflet and you will wait many months for the Ombudsman to deal with any complaint.
 

NHS complaints advice 
 

Source

Late Diagnosis - More AIDS Deaths

posted: 11/04/2011

12 years of UK HIV data shows that people diagnosed late with HIV (when the CD4 count was under 350) are 6 times more likely to die of AIDS than other people with HIV.Three quarters of all the people who die with an AIDS diagnosis were diagnosed with HIV late – when their CD4 cell count was below 350.
 

The researchers who gave this news to the British HIV Association Conference in Bournemouth last week, used the UK’s national HIV surveillance system data and death certificates at the Office of National Statistics, for the years 1997 to 2008.
 

While HIV deaths have plunged since combination treatments began in the mid 1990s, over 500 people with HIV die each year, and the HIV death rate is still five times higher than for the general population.
 

Over these 12 years, almost half the deaths were due to AIDS (49%). The proportion varied during this time but is not falling steadily, as we would hope.

The researchers milked the data by using advanced statistical tools. That is how they discovered that being diagnosed when the CD4 is below 350 makes people six times more likely than others with HIV to die of AIDS. They also estimate that 74% of all AIDS deaths are explained by late diagnosis. Even among people infected in the UK, 66% of AIDS deaths are linked to late diagnosis.

• Men were more likely than women to die of AIDS.
• But men who have sex with men were less likely to die than heterosexually infected men and women, whether this was in Africa, the UK or anywhere else.
• Injecting drug users had a much higher risk of death than all others.

The most common causes of AIDS deaths were PCP (a type of pneumonia common with advanced HIV illness), other AIDS-related pneumonias, non-Hodgkin's lymphoma, TB and neuro-cerebral causes.
These findings make very clear how important it is to reduce late diagnosis – NorthWest England is the worst region in England for late diagnosis.

Source with link to reference

Guides for More HIV Testing

posted: 04/04/2011

The number of people who got infected with HIV within the UK in the last 10 years has almost doubled. New infections that happened in the UK (rather than abroad) rose from 1,950 in 2001 to 3,780 in 2010.

In response the National Institute for Clinical Excellence (NICE, the body that tells the NHS what healthcare works and is good value for money) has issued new guidance for the testing of the two groups most at risk of getting HIV in the UK, gay/bi men and African people.

HIV testing helps people keep good health

Testing and treating people with HIV helps the person with HIV stay healthy and to live a near-normal life, helps avoid passing on HIV to others, and can save the NHS a lot of money.
 

The NICE guidance aims to increase the numbers taking HIV tests to reduce the number of people who do not know they have HIV and so help prevent HIV being passed on by Africans living in the UK and gay men.

Gay and bisexual men remain the group most at risk of becoming infected with HIV in the UK with 70 per cent more men being diagnosed with HIV in the past 10 years (from 1,810 in 2001 to 3,080 in 2010).
 

‘NAT welcomes the new NICE guidance on increasing testing among African communities and gay men. Not only is the number of people being diagnosed with HIV still too high, late diagnosis is an extremely important problem as it means a person is likely to have had HIV for a number of years – with a high risk of transmission to sexual partners – and it can also reduce the effectiveness of treatment,” commented Deborah Jack, Chief Executive of NAT (National AIDS Trust).

‘It is crucial that HIV testing becomes ‘normalised’ in our society, not just among gay men and African communities, but also amongst health professionals. Many people with HIV attend NHS services for years without being offered an HIV test and this neglect needs to be addressed and stopped.’

'The importance of HIV testing should now be reflected in Government plans as they reorganise the NHS and public health. In particular, it is essential that HIV late diagnosis remain a key outcome indicator to assess progress in public health at the local level. It is also vital that the extensive reorganisation of the NHS does not undermine recent momentum in HIV testing.’
 

‘Public Health England must ensure that the vision for HIV testing amongst gay men and African communities set out in the NICE Guidance is consistently implemented across the whole of the NHS and public health system.’
 

NICE HIV testing guidance for gay/bi men

NICE testing guidance for Africans living in the UK

Source – HPA press release

Image

HIV Migrants Detained and Denied

posted: 14/03/2011

UPDATED  4 April 2011

In their new report Detained and Denied: The clinical care of immigration detainees living with HIV, the charity Medical Justice produce evidence showing that their experience is that most HIV+ immigration detainees are denied HIV medication and care.

This study is the first ever comprehensive analysis of the UK's treatment of 35 HIV+ immigration detainees who were supported by Medical Justice. Eight independent expert clinicians assessed the detainees's health and needs, and there are also legal documents and testimonies from detainees.

Is HIV detention illegal? - Appeal Court will decide

The evidence in this report will be heard in the Court of Appeal in April when three HIV-positive migrants seek to have their detention ruled unlawful because of the centres' failure to treat them properly.

The key findings in Detained and Denied are :

• The British government treats HIV+ detainees’ health beneath contempt : 60% had breaks in their HIV treatment due to their detention, and many developed drug resistance. 77% were deported with little or no medication.
• The government may well have shortened detainees’ lives and prematurely orphaned children
• The process of detaining people who are HIV+ inherently puts them at risk
• The denial of medication has in some cases meant that detainees developed drug resistance, necessitating more complex drug combinations, which are rarely available in many countries
• The government is willing to deport people who may die within a few years as a consequence of that drug resistance.

Detained and Denied - Medical Justice report 

Chronic Indifference is a similar study, about the experience of HIV+ migrants who were detained and denied in the USA.

NAT (National AIDS Trust) points out that the Government has a special duty of care to people it detains. All detainees and prisioners are entitled to the same level of healthcare as is available to everyone else, particularly for a serious life-threatening condition like HIV.

Instead the report shows people with HIV are continuing to face unacceptable neglect. NAT worked with the British HIV Association (BHIVA - the professional association for HIV clinicians) to produce best practice advice on HIV treatment at Immigration Removal Centres precisely to prevent these problems. It is a disgrace that the advice is being ignored in so many cases.

Deborah Jack, Chief Executive of NAT (National AIDS Trust), said:

'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.

‘NAT has asked the UK Border Agency to work with us on a 12-month audit of every person with HIV who goes through the immigration detention process, to assess the quality of their care. We are still waiting for a response. The Medical Justice report underlines how urgent it is for such an audit to take place and concerted action to be implemented to address problems identified. We urge the Government to agree to the HIV audit as soon as possible.'

NAT call on the Government:
 

• To investigate the breaches of care outlined in the Medical Justice report 'Detained and Denied’
• In particular, to investigate the failures at Yarl's Wood and in advance of this and any resulting action, to immediately stop using Yrarl's Wood for detaining anyone with HIV
• To commission centrally healthcare in Immigration Removal Centres through the planned NHS Commissioning Board
• To agree to a 12-month collaborative audit with NAT of all those with HIV detained at any Immigration Removal Centre