Reasons for Travelling to Clinics

posted: 09/12/2010

Most people with HIV in England live within 5km (3 miles) of a specialist HIV clinic, according to a new study. The average distance people travel to their clinic was 2.5km (just over 1.5 miles). However, fewer than 1 in 10 people with HIV use the clinic that is nearest to their home. Why do people travel to a clinic further away?

Researchers wanted to see how far people live from a HIV clinic, and understand why some people travel further than they have to for HIV care.
 

Choice and advice on chosing clinics

People have the right to choose which HIV clinic to use and the British HIV Association recommends people who require routine, uncomplicated care to use their local clinic, and that people with more complex needs should use a more specialised clinic.

Not much has been studied about travelling to HIV clinics in the UK, nor about the social, demographic or clinical characteristics associated with people's choices about travelling to a HIV clinic.

Over 46,000 people studied
To get a clearer understanding of clinic travel, researchers looked at data on 46,550 HIV-positive adults who received HIV care in England in 2007. They pinpointed the closest HIV clinic for each person. All clinics within 5km of a someone’s home are considered ‘local’.

They looked at the wealth in each person’s borough of residence, and the person’s ethnicity, HIV risk category, length of HIV diagnosis, and HIV treatment status.

What they found – urban and often poor

Most (66%) of the people were men and 50% were white. The great majority (95%) live in an urban area, and 42% live in an economically deprived area. Almost three-quarters (73%) were on HIV treatments.

The median distance travelled to their clinic was 2.5km; but this ranged from less than 1km to 80km (50 miles). People in London travelled less than everyone else (2km vs. 3.7km).

Clinic access is good: 81% live within 5km of a specialist HIV clinic, and 93% live within 10km.
In London people had an average choice of three clinics within 5km, but those living outside the capital average just one local clinic.

The average distance travelled by patients to their clinic was a little under 5km. Overall, 73% use a local clinic. However, only 9% used the clinic closest to where they lived.

Reasons for travelling further
Haemophilia - People who were infected with HIV by blood products (mainly haemophiliacs infected during an old UK blood scandal) were most likely to travel further (51%). “These patients may need to attend specialist services that are not provided locally,” comment the authors.

Urban – People living in urban areas were significantly more likely to attend a non-local clinic than those who live in rural areas (44% vs. 22%) – people in major towns and cities are more likely to have a local choice. People living in rural areas and smaller towns have less or no choice nearby. Travelling to the next clinic is also less practical.

Ethnicity - Black African and black Caribbean people were statistically rather less likely to travel beyond their local service than white people.

Length of diagnosis - How long people have been diagnosed also affected travelling distance. People who had been diagnosed for at least a year were 50% more likely to use a clinic over 5km away service than those diagnosed within the last year (27% vs. 20). The investigators suggest “this may be because patients may not become aware of the choices available to them until they have adjusted to their HIV diagnosis.”

Poverty - Wealth also significantly affects the choice of clinic. People who lived in the better areas were twice as likely as those living in the poorest districts to travel further for treatment (42% vs. 21%). The investigators suggest that “financial difficulty” may prevent some people from travelling to clinics further away. Another recent study showed that almost a third of people with HIV in the UK did not have enough money to meet their needs and that 10% had difficulty meeting travel costs.

Help with paying to travel

If you have a low income or are on benefits, you may have a right to help with the costs of travelling to your clinic. Here's information on help with hospital travel costs.

“Barriers to service choice are likely to related to poverty and unfamiliarity with the options for HIV care,” conclude the authors, “consequently, provision of local services remains vital.”

Source including reference details

 

Life Insurers Discriminating

posted: 07/12/2010

Many life insurers discriminate against people living with HIV by refusing to offer any life insurance, or by charging unaffordable premiums, it was claimed this week.
 

8 out of 12 won't insure

Compass, a firm of financial advisers that offers specialist advice to gay and HIV-positive communities, said that eight of the top 12 UK insurers say they do not accept applications from HIV-positive people.
 

The 4 that will insure

When Compass put forward a test application to the four insurers that say they will insure people with HIV, two – Scottish Provident and Fortis – refused to offer any life insurance, said Chris Morgan, marketing manager of the Devon-based firm.
 

The other two companies were little better. Zurich wanted to charge so much extra for HIV that the customer would have to pay around £220 per month, almost double the £116 that Prudential would charge, he added.
 

Testing Insurers
They wanted to find out what life insurance would cost for a 30-year-old non-smoker with HIV, who wanted £250,000 of life cover for 10 years. He was chosen because he has one of the best blood cell counts and "viral loads" – a measure of the severity of a viral infection – of any person with HIV that Compass has tried to insure.
 

Prudential  leads, others left behind
Chris Morgan said Prudential had increased the premiums because of HIV like Zurich, but at least it was offering "useful cover at a realistic price". Early last year, Prudential became the first mainstream insurer to offer life cover to people with HIV. Since then, a few other companies have started to offer this too.
 

Stigma and in the dark ages

Morgan said: "Some of our findings and answers received from insurers are completely worrying. It is apparent the majority are still in the dark ages and attaching a stigma to HIV." In fact it is likely to be evidence of illegal discrimination.
 

He added that his firm recognised insurers had the right to decline applicants on medical grounds, but it felt they were not dedicating enough attention to this developing market, and taking the needs of HIV-positive people seriously enough.

"Either companies are avoiding the issue by not offering cover, or offering completely inadequate, overpriced products and services."
 

Paul Ward, deputy Chief Executive of Terrence Higgins Trust told BBC Radio 4 this week: "If you are positive, you can start treatment and it's very effective. For someone in their 30s, diagnosed today, there is every likelihood they are going to live into their 70s."
 

Excuses

In a statement, Phil Brown, Zurich UK's life, underwriting and claims director, said that while it would be inappropriate to comment on individual cases, "of decisions made on HIV positives this year, approximately 85% have been offered terms". He added: "We assess each applicant on their own merits, considering the many aspects of risk involved including treatment, response to treatment and the applicant's compliance with treatment."
 

Scottish Provident said it was happy to assess applications from HIV-positive customers on an individual basis, and is most likely to offer terms where the customer has an "undetectably low" viral load, and a consistently high white cell count, has shown good compliance with anti-viral treatment, and needs cover for 10 years or less.
 

But Chris Morgan said: "We have submitted 10 pre-sales enquiries over the past three months and it eventually told us to stop sending any because it was not in the position to offer any terms."
 

Fortis commented: "We do not automatically exclude cover for customers with any pre-existing conditions. However, we assess every case on a wide range of factors in arriving at decisions on whether terms can be offered."
 

HIV and Insurance - links to Compass, insurers and more information

Source
 

How Much to Treat HIV?

posted: 30/04/2009

The Health Protection Agency is updating the estimates of how much it costs to treat someone with HIV for the rest of their life. They have given an early estimate - HIV treatment costs between £113K and £201K over a lifetime.

The lifetime HIV treatment costs matter - health economics means the NHS needs to think about how much it costs to prevent infections, as well as the cost of treating people.

The more treatment costs and the more people there are who need it, the more it makes sense to increase HIV prevention budgets and prevent more people adding to the NHS treatment bill.

The new estimates are not much different from before. The top figure, we think is new - reflecting the fact that people are now expected to have a near normal lifespan, as long as treatment is started at the right stage (for most people this means starting treatment before the viral load falls below 350). The longer people are on treatment as people are expected to live into their 70s, the higher the lifetime cost.

The lifetime cost is likely to rise - treatment guidelines in the USA and UK are likely to recommend starting treatment earlier, probably at around a CD4 count of 500.

Source - recent HPA presentation to HIV Commissioners' Group