Free Treatment for All Works

posted: 13/01/2011

A French government enquiry shows that free healthcare for all migrants, even those without official papers, works well. By contrast, in England, some migrants with HIV have no right to free HIV treatment and can be charged thousands of pounds.

The Department of Health in London has repeatedly claimed (without evidence) that migrants with HIV abuse the NHS. Treatment of HIV is the only sexually transmitted infection in England which anyone has to pay for.
 

In France, right-wing politicians make similar claims to our own Department of Health, that fraud and abuse infects their system of free healthcare for undocumented migrants.

This French enquiry disproved this and says that adding any new restrictions (like charges) will be harmful. Restrictions would discourage people from testing and treatment at the best time, resulting in worsened health for individuals and the spread of infectious diseases.
 

The English Department of Health could learn useful lessons from this French enquiry.
 

HIV organisations condemn ‘scandalous concealment’
HIV non-governmental organisations AIDES, ARCAT, ActUp Paris, Sida Info Service and Solidarité Sida, are among those condemning the "scandalous concealment" of the French enquiry report from trhe French National Assembly and call for the new charge of €30 to be suspended.
 

The French model
France has an unusual system, with easy rules. The person simply has to show that

• he or she is living in France
• has lived in the country for at least three months, and
• is poor (monthly income below €634, about £530).
   

Then the person (and his or her family members) gets a wide range of free healthcare for one year, after which time he or she must re-apply.

While the French right wing has attacked this system for years, HIV and health non-governmental organisations point out that healthcare is a fundamental and universal right, that the people forced by circumstances to use this system are among the poorest and most socially excluded. They argue that any restrictions undermine HIV testing, boost late diagnosis, worsening individual’s health and the public health.
 

The real problem : migrants avoiding healthcare
The government asked two official bodies (of auditors and of social care inspectors) to see how well the system works. The French government seems to have disliked the message from the enquiry, and suppressed the reports until New Year’s Eve, after the National Assembly had already debated reforms and added a new charge.
 

The auditors found almost no evidence of fraud or abuse. They said that the real problem is that many migrant people avoid healthcare to save money. Most of the people with a right to free healthcare have not joined the scheme. Most only apply when their health gets very poor and when they need urgent treatment.
 

Reforms and charges
The auditors looked into possible reforms to the French system, including making an annual charge of €30. They found this charge would only raise €6 million, about 1% of the annual cost of €500 million, but would deter even more people from seeking healthcare, be costly to administer, and increase total health costs even more (people will put off getting simple early treatment and then need expensive hospital care later). The charge would worsen public health - tuberculosis and other infectious diseases are common among people entitled to the help; these infections will spread.
 

The social inspectors report decided charges are a mistake for the people, administratively complex, and risk harming public health.

Hiding this report meant the National Assembly was kept in the dark and voted for the charges, which will begin in April. HIV protests continue.
 

UK healthcare and migrants rights information
Information about access to healthcare for migrants in the UK is in NAM’s Social and Legal Issues for People with HIV.

Source, with reference

Help Give Stigma the Index Finger

posted: 10/11/2010

People living with HIV can help give HIV stigma the index finger on World AIDS Day, at a George House Trust event for people with HIV from the whole of North West England. The UK part of the HIV Stigma Index already has details on hundreds of people's stigma experiences.

Time for thinking and action

Now it is time to share the findings and look at what we can do as individuals and together to tackle HIV-related stigma.
 

The People Living With HIV STIGMA Index is an international effort of people living with HIV recording and campaigning against HIV stigma and prejudice.
 

Where, When

Wednesday 1 December

10.30am – 2pm
 

George House Trust, 77 Ardwick Green North, Manchester, M12 6FX
 

Lunch, Travel, Crèche

• Lunch included
• We will pay reasonable travel costs to people on a low income
• Crèche spaces at this event are limited and must be booked.

To find out more about this event or to book a crèche space please e-mail Lynda Shentall Director of Services, or ring her on 0161 274 4499.

Give Stigma the Index Finger UK report

HIV Prejudice Evidence

posted: 13/09/2010

More detailed information about HIV stigma, prejudice and discrimination against people living with HIV in the UK is now becoming available. 857 people with HIV took part in the UK part of an international survey the The People Living with HIV Stigma Index.

The first UK results were reported in Give Stigma the Index Finger.
All the HIV prejudice, stigma and discrimination evidence is grouped into main themes 

• health settings
• exclusion
• disclosure decisions
• diagnosis experiences
• disclosure experiences
• self-stigma
• rights and laws
• effecting change.

Now the UK workers on the Index want to help people understand and use the wealth of detail that was collected about HIV prejudice and discrimination. All the data (anonymised of course) is in a computer database and they have done some more detailed analysis, and produced a computer tool to crunch the numbers, find relevant comments and produce fully detailed evidence. The idea is to use these to inform and train organisations to help end HIV prejudice and discrimination.

There’s now a presentation report called questionnaire, pointers and qualitative exploration that explains this. ‘Pointers’ is the name of their tool for detailed computer analysis. Starting on page 29 there are four presentations, to illustrate how people can make use of all the data in the UK index.

The index covers discrimination in

• family planning and pregnancy
• housing and UK residency
• employment
• family and friends
• mental health
• dental health
• faith and religions
• doctors in general practice.

Questionnaires, Pointers and Qualitative Exploration presentation with examples

Rolling Back HIV Prosecutions

posted: 03/08/2010

While over 600 people have now been convicted worldwide of transmitting or exposing others to HIV, and some countries are making new laws for prosecuting HIV, there is some good news.

Ghana, Mauritius and other countries have rejected a ‘model law’ that proposed prosecuting HIV transmission; in the Netherlands a new policy makes prosecutions for unintentional transmission unlikely; and Sierra Leone has ended its policy of prosecuting mother to child transmission. In England and Wales, work with police, prosecutors and expert virologists have helped make successful prosecutions a rarity.
 

UNAIDS Priority
Susan Timberlake of UNAIDS stated at a International AIDS Conference session that it was now a “corporate priority” of UNAIDS to “remove punitive laws, policies, practices, stigma and discrimination that block effective responses to HIV”.
She said that it was essential that advocacy does not just consider laws, but also must dealwith law enforcement and access to justice.
 

Working with legislative bodies to remove laws is an extremely complex and time-consuming process that requires political know-how and can backfire.
 

Harm Reduction - Working with Police and Prosecutors

Timberlake suggested law enforcement approaches (engaging with the police, prosecutors and judges who make decisions on taking cases forward or not) can be more productive than risking law repeal which could backfire and make the situation worse. She said that any countries that do not yet have prosecutorial guidelines should make these high priority.

In England and Wales, because helpful law reform is unlikely, a lot of effort has been put into reducing the harm of prosecutions – and as a result of HIV prosecution and investigation guidelines few cases get to court, and convictions are now rare.
 

An English court accepted expert scientific evidence that showed the limits of phylogenetic analysis (the scientific evidence comparing the viral strains of the complainant and the accused). At first prosecutors presented phylogenetic analysis as providing definitive proof that the accused must be guilty. However expert evidence showed that two viral strains can seem closely related without there being any certainty about who had infected who. It is now a key part of police investigation guidelines and prosecution policy to use phylogenetic analysis. This evidence seriously weakens most prosecution cases and convictions are now rare.
 

Knowledge, Representation and Stigma

More still needs to be done to improve people with HIV’s knowledge of laws and their rights (‘legal literacy’) and access to legal support and services. This needs to be linked with broader efforts to reduce HIV stigma and discrimination.
 

New Book on HIV and Criminal Law

This International Conference meeting also saw the publication of HIV and the Criminal Law, a new guide to the use of the criminal law in prosecutions related to HIV transmission, written by Edwin Bernard and published free online by NAM.

Videos

The video of the meeting is now online at aidsmap
The video of Edwin's presentation and press conference

Sources
Criminalising Transmission

Tactics to Stem Tide of Prosecutions

HIV Microbicide Success

posted: 20/07/2010

A vaginal microbicide gel containing the anti-HIV drug tenofovir (Viread) reduces the risk to women of HIV infection by 39%, results of a study show. This is the most hopeful news in the years long search for something that women can use to protect themselves from HIV risk. There was a recent flurry of hope about another microbicide which showed some signs of working but further study showed it wasn't good enough.

Women who used this new gel more reliably, during four out of the last five times they had had sex saw their risk of HIV infection reduced by 54%. The microbicide also had another useful sexual health benefit, halving the risk of infection with genital herpes.
 

Other reports about this microbicide explain that women must apply the gel 12 hours before sex and once again as soon afterwards as possible.

There is more work to be done before this microbicide can supplied publicly, but this was a top-notch scientific study, a randomised, placebo-controlled trial – called CAPRISA 004 – in South Africa. 889 HIV-negative women were randomly divided into two groups, one was given the tenofovir-containing gel and the other group was also given gel that looked exactly like the first but without any tenofovir in it. No-one (neither women nor the clinic staff) knew who was getting what. Both groups of women got advice about safer sex and free condoms. The women were monitored for two and a half years.
 

Results from the study will be officially presented to the AIDS 2010 conference in Vienna today, but they have already generated a lot of excitement.
“This is an important day,” said Yasmin Halima, director of the Global Campaign for Microbicides. “We now have evidence that a vaginal gel can help prevent HIV. This is good news for women, good news for the field and a good day for science.”
 

Next Steps

To stimulate and prioritise rapid action, WHO and UNAIDS announced that they will convene an expert consultation in August with women’s health and HIV prevention advocates, scientists, microbicide research teams and product developers, and public health experts to discuss the next steps with the product.

A webcast of this session and interviews are available on the Kaiser Family Foundation website

More information from NAM/aidsmap.com

Image - Prof. Quarraisha Abdool Karim, Associate Scientific Director of CAPRISA, explains how to use an applicator with gel       from blogs.timeslive.co.za