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

French, Swahili, Shona, Luganda, Portuguese Speakers

posted: 08/06/2010

The Black Health Agency in Manchester wants helpline advisers for the national African AIDS Helpline that it provides.You must speak English and one (or more) of these languages fluently.
 

The work is part time and a minimum of 4 hours and a maximum of 8 hours per week (Thursdays) and the pay is £8.25 per hour. The work will be irregular – you would only be asked to work when regular staff are absent because of holiday, sickness, at meetings or in training.  The law says you must have permission to work in the UK.
 

You would provide a comprehensive range of over the telephone advice and information on Sexual Health, HIV and AIDS, as well information about specialist HIV testing, treatment and support services available to Africans all over England.
 

Support Africans with HIV
You will provide emotional support to people living with HIV as well as advice and information to people affected by HIV/AIDS (e.g. family members, partners and carers of those living with HIV).
You must be able to deal with these calls sensitively, in a non-judgemental way and appropriately. You must have an understanding and knowledge of HIV/AIDS and related issues facing African people with HIV/AIDS.
 

More Information

For an informal chat, or more information, please call Gertrude Wafula on 0161 232 5393.
For an application pack, please contact Melanie Lathrope on 0845 450 4247 or email her  
Closing date for applications is Friday 18th June 2010.
 

African AIDS Helpline

French Gay Men – Half Diagnosed Recently Infected?

posted: 21/12/2009

Over the last five years, half of the gay men diagnosed with HIV in France were infected in the six months before their diagnosis, researchers report in Eurosurveillance. In the UK, a study in Brighton gave a similar result in 2007, but more recent work suggests the true UK figure is much lower – about 1 in 5 gay men diagnosed were recently infected.

The French study suggests that the rate of new infections among gay men in France is very high. However it could also be due to high rates of testing among some gay men.

After many years in which only AIDS diagnoses had to be reported in France, recently there have been big improvements in the French public health HIV reporting system. Since 2003, HIV diagnosis must be reported. A test to identify recent infections is also now usually performed as well.

Recent infections tests

Testing for recent infections (known as STARHS or incidence tests) looks for antibody markers that change depending on how long ago the infection happened.

There are now around 6,500 - 7,500 people newly diagnosed with HIV every year in France. [In the UK, in 2008, 7298 people were newly diagnosed, 2,760 of them gay men.] The numbers of gay men in France diagnosed with HIV has increased from below 2,000 in 2003 to around 2,500 for each of the last three years.

Epidemiologists analysed the available data on gay men diagnosed between 2003 and 2008, although quite a lot of information is missing. Recent infection results were only available for 4,819 gay men.

The average age for gay men diagnosed was 37. Doctors judged that around 1 in 5 gay men were in the primary infection stage. The test for recent infections showed that in fact 48% of men had been infected in the previous six months. This figure remained stable between 2003 and 2008.

More frequent testers
Men who had taken at least three HIV tests in their life were four times more likely to be diagnosed with recent infection than men who were diagnosed on their first HIV test. Being diagnosed in recent infection was more common both for men with French nationality and those with higher socio-economic status.

Younger men more likely to be recently infected, older men to be diagnosed late
Moreover, recent infection was more common for younger men, with 57% of those diagnosed aged 15-29 having recent infection, compared to 30% of men aged 50 and over. In line with this, whereas 11% of all gay men were diagnosed very late (with an AIDS-defining illness) this figure rose to 27% for those men aged over 50. The numbers of men diagnosed late fell during the study.

Older men were more likely to take a test because of symptoms, but younger men usually tested because of their risk-taking.

The authors note that the high number of recent infections in gay men probably reflects both testing behaviour and HIV incidence. They plan to publish a study estimating incidence rates in 2010.

Describing their data as worrying, they comment: “Prevention campaigns remain crucial, but they do not seem sufficient to contain sexual risk behaviours among MSM in France, despite the wide availability of screening, condoms and information and the fact that MSM represent a highly educated sub-population”.

In the United Kingdom, the Health Protection Agency (HPA) is also rolling out the use of recent infection tests. Whereas a 2007 study from Brighton estimated that half of new diagnoses in gay men were recent infections, the HPA’s preliminary results for 2008 suggest it is much lower - one-in-five for gay men, and one-in-ten for heterosexuals.

Source

Reference
Semaille C et al. Recently acquired HIV infection in men who have sex with men (MSM) in France, 2003-2008. Euro Surveill 48: 5-8, 2009.
 

USA - Treatment as Prevention

posted: 10/12/2009

The USA has joined the list of countries producing national statements about how effective HIV treatment can make passing on HIV during sex very unlikely. 

The USA statement uses much the same evidence as the earlier Swiss, French and German statements on HIV treatment as prevention that we have reported. However, it is a lot more cautious, urging continued consistent condom use.

"In summary, for couples in which one member is HIV-infected, treatment of the infected partner with effective ART and suppression of viral load to undetectable levels should greatly reduce the risk of transmission to the uninfected partner. However, this risk is not eliminated and it may not be maximally reduced at all times due to some of the factors discussed above. Moreover, the likelihood of transmission may be expected to increase with repeated exposures over time."

"In a model which estimated transmission risk in the setting of suppressed viral load (<50 copies/mL) without intercurrent STIs, the number of expected transmission events occurring within a population of 10,000 serodiscordant couples over 10 years was estimated to be 215 for female-to-male transmission, 425 for male-to-female transmission, and 3,524 for male-to male transmissions [31]."

"In a meta-analysis of data from 11 cohorts including 5,021 heterosexual couples observed no transmissions among persons receiving ART with a viral load of <400 copies/mL; however, analysis of the data was compatible with the possibility of one event per 70 person-years [32]. For this reason, it is important that individual couples recognize the risk, and use additional preventive methods (e.g., condoms) in order to further minimize the chance of transmission."

So they advise condoms for heterosexual couples to prevent a 1 in 70 person years possibility of transmission.

This statement and advice comes from the US Centers for Disease Control.

Effective HIV treatment where the viral load is undetectable reduces the risk of HIV transmission but some slight risk remains. The risk is higher for gay men than most heterosexual people, and sexually transmitted infections especially raise the risk of transmission.

US Centers for Disease Control statement Effect of Antiretroviral Therapy on Risk of Sexual Transmission of HIV Infection and Superinfection [read on webpage] OR download it as a pdf

French statement

German statement

Swiss statement

Mental Health and HIV Survey

posted: 13/08/2009

NAM (National AIDS Manual) are involved in a survey to help understand better the mental health support needs of people living with HIV in the UK.

If you are interested in taking part in this survey, it is online here. The survey is anonymous and confidential. It will take about 15 minutes.
 

In French too

Ce questionaire est disponible en Français.

NAM (and we) thank you for your help. Hearing about your experiences is very valuable for organisations providing support and information services.

Mental Health and HIV booklet

NAM's Mental Health and HIV booklet is here.