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
 

Tell Your MP – No Prescription Charges with HIV

posted: 22/07/2010

It's prescription charging decision time. We need your help. Now the Department of Health and other parts of government are making the spending decisions which will be part of the Autumn Spending Review. This includes deciding whether to stop charging people with conditions including HIV, MS, Parkinson’s and heart disease for the prescriptions people need to stay well.

Money may be tight but that is no excuse for continuing the gross unfairness of England's prescription charging system. Prescription charges have already been abolished for everyone, not just people with long-term conditions, in Wales and Northern Ireland; Scotland will abolish the last £3 of their charge in 2011.
 

Campaigners like you have already helped persuade MPs to support this campaign to end prescription charges for people with long-term conditions, including HIV. In May, the Government's independent review of prescription charges showed how this can be achieved. Now, before Parliament goes on its summer holiday and the Autumn Spending Review appears in October, we need a last push - please ask your MP to support the campaign.

It's easy to act

Please click here to ask your MP in England to sign a Parliamentary motion calling on the government to scrap prescription charges for people with long-term conditions this Autumn.
 

Thank you for your support.
 

More information about the prescription charges review here

Information on help you can get with prescription costs here
 

Prescription Charges Coalition There are 22 members of the Prescription Charges Coalition, including Terrence Higgins Trust who represent the HIV sector:
Androgen Insensitivity Syndrome Support Group, Arthritis Care, Association for Spina Bifida and Hydrocephalus, Asthma UK, Behcets Syndrome Society, British Heart Foundation, Diabetes UK, Disability Alliance, FibroAction, Klinefelter’s Syndrome Association, Mind, Motor Neurone Disease Association, MS Society, National Ankylosing Spondylitis Society, National Association for Colitis and Crohn’s Disease, National Rheumatoid Arthritis Society, Parkinson’s UK, Pernicious Anaemia Society, Rethink, The Stroke Association, Skin Care Campaign, Terrence Higgins Trust
 

HIV Treatment Charging Harms

posted: 28/06/2010

The UK rules that mean some migrants have to pay for HIV treatment are harming the health of migrants and the UK public, says a new study in the journal AIDS Care.

The study of African migrants with HIV in London found some migrants delay taking HIV tests, some only go for HIV treatment when they are so sick they need an ambulance to take them to hospital, some use herbal treatments that don't work, and others send abroad for HIV drugs but don't take enough of these.
 

Findings and the government review

This Wednesday the government ends its public consultation on changing the rules and guidance about who has a right to free NHS treatment. Anyone who has a sexually transmitted infection (STI) or an Infections Disease always has a right to free treatment, but not if they have HIV. The proposed new rules and guidelines still bar some migrants from automatic free HIV treatment. While asylum seekers and those with leave to remain are entitled to free care in NHS hospitals, refused asylum seekers and undocumented migrants, including pregnant women with HIV, among others, are sometimes handed very large bills for HIV and other medical treatment.
 

The researchers interviewed HIV-positive migrants from Zimbabwe, Zambia and South Africa who live in London. 70 people took part in eleven focus group discussions.
 

Problems getting a GP
Even though there is no law stopping migrants from having a GP or free primary care, people said they had problems even registering with a GP. They are often asked to show documents that they do not have (for example, their passport – these are often held by the Home Office / UK Borders Agency because they are making an asylum claim or other application).
 

Waiting until you need an ambulance
The law says all treatment in a hospital Accident & Emergency department is free-of-charge for everyone. Many people in the survey knew this, and said they did not try to get treatment until their condition was so serious that an ambulance was needed. One man said:
“You would rather wait for a situation where you get taken to hospital by ambulance because even if you walk in they want to know who is your GP. And if you don’t have one they become very suspicious.”
Accident & Emergency (A&E) treatment is extremely expensive to provide. Moreover, in most cases, the person then needed immediate HIV treatment and a lengthy stay in hospital.

The rules say if you are admitted to a hospital ward after A&E, or are referred to another department (eg the HIV clinic) then you will be charged; but HIV treatment should always be provided because it is 'immediately necessary.' If you can't pay the bills, the hospital will have to cancel the debt anyway.

Some people had received bills for several thousand pounds for hospital admissions, surgery and treatment. The researchers found that these experiences often affected people’s feelings toward health providers.
 

In hospital but fearing bills and immigration
People who were entitled to free NHS care feared intrusive visits from immigration and hospital officials. For example one woman who had been recently diagnosed with HIV received a bill for hospital treatment:
“I was worried how am I going to pay this £4000? So what kills you first is the stress and worry . . . I found myself thinking if I did not have indefinite leave to remain in this country then what would I do?... You’d just try to go away, you’d remove the drip and run away from there before immigration got there.”
 

Do it Yourself treatment
Some people said they treated themselves. Some sent for drugs in their home countries, but said they took too few pills for them to work properly, for example. Some had depended on herbal remedies and other alternative treatments, and sometimes delayed taking a HIV test until it was clear herbal and alternative treatments were not working. One woman said:
"There are some people who do not have papers in this country, who can’t have access to a GP or a hospital and they have to rely a lot on the traditional medicines."
Although HIV testing is free for all (on public health grounds), HIV treatment is not. People said this discouraged others from HIV tests:
“If I cannot access services, then there is no reason for me to test. If I test and I know I’m HIV-positive, I know it will be very difficult to access [treatment].”

The researchers end by saying that current policies for charging some migrants may appease a part of the UK electorate but act as a barrier to the uptake of HIV testing and treatment. Moreover, these policies are pushing some people to resort to other forms of treatment that may be costly, harmful or ineffective. As well as having implications for the health of individuals, the policies are likely to have an impact on the onward transmission of HIV.
 

Campaigning for free HIV treatment for all
This Wednesday the Department of Health closes its public consultation on planned changes to the rules and guidance for free NHS treatment. This does not include adding HIV to the list of sexually transmitted infections and infectious diseases that would mean free treatment for everyone. George House Trust and the HIV sector are campaigning for free HIV treatment for all.

Source and reference 
Thomas F et al. ‘‘If I cannot access services, then there is no reason for me to test’’: the impacts of health service charges on HIV testing and treatment amongst migrants in England. AIDS Care 22: 526-531, 2010.

HIV Treatment Rights Review

posted: 23/06/2010

Wednesday 30 June is the last chance to tell the Department of Health whether its plan to update the law and official guidance on who is entitled to free NHS hospital treatment is right. At present some migrants with HIV are charged for HIV treatment, although every other sexually transmitted infection (STI) and infectious disease is always treated for free, for everyone. The rules affect lots of other people in other ways but our focus is on access for all people in this country to free HIV treatment.

Free treatment for STIs like HIV, and infectious diseases makes financial and disease management sense. It saves money and stops diseases spreading when states provide free treatment for these for public health reasons. Untreated conditions spread diseases and increase the total bill.

New Regulations - useful changes
The new regulations propose some useful changes:

• Refused asylum seekers getting Section 4 or Section 95 support will be exempt from charges
• Primary care services are explicitly excluded from charging
• Unaccompanied migrant children will be exempt from charges
• People with an Article 3 claim will be included alongside people seeking asylum or humanitarian protection, and so will be exempt from charges

New Guidance - some good bits

The new official Guidance is also better:

• Maternity treatment is now defined as 'immediately necessary' treatment. This means there will always be a right to treatment and it must be provided. But a bill could follow.
• The Guidance does not yet say, but we are hopeful that HIV will also be defined as ‘Immediately necessary treatment’ because that is what the British HIV Association has formally told the Department of Health.
• Overseas Visitors Managers and clinicians are instructed to tell patients that all ‘immediately necessary’ treatment will not be withheld, regardless of their ability to pay.

Want to help?

The major problem with the rules is that there is still no automatic right to free HIV treatment. The Department of Health says it is reviewing this rule. We think this shouldn't wait a moment longer and HIV community organisations are making the case now for free HIV treatment for all.

The review of the rules and guidance was started before the election. Now there has been a change of government, an emergency budget, cuts and more cuts to come in the autumn Spending Review, so it is important to support the positive changes they have made. We want to push the Department of Health to take the sensible next step of adding HIV treatment to the list of Sexually Transmitted Infections and Infectious Diseases which are all treated for free, whoever you may be. And we want to discourage the Government from making some unhelpful changes that it plans.
 

NAT (National AIDS Trust) response

NAT have prepared a fairly simple response for some HIV organisations. This deals with the key points. You could use this - just add your name and details in the first pages and send it to them by email. You can of course say whatever you wish and make your own points.
 

If you want to comment in more detail you could look for more in the Model Response you can find on a blog set up by Medact and other community organisations that are campaigning together.
 

Here are all the Department of Health papers for the consultation. 

George House Trust draft response

Here you can read the draft response of George House Trust.
Please note that this is not our final or official view but we are sharing this to help others, before the official deadline. We welcome any comments and suggestions.

We have considerable experience with HIV treatment charging and this draft is built on our experience, expertise, and we are especially grateful to NAT and the blog for their detailed work on this. 

This George House Trust draft is more detailed than the NAT response above and it includes some significant additions. 

Two of these George House Trust extras are 

• much better Guidance is needed on who fits the definition of 'ordinarily resident'. The details are for legal experts BUT this is really important. The poor Guidance on who is 'ordinarily resident' has caused most of the problems with charges for HIV treatment in NW England. We have won almost every case we have argued on this point. We have been able to argue that most migrants with HIV who are charged are in fact 'ordinarily resident' in this country and so should never have been charged. If you can show you are 'ordinarily resident' none of the charging rules apply.
• There is no system for independent reviews or appeals - like there is if your claim for a state benefit is refused, or your asylum claim or immigration appeal is refused. In the 21st century, basic rights like hospital care deserve a system of independent reviews and appeals considered by an independent Tribunal chaired by a judge, so people can obtain justice and justice is seen to be done.

Prescription Charges Review

posted: 01/06/2010

The long-awaited review of prescription charges by Professor Ian Gilmore has appeared. Over a year ago, Gordon Brown promised at the Labour Party Conference to end prescription charges for people with long term conditions. People with cancer were exempted from charges but people with other long-term conditions, like HIV, are still waiting.

The report recommends that people with long-term conditions should have free prescriptions. It sets out a plan for how the government should change the unfair prescriptions system to make sure people get the medications they need to stay well.

You can read the full report.

Depends on autumn spending review
The coalition government has welcomed the review, but says it will only consider this in the autumn, as part of the Spending Review. Many MPs already support this campaign.

HIV and prescriptions

Since the start of 2009 Greater Manchester HIV clinics (among most other HIV clinics) have stopped prescribing any drugs except those for HIV and their treatment side effects. People must now turn to a GP for prescriptions for all other healthcare needs, such as depression and anxiety, and sexual dysfunction.
 

Some help already available

For some people with HIV this means paying for these prescriptions - some people are exempt, some are exempt because of low income, and some people can buy a discount card. Find out what help is available with English prescription charges here.

There are 22 members of the Prescription Charges Coalition, including Terrence Higgins Trust:

Androgen Insensitivity Syndrome Support Group, Arthritis Care, Association for Spina Bifida and Hydrocephalus, Asthma UK, Behcets Syndrome Society, British Heart Foundation, Diabetes UK, Disability Alliance, FibroAction, Klinefelter’s Syndrome Association, Mind, Motor Neurone Disease Association, MS Society, National Ankylosing Spondylitis Society, National Association for Colitis and Crohn’s Disease, National Rheumatoid Arthritis Society, Parkinson’s UK, Pernicious Anaemia Society, Rethink, The Stroke Association, Skin Care Campaign, Terrence Higgins Trust