Budget Pain Worse With HIV

posted: 24/06/2010

Low income is a major problem already for many people living with HIV. The emergency budget and service cuts will now make a bad situation even worse.

Here we try to pick out how the budget that is claimed to be ‘tough but fair’ will affect people living with HIV in NW England. We find out how tough and unfair it will be on many people living with HIV.

The Institute for Fiscal Studies analysis shows that the poorest 10% of the population (typically people on benefits and workers on the minimum wage) will face the worst financial pain of the whole population. Excluding cuts in Disability Living Allowance, Housing Benefit and funding for important public services like social care, over the next five years they worked out that the spending power of the poorest 10% of the population will fall by 2.6%.

Add in the affect of changes in disability living allowance, housing benefit cuts and cuts to public services and the poorer part of the population will suffer even more than this.

The budget will cut the incomes of the richest 10% of the population by just 0.6% compared with over 2.6% for the lowest income tenth of the population. How fair is that?
 

What we have to tell you below makes for depressing reading.

We think people with HIV have a right to know how the planned changes over the next five years could affect them.

These changes are not all cast in stone. They have to go through Parliament and you can tell your MP what you think.
 

Disability Living Allowance
Many people with HIV receive Disability Living Allowance (DLA), a benefit paid at different rates to compensate for disability and mobility problems. The budget announced that people on DLA will have a strict new medical examination; these medical examinations will start in 2013. Some people will lose DLA, others will go onto a lower rate. The government aims to cut spending by £1.4 billion within two years of these medicals starting.

We do not know yet if people who have DLA ‘for life’ will have these medicals.
 

Housing Benefit
Housing Benefit / Housing Allowance will be cut after one year by 10% for people claiming Job Seekers Allowance. The amount of Housing Benefit will also be capped, depending on how many bedrooms you have.This and other changes will be cuts costing people on the benefit £1.8 billion a year.

People will either have to pay the extra for their rent from their other income, move somewhere cheaper or smaller, and if evicted for rent arrears are likely to be refused rehousing as a homeless person. Eviction for rent arrears is treated as making yourself intentionally homeless so people are not entitled to be rehoused.
 

Unemployment
There are around 2.5 million people unemployed and about 0.5 million job vacancies. Unemployment is higher in NW England than most other regions. The job vacancies are often low paid.

The budget alone will increase unemployment by another 100,000 and independent experts expect it to reach close to 3 million.

Job seeking prospects will worsen and it is already harder to find work with a condition like HIV.
 

Slow-burn cuts and taxes
Over the next five years people on benefits will slip further behind in what their benefits will be able to buy and with tax changes.

VAT rises at the beginning of January to 20% and VAT always hits people on low incomes hardest.

Most benefits will be uprated for inflation in a new way that will leave people increasingly worse off. This will cut £6 billion from benefits over the next five years.

Child Benefit is frozen for three years from next April – a £3billion cut. Parents who are working will be compensated by Tax Credits, but that doesn’t help parents who aren’t working.
 

Social Services
Local Government and other public services are most used by people who are on lower incomes. Social Services departments of local councils now face cuts of between 25-33%. Social Services provide essential services to people with HIV and they help fund HIV community services like George House Trust.

The AIDS Support Grant which is used to pay for extra support for people with HIV and community HIV services is no longer protected by a ‘ring-fence’. This means councils can now spend it on whatever they like.

We don’t know yet how cuts of between one quarter and one third will affect essential social services for people with HIV and community organisations but we should start to know more from October. We can expect some painful cuts and changes.
 

NHS cuts
The NHS in NW England has been told to save almost £1 billion within the next three years. We do not know whether this will affect people with HIV.
 

State Pension Age to rise sooner
Details are sparse but the government is planning to raise the age at which men and women will get a state pension sooner than was planned. Men who are now 59 will have to work one more year before they can claim a state pension. Pension age will be 66, not 65 as now, for men from 2016. It does not stop there.

They are consulting about raising the pesnion age to possibly 70. Pension ages for women and men could be raised by one year every five years until it reaches 70 for both sexes. If they start this in 2016 as they say they now plan to, men now aged 40 would not get a state pension until they reach 70. Three out of four people will have some disability by the age of 68. Many people with HIV (among many others) are not fit enough to work until the current pension age of 65, particularly in a region like NW England.

Benefit cuts and changes will make it harder for people with disabilities like HIV to live with a decent fair income before pension age.
 

Expect more pain
In October the government will publish its Public Expenditure Review. We can expect lots more cuts in government spending. The government is already saying that it will try to reduce cuts in education and some other public services (but it has not said that it wants to protect social services) by making even more cuts and changes to benefits.
 

Since the second world war, no government has managed to cut public spending for more than two years in a row. This government plans five years of cuts.
 

Some reputable economic commentators, and President Obama, are warning that European countries are behaving like a panicking herd, cutting spending harshly and that this has a high risk of plunging the world into recession once again. The harsh medicine of cuts could kill economic recovery and make the situation even worse.
 

Heath Inequality
The Marmot Review earlier this year was to help the government plan policies that will end harsh health inequalities. It showed that the poor die 7 years younger than the rich, and the poor become disabled 17 years sooner. Cuts to services and benefits in NW England will worsen the already bad record of ill-health, disabilities and early deaths in this region. More unemployment and low income harms people’s health and well-being.

Reductions in benefits, and those 25%+ public service cuts expected in the Autumn Spending Review are estimated to increase alcohol related deaths by about 2.8% and cardiovascular deaths by 1.2%. Both of these disproportionately affect people living with HIV. Every £80 cut in social welfare spending per person causes this, according to a Europe-wide analysis by Oxford University epidemiologist David Stuckler, reported in the Guardian on 25 June and in the British Medical Journal. There are likely to be between 6,500  and 38,000 more deaths in the next ten years. If the economy worsens, extra deaths rise steeply. Apart from benefits cuts, it is cuts to social services and health budgets especially that cause the most health harm. 

The Treasury is ending the public sector agreement with the NHS to raise the life expectancy of the poor. Marmot presented the government with a vision and plan to make sure everyone has a ‘healthy income’, enough money to live healthy lives and improve life expectancy.

The budget and cuts to come make it even more likely we will go backwards and poorer people and people with disabilities, like many people with HIV in NW England, will face worsening life expectancy and poorer health.

Sit back or act?
These changes are not all cast in stone. They have to be passed by Parliament and you can tell your MP what you think. With your postcode you can contact your own MP here.

Help for people on Low Incomes on our website

AIDS Support Grant Ending?

posted: 04/05/2010

AIDS Support Grant seems to be on its last legs - the Communities and Local Government "Smarter Government" plan shows that AIDS Support Grant (ASG) will no longer be ring fenced from April next year - 2011. Instead this money would be included in the central government area based grant to councils for providing Social Services. A copy of the Smarter Government paper is attached and ASG appears on page six.

After the general election we, NAT and other HIV organisations, will consider what we can do to keep ASG with its ring-fence.

As councils and HIV community organisations revealed in NAT's recent survey, there are serious concerns for HIV services, if the ring-fence is lifted, at a time when there are major public spending cuts on the horizon.

NAT carried out a detailed review of ASG in 2009 
 

Smarter Government proposal to abolish ASG - see page 6

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Training for Councils - No Recourse to Public Funds

posted: 21/12/2009

A full day's training for councils on their legal duties to support people and families with ‘no recourse to public funds’ (NRPF) is provided by the NRPF Network along with London’s Islington Council. A significant number of migrants with HIV in NW England are subject to the No Recourse to Public Funds rules. Some NW England councils apply the rules very harshly or refuse to even accept they have any legal duty to assess people or help. Other councils do their duty well.

The training

• focuses on good practice in assessing and supporting people with NRPF
• provides an overview of relevant legislation and case-law and
• invites participants to explore other factors to be considered where immigration status impacts on entitlements to services in the UK.

Since April 2009, there have been 17 of these sessions for councils and voluntary sector organisations across the UK and the feedback is very positive.

The full details of the training days are on the NRPF microsite and any requests or enquiries can be made by email

In NW England councils vary widely in how well they perform meet their legal duties towards people with HIV under these rules.  
 

HIV Harassment Investigation

posted: 08/12/2009

Public bodies in England, Scotland and Wales face an inquiry into how they deal with disability-related harassment by the Commission for Equality and Human Rights, the watchdog announced.
 

The commission promises that bodies that do not adequately uphold the rights of people with disabilities, including everyone living with HIV, could face legal action.

Public bodies have a legal duty to take steps to eliminate disability-related harassment – part of their disability equality duties.
 

The inquiry, which will publish its final report in early 2011, follows the inquest into the deaths of Fiona Pilkington and her disabled daughter Francesca. Their deaths followed years of harassment and exposed weak public responses to tackling this.
 

EHRC commissioner Mike Smith said: "Disabled people experiencing harassment can become conditioned to hostile treatment, or are sometimes told to ignore it by those around them - including by public authorities. They may also go to enormous lengths to avoid putting themselves at risk which can limit their freedom and opportunities. These are unacceptable outcomes for anyone in our society."
 

Evidence exists
The commission said it already had evidence that harassment of disabled people was widespread throughout Britain and that people with learning disabilities and mental health problems were at a particularly high risk. People living with HIV similarly may experience significant harassment and violence because of stigma.
 

What are Councils and Health Bodies actually doing?
The Inquiry will look at what public bodies are doing to end disability-related harassment and to deal with its causes, including prejudice and negative attitudes; and how public authorities have involved people with disabilities in eliminating harassment and its causes – for example by effective joined-up reporting procedures.
 

Ruth Scott, director of policy and campaigns at disability Scope, said: "We would like to see the inquiry focus on how public authorities are raising awareness of disability related harassment among disabled people, to increase their confidence in reporting such cases, and supporting and training frontline staff across public authorities to ensure they respond appropriately and promptly."
A document outlining the terms of reference will be published shortly for consultation and the terms will be finalised early next year. The whole review will be completed within the year.
 

Have you evidence?

The Inquiry will collect evidence from people with HIV and other disabilities and from people affected by disability-related harassment (such as HIV negative partners and family) and from public authorities on what they are doing to tackle the issue.
 

George House Trust will work with other HIV bodies to collect and submit evidence of HIV harassment. Few cases are ever reported, mainly because of HIV stigma and the belief that complaining won’t change things for the better. This investigation, linked to the use (or not) of public powers to deal with HIV stigma, is the best opportunity to make councils, police and health bodies take real action to cut HIV harassment in society.

If people have information on HIV harassment in NW England please contact HIV Policy worker Chris at George House Trust.
 

The investigation follows the recent publication of the UK HIV Stigma Index - information in our recent report and also here. 
 

Good practice too
The Inquiry may also aim to identify examples of good practice in eliminating disability related harassment and addressing its causes.
 

The Commission will consider how public authorities have complied with their obligations in relation to the Disability Equality Duty set out in the Disability Discrimination Act 1995, the Human Rights Act, and the UN Convention on the Rights of Persons with Disabilities.
 

Useful Information and Guidance

Public Bodies Duties Guidance 
ECHR report – Promoting the safety and security of disabled people 

Sources          The ECHR press release              Community Care 
 

Hospital Detention for HIV

posted: 07/09/2009

How many people now remember that 24 years ago a Manchester gay man with HIV was locked up for 10 days in the  hospital by order of the city's Magistrates, just because he had AIDS?

It has never happened since in this country, but HIV lock-ups often happen in Sweden, and might even happen once again in this country, if Parliament allows the Department of Health and the Health Protection Agency to get their way.

The government is consulting on changing the infectious diseases regulations which could allow it to force people into hospital isolation wards and more, if they have infectious diseases. The deadline for comments on the proposed rules is at the end of this month.

We are campaigning to make sure people living with HIV cannot be touched by any updated public health law and regulations.

What happened almost 25 years ago in Manchester?
There is a very brief mention in our history page for 1985,  but it was an event that rocketed Manchester and HIV onto the front page of the papers locally and nationally. Manchester AIDS-line, which became George House Trust, was closely involved and (now Councillor) Paul Fairweather, a gay rights worker at the former Gay Centre in Bloom Street, was in the thick of the campaigning. There were pickets outside the Town Hall and the old Monsall Isolation Hospital, and a national demonstration was held here. We’ve never forgotten it, and at Secrets and Lives, Cllr Paul Fairweather reminded our audience about it.

Old files and papers

We've dusted off old files and the papers to find out exactly what happened and tell the story again here. We’ll be reminding the government that they didn’t get away with discriminating against people with HIV in 1985, and shouldn’t even be thinking of making laws and regulations that would allow this again today.

What was it like in 1985?
It’s a bygone age in UK HIV history. For a start no-one talked about HIV - if people ever talked about the virus, they called it HTLV3. There were no tests available at clinics for it in Manchester, only in London.

There were only two people known to have AIDS in the city, and both gay men were ill in Monsall Hospital. In the whole of the UK there were only 100 people, gay men and haemophiliacs, with AIDS at the start of 1985. Now there are over 70,000 with HIV.

We knew the virus was sexually transmitted but not how exactly - so oral sex was thought to be high risk, as well as anal and vaginal sex. The connection between the virus and AIDS wasn’t properly understood. Gay men were struggling to get to grips with the idea of using condoms.

Hysteria and Panic

It was at the height of AIDS hysteria, but the first public campaign - the tombstone and leaflet campaign warning Don’t Die of AIDS - didn’t start until the following year, 1986.

In the UK press, AIDS was in the headlines and caused alarm. In most newspapers such as the Sun and Manchester Evening News, and on radio stations (Piccadilly Radio - now Key 103 and Magic), the prejudice was obvious.

Haemophiliacs were "innocent victims," whereas gay men and injecting drug-users brought it upon themselves. Firemen banned the kiss of life, and holiday makers cut short cruises on the QE2 for fear of getting AIDS from a passenger. A 9-year old haemophiliac was allowed to go to school, but some parents kept kids away. Actor Rock Hudson died of AIDS in the first days of October. He was the first major public figure known to die of AIDS. Almost as much of a shock to most people was to discover such a butch film star was gay.

Swirling in a cesspit of our own making - Manchester Chief Constable

And the Chief Constable of Greater Manchester Police, James Anderton, preached that gay men were "swirling about in a human cesspit of their own making". Gay papers, like Capital Gay and Mancunian Gay, provided the most accurate news and information.
 

Can I go home please, just for the weekend?

One of the two men in Monsall Hospital decided in the middle of September 1985 that he wanted a weekend break from hospital, to go to his home in South Manchester, where he would be looked after by his friends and family, and then he’d go back in the hospital. He asked his doctor if he could do this one Saturday morning. The doctor refused. In fact the doctor couldn’t stop him leaving the hospital and knew this, but didn’t tell the man.

Whirlwind of events that Saturday

A whirlwind of events followed that Saturday. We don’t know why, but the doctor panicked. He called the Council’s medical officer and asked her to stop him leaving the hospital. She called the Chair of the Environmental Services Committee, who authorised the making of an emergency application to the Magistrates Court.

The City Solicitor was called in and a special sitting of the Magistrates was held. The Magistrates, in open court, granted an Order for 3 weeks detention in the hospital, named him and said it was to protect the public from AIDS.

The hostile local press and independent radio were tipped off and his name and the details were broadcast and published - including in the national press.

The man has no idea any of this is going on behind his back, until he was presented with the Court Order.

10 days detained by Court Order

He spent the next 10 days in compulsory detention at hospital before he and his friends could get a solicitor and the Crown Court could review the decision. No doubt the stress added to his health problems.

Outrage and Uproar

Meanwhile absolute uproar broke out in the city’s gay community. The Council had already promised to do what it could to dampen down AIDS hysteria. But here was the council using the courts in a way which just poured petrol on the flames of that hysteria. The Public Health (infectious Diseases) Act had been rushed through Parliament only in the summer of the year before (1984) and in February of 1985, AIDS was quickly added to the official list of infectious diseases. Now the Council was using that panic list and law to detain a gay man who posed no health threat to anyone.

There were demonstrations and pickets outside the hospital and Town Hall.

Crown Court frees man

The Crown Court decided to approve the application by the man's solicitor for the order to be withdrawn 'by consent.' The man was spared the rest of the 11 days of forcible detention.

Withdrawal ‘by consent’ means the Council didn't attempt to defend its application, and it could not have produced a shred of evidence to justify the man's continued detention, because legally it was indefensible - he was no health risk to anyone.

A city behaving badly - but then it promises: never again
The city’s gay men’s consultative committee demanded the city council promise never to use the law again, and to campaign for its repeal. The vote was tight, but it agreed not to use the law again.

All involved - hospital doctor, city health officer, chair of social services, city solicitor, magistrates clerk, magistrates, the radio and press, all behaved badly. They had no legal power to act as they did in the circumstances and all were swept up in the panic and power-rush of taking emergency action. Nobody stopped to think and ask questions. No-one told the man in Monsall. He had no solicitor to say the law doesn’t allow you to do this to me.

Why are we concerned now?
In Sweden a man with HIV was ordered to be detained and isolated under their public health laws for an incredible seven years. Detention and isolation happens to quite a number of people with HIV in Sweden. Fortunately the European Court of Human Rights said in 2005 that this is illegal and breaches people's human rights under Article 5.

They ruled that detention for HIV always has to be a last resort, after everything else has been tried and has failed to prevent the person from passing it on. We don't think that judgement goes far enough - after all the criminal law can be used against reckless sexual transmission of HIV and that's more than enough protection for public health. But at least the European Court has drawn a useful line in the sand to protect people with HIV from unreasonable detention on health grounds.

There are some infectious diseases that are passed on easily by day to day contact. If they are serious - for example multiple drug-resistant TB - then there is a case for using the law to prevent its spread and protect the public, but only if the person doesn’t agree to temporary isolation for treatment, until they are no longer a risk to others.

Why are Sexually Transmitted Infections even on the list of infectious diseases?

Sexually Transmitted Infections (STIs) are not public health hazards like drug-resistant TB. HIV and other sexually transmitted infections aren’t passed on by touching, sneezing and the like. People need to have sex with the person and even then the risk of HIV transmission is pretty low. We think there is no case at all for any STI to be included in public health powers in the 21st century in the UK.

HIV - we take action and we fight back

The government seems not to have learnt anything from Manchester's shameful behaviour in 1985 - you mess with people with HIV at your peril. We won’t stand for it again. We take action and we fight back. And we hope Manchester City Council will now do as it was asked 24 years ago and campaign to remove any possibility of this happening again under public health laws and regulations. 

Here’s a full transcript of the 1985 reports in Mancunian Gay - written by the campaigners in the thick of the action. You can see this for yourself, along with other papers in the local history collection, in Manchester central library, St Peter’s Square.

The European Court of Human Rights judgment Enhorn v Sweden 2005

A useful article on the Enhorn v Sweden and its application to UK Public Health law and the detention of people living with HIV 

[Medical Law Review 2006 14(1):132-143; doi:10.1093/medlaw/fwi038
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