People’s Guide to Police HIV Investigations

posted: 11/05/2011

NAT (National AIDS Trust) have just produced a guide for people living with HIV about how the police should investigate any complaints about HIV being passed on. The Police now have their own detailed guidance for doing these investigations.

This plain English leaflet is for people with HIV and it gives the key points and answers people’s common questions. It does not deal with Scotland where the law and legal system is different, so the guide is just for England, Wales and Northern Ireland.

Prosecutions are rare

Police investigations into reckless HIV transmission are uncommon. In 2009 around 6500 people found out they had got HIV but few people complain to the police about someone infecting them recklessly, and there was only one prosecution in 2010 and none at all in 2009.

Answers to common questions

The leaflet answers these common questions:

• What should I do if someone goes to the police (or threatens to) accusing me of giving them HIV?
• How much will the police know about HIV?
• Should the police investigate if the person complaining does not have HIV?
• When will police end the investigation?
• Will the police keep my HIV status confidential?
• Can the police see my medical records?
• Should the police comment to the media?
• What if the person accused is under 18?

Expert Guidance for Police and Prosecutors

The police now have their own national guidance to follow when investigating these unusual, complex and sensitive cases. The Crown Prosecution Service also has a guide about prosecuting these cases.

HIV organisations like NAT, George House Trust and Terrence Higgins Trust have worked hard with police and prosecutors to produce these guides to reduce as far as possible problems for people with HIV who may be accused.

The police guidance makes plain that all allegations should:

• be fairly investigated
• not be begun or continued if a successful prosecution is not considered realistic
• respect the dignity and confidentiality of people with and affected by HIV.

The Association of Chief Police Officers (ACPO) has approved ‘Investigation Guidance relating to the Criminal Transmission of HIV’ for the police.
This sets the standard for police investigations. Police will find the guidance very helpful; it is available on the national police information and training website ‘POLKA.’ The public can find a public copy on the NAT website.
 

Accused? Remember:

If you are accused of reckless or intentional HIV transmission, get immediate advice from a HIV voluntary organisation with experience in HIV prosecutions, or ring THT Direct (0845 12 21 200)

• Get legal advice when the police start to investigate
• Make sure the police know about and use the ACPO Investigation Guidance
• Get advice and support from a HIV voluntary organisation with experience in dealing with HIV prosecutions.

 NAT Guide for people living with HIV on police investigations is at the bottom of this page.

Charging Migrants for HIV Treatment

posted: 04/04/2011

The government has said it will soon change the rules about charging people from abroad for most treatment at NHS hospitals in England. At the moment the rules do not affect many people in North West England with HIV but that is likely to change. New Rules will probably appear in June.

The government has also announced another, bigger review of NHS charges. This will look at anything and everything and is intended to save the NHS a lot of money.

The next step is the department of health will publish the new rules for NHS hospital and clinic charges and guidance quickly – probably before June.

They have just published their response to a public consultation so now we know something about what the new rules from June will probably say. George House Trust gave evidence and comments to this consultation.

The Department of Health's plans for the June rules are 

• They won’t change which treatments will be charged for yet – but may do so later.
• The rules will be changed to make it clear that refused asylum seekers who get Section 4 and Section 95 payments do not pay for NHS treatment
• Unaccompanied children will no longer have to pay, but children with parents here can be charged
• They will make clear in the new rules that anyone who has begun HIV treatment that is free of charge (e.g. because they have an asylum claim which has not been finally decided) will continue to receive free HIV treatment
• They will keep putting up posters about charging for treatment in hospitals and clinics, even though they know this frightens some people that need treatment away and can lead to discrimination by hospitals
• They will change the guidance that tells doctors to think about the cost of treatment, because this encourages discrimination
• They will start a new system of telling the UK Borders Agency about the people who owe the NHS money. This will mean people will be refused permission to stay longer, applications for citizenship may be refused and people will be refused a visa to return to the UK if they leave
• They will consider introducing a rule that will force visitors from overseas to have health insurance
• They will look at charging people for primary care (treatment by family doctors)

Free HIV treatment for all?
The Government still has not decided whether to make HIV treatment free for everyone who needs this on public health grounds, like for all other sexually transmitted infections. They say they are still considering this and will report “in due course”.

Next, an even tougher review
They have also announced another major review which is designed to save the NHS a lot of money. This will look at

• Changing the residence rules, including the definition of ordinary residence
• Changing some or all of all the types of treatment and types of people who do not have to pay for NHS treatment
• Making people pay for primary care (that is treatment by family doctors and dentists)
• Changing which bit of the NHS has to pay when people cannot pay
• Making the procedures for checking who should pay tougher before treatment begins
  Making the procedures for collecting charges tougher
• Using new ways to collect charges 
• Requiring migrants to have health insurance 
• They will consider anything and everything else.

They try to soften this tough new cost-saving review by saying “the NHS is, and must remain, ultimately a humanitarian organisation. In undertaking the review, we will be mindful of the NHS’s core values, in particular its obligations to provide urgent treatment to any person irrespective of their status or ability to pay, to protect the vulnerable and respect our obligations on healthcare provision under international treaties . There is no intention to consider policies that would deny access to any group, only whether an individual should be charged. It will consider the full benefits and costs of introducing new charges including risks of deterred or delayed treatment and any other societal costs. In addition, we will ensure that public health considerations are fully factored into proposed rules and processes (ensuring in particular that access policies do not compromise the identification and control of infectious diseases).”

A comprehensive package of confirmed proposals will be put to full public consultation on completion of the review work, in 2012. We may consult separately at an earlier stage on some options, such as primary care charging.
 

You can read the details of the government's proposals for the June regulations and this new review here. The new review details begin on page 24. 

Proposals and Review report

Guide to Safer Sex Advice

posted: 01/03/2011

The British HIV Association has produced draft guidance for STI clinics on offering Safer Sex Advice for the UK. They are inviting comments on their draft Guidelines.

The Safer Sex Advice guidelines recommend behaviour change interventions, what safer sex advice to give people at risk of STIs, and advising people living with HIV and people at greater risk of HIV infection.

The guidance is also useful for GPs and HIV care services when offering Safer Sex Advice.
 

Comment on Safer Sex Advice Guidance

Comments deadline is 31 May 2011 - comment through this webpage

Safer Sex Advice Guidance for the UK

Public Health Watch

posted: 29/10/2010

Updating of public health rules means public authorities in England and Wales have powers they can use against individuals with HIV to protect the public health from 'infection or contamination'. Magistrates can make compulsory public health orders (known as Part 2A orders) on people. Similar powers were used in Manchester against a man with HIV in 1985.

Late in 1985, just after Manchester AIDS-Line (later George House Trust) was set up with the help of a small grant from Manchester City Council, the same council used its public health powers backed by a magistrate. It compulsorily detained a man with HIV at Monsall Hospital. Major protests followed and, after a court case, he was freed to leave hospital a few days later.

This was the first and only time public health powers have been used against someone with HIV in this country. You can read more about this here.

New Health Protection Regulations

These old public health powers have now been updated in new Health Protection Regulations. Helpful guidance has been produced by the Department of Health on how to use (and not use) these powers.

This makes clear that in almost all cases using these powers to manage the risk of HIV or STI transmission would be inappropriate and should only be considered, if at all, in the most exceptional of circumstances.

HIV community and clinical organisations like BHIVA and BASHH oppose the use of these powers against people with HIV. They would cause more harm than good, damaging trust in STI and HIV clinic confidentiality, increasing HIV hate and discrimination, and would only ever be a short-term fix for someone with a life-long health condition.

More information

More information on the new public health powers and HIV can be found at the NAT website.
 

The official guidance makes clear that Part 2A orders 'are not a tool for managing long-term problems' and that the orders:

• are not meant in any way to change the current system and culture of confidentiality within sexual health services
• are not to be a routine part of managing those with HIV who present with evidence of ongoing unsafe sex (for example by presenting with repeated STI infection)
• are not generally appropriate for contact tracing
• could have harmful consequences for wider trust in sexual health services
• and that in the very exceptional circumstances where a Part 2A order might be considered, advice should be sought from the treating clinician and clinic director as to the possible consequences of such an order, and confidentiality must be respected at all times.

Even with this guidance, these powers could be misapplied to people with HIV or another sexually transmitted infection.

We, and NAT, are keen to hear about any attempts to coerce someone with HIV, through the use or threatened use of these powers. We do not expect the powers to be used, because the old powers were only used once against someone with HIV, 25 years ago, and have not been used again since. But it could happen. 

Department of Health: Health Protection legislation guidance 2010, laws and regulations

‘Health Tourism’ Mischief

posted: 08/06/2010

Sunday Times deputy editor Isabel Oakeshott has written an ignorant and mischief-making scare story about people from abroad using NHS money. People with HIV were included among those the NHS ‘counter-fraud unit’ listed as responsible.
 

The story calls it health tourism. The Department of Health has published no evidence that people with HIV come here as tourists deliberately to get HIV treatment. The only evidence there is (a snapshot survey by George House Trust and Terrence Higgins Trust) shows people do not know they have HIV when they travel here (to seek asylum, to start a university course, or to work, or visit family …. ).
 

Legal rights ignored
Most people from abroad who do have HIV treatment have every legal right to this. The few who are chargeable under the legal rules usually only find out they have HIV months or years after arrival, and their HIV diagnosis is always a big shock.

The NHS charging rules worsen public health in the UK by discouraging people from taking (always free) HIV tests. Untested and untreated people with HIV are likely to be much more infectious and lead to more HIV infections in the UK. Testing and HIV treatment can make people with HIV almost uninfectious, and that can save the NHS a lot more money than not treating everyone who needs this. HIV is the only sexually transmitted infection that can be left untreated because of these charging rules.
 

The Times report says that in eight-months last year, hospitals reported £24m in “bad debts”, 'most linked to patients from abroad'. The article suggests hospitals recover some of the cash later, but not much. The report says ‘According to the NHS’s counter-fraud unit, health tourism has a particularly heavy impact on maternity services, HIV care and cancer and heart units’.
 

Wrong about pregnant women, cancer, serious heart disease, HIV rights
The newspaper report is mischievous and malicious. The law and official guidance to NHS hospitals tells hospitals they must provide ‘immediately necessary’ or ‘urgent’ treatment.

Who would or could refuse a pregnant woman emergency care, or someone with life-threatening heart conditions, cancer, HIV?
 

Accident and Emergency – wrong again
It claims, without quoting any evidence, that “thousands of foreigners have been diagnosed in their own countries who cannot afford treatment there simply turn up at accident and emergency units in British hospitals and demand to be seen”.

Again this completely ignores the law and official NHS guidance – anyone needing accident and emergency care is always entitled to it without any charge. We get and would expect this if we are abroad and need emergency care.
“6.7 Some NHS services provided in NHS trusts are free to everyone regardless of the status of the patient. This Regulation says what these services are. The current list includes: a. treatment given in an accident and emergency department or casualty department......”
 

Doctors opposed
It correctly reports that most doctors dislike the charging system because medical ethics and the Hippocratic oath mean it is unethical to turn away patients who need urgent medical help.
 

Blame the Irish and Welsh – wrong
It also falsely blames people from the Irish Republic. Irish Citizens have always had the right to come and go freely and live here and use UK services. Brits can do the same in Ireland.

It seeks to create divisions within the UK by blaming people living in Wales for using NHS services in England, although the Welsh pay UK taxes just like everyone else. The Welsh are not foreign or migrants.
 

The Department of Health is already reviewing its policy on foreign patients.
 

Times article