Asylum UK - Life on £5 a week

posted: 16/03/2009

Hundreds of thousands of refused asylum seekers are living in extreme poverty in the UK, including some with HIV, because of fears of torture or death if they return to their home countries, according to a report released today.

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Trapped in a twilight zone - no home, can't work, can't claim

The report warns many refused asylum seekers are living in a "twilight zone", with no housing or financial support, and no right to work. Many refused asylum seekers are living on less than "a dollar a day", the global yardstick for extreme poverty, it claims. Recent research by the London School of Economics estimated there are 500,000 refused asylum seekers in the UK.

Christine Majid, from the refugee charity Pafras, who commissioned the report Underground Lives , says the number of destitute asylum seekers the charity dealt with tripled in the past two years and called destitution a "deliberate" policy to force asylum seekers out of the country.

Starving people out

She said: "In the 21st century the fact that the government is trying to starve people out of the country, it is absolutely inhumane and it just isn't working. These people would rather starve on the street here than return to their own countries."

A series of governmental policy decisions including preventing asylum seekers from working in 2002, cutting legal aid in 2004 and an overhaul of the system in 2007 has lead to an "untenable strain" on local charities, she added.

Most live on £5 a week or less

The report found that, on average, failed asylum seekers were surviving on £7.65 per week, but the majority lived on less than £5. Two thirds had experienced torture in their countries.

Homeless and vulnerable

Following the refusal of their asylum claims, 72% have spent time sleeping outside; of these, 38% have experienced physical attacks. More than a third of the women sleeping rough had experienced sexual assault, including rape.

The Liberal Democrat leader Nick Clegg called the report "a timely reminder of how the government has combined incompetence and inhumanity to create one of Europe's most inefficient and cruel asylum systems". "Responsibility for asylum should be taken away from the cack-handed blunderings of the Home Office and given to an independent agency."

Asylum claims fallen sharply but human rights record shames us

Asylum claims have fallen sharply in recent years and are at a 14-year low, with 23,430 applications for asylum in 2007 - 4% of all immigration applications - compared with 103,080 in 2002. A lack of access to proper legal advice is having a significant impact on the number of valid asylum seekers being refused sanctuary, and returned to countries where they could be tortured, said human rights lawyer Louise Christian. "The government's asylum policies are entirely at odds with its human rights obligation - particularly with regards to children in detention. It is a huge source of scandal and shame to this country."

UKBA emergency support spurned by most

A UK Border Agency spokesperson said the government provided measures to ensure individuals are not left without basic essentials. But the report says only around 9,000 people receive UKBA support, which provides £35 in supermarket vouchers a week and no-choice accommodation. Many are reluctant to apply for it as they must sign an agreement consenting to be removed from the UK at a later date.

The report is being released in conjunction with a major exposition of photographs of failed asylum seekers, launched in association with the Still Human, Still Here campaign, led by a coalition of human rights organisations including Amnesty International and the Refugee Council.

The secret world of destitute asylum seekers is captured in pictures in the exhibition Still Human, Still Here, at the Host Gallery, London from March 18.

Underground Lives report

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image from Refugee Council

Swiss Court Frees HIV+ Man

posted: 10/03/2009

In the first ruling of its kind in the world, the Geneva Court of Justice has freed a man given 18-months prison for exposing someone to HIV.The court ruled that the risk of HIV transmission while the man was on treatment was far too low to justify the conviction.

In Switzerland, public health law effectively made it a crime simply for people with HIV to have any  unprotected sex. However this court has now changed this. It accepted expert testimony from Professor Bernard Hirschel – one of the authors of the Swiss Federal Commission for HIV/AIDS consensus statement on the effect of treatment on transmission – that the risk of sexual HIV transmission during unprotected sex on successful treatment is 1 in 100,000. It ruled that this level of risk was far too low to keep unprotected sex a public health crime.

The case began in Lausanne in 2007, when a court sentenced the HIV-positive man, originally from the Democratic Republic of the Congo, to a suspended 28-month sentence for having unprotected sex, without telling his woman partner his HIV status.

Swiss HIV Law

Under the public health parts of the Swiss criminal law, Article 231 allows prosecutions against HIV-positive individuals for having unprotected sex, with or without disclosure. The UK doesn’t have a public health criminal law about disease exposure. Prosecuting and criminalising public health was dropped in the UK because it goes against the principle of encouraging people to come for testing and treatment. Criminalising public health drives people with health needs underground and protecting public health becomes far more difficult.

People with HIV in Switzerland can also be prosecuted under Article 122, for an attempt to engender grievous bodily harm. This makes it an attempted grievous bodily harm to have unprotected sex, even if there is no HIV transmission. People with HIV in Switzerland are jailed simply for having unprotected sex. This can't happen under English law. Here HIV transmission has to take place before the charge of "grievous bodily harm" can be made. There is no English crime of attempted grievous bodily harm.

Deborah Glejser of Swiss community HIV organisation, Groupe SIDA Genève, explains that although this public health law could be used even more harshly, to prosecute unprotected sex even when HIV status has been disclosed, in practice, the Swiss only prosecute HIV exposure without disclosure. Suspended sentences are normal so this man’s imprisonment was unusual.

Trial judge refused to consider Swiss statement

A second complaint last year led to the man standing trial again in Geneva in November 2008. According to a report in The Geneva Tribune, an expert medical witness had testified that although treatment greatly reduces the risk of transmission, there remained a residual risk. Although the man's lawyer had put forward the statement by the Swiss Federal Commission for HIV/AIDS as evidence, and Geneva's deputy public prosecutor wanted to suspend the hearing to consult with the Swiss HIV Commission, the lower Geneva court refused to allow this. This made it his second conviction so he was sent to jail for 18 months, in December 2008.

This clearly annoyed the deputy Public Prosecutor who felt justice was not being done or being seen to be done. The court refused to consider the evidence even the prosecutor thought was relevant. We are left with the suspicion that a white Swiss native would have not been jailed for 18 months like this black African migrant. The British pattern of a disproportionate numbers of migrants being jailed for HIV crimes is found across much of the globe

It's Super-Public-Prosecutor to the rescue

Late in February the deputy public prosecutor came to the rescue and told the Geneva Court of Justice that he was convinced by the Swiss Federal Commission for HIV/AIDS that the risk of transmission for an HIV-positive individual on successful treatment was less than 1 in 100,000. Under the circumstances he wanted to appeal so as to withdraw the charge and for the court to cancel the conviction.

On Monday, the Geneva Court of Justice acquitted the man, who was freed  after almost three months in prison. Geneva’s deputy public prosecutor, Yves Bertossa, called for the appeal, told the newspaper Le Temps that although there is still some debate regarding the slight risks of transmission in people on successful treatment this should not be used unfairly: "One shouldn't convict people for hypothetical risks,” he said.

Swiss statement did what it set out to do

Professor Hirschel said that he was very pleased with the outcome. It was, he said, the main reason that he and his colleagues issued their January 2008 statement of advise for courts and prosecutors.

The Swiss panel has had enormous global attention and a great deal of criticism for openly talking about and applying the lessons of modern HIV treatment to the lives of people living with HIV. Swiss HIV clinicians wanted to put a stop to much of the jailing of people with HIV - simply for having unprotected sex without any HIV transmission.

Deborah Glejser of Groupe SIDA Genève added that Monday’s ruling means that, in Switzerland, HIV-positive people on treatment which is working properly should no longer be prosecuted for having unprotected sex. She hopes that this ruling will help people in other countries that prosecute HIV exposure – and she’s been contacted by many already.

Hopes for fall in global prosecutions

Last May, a five member US Court of Appeals for the Armed Forces panel rejected, but only by a narrow majority, an appeal by an HIV-positive soldier who had previously pleaded guilty to HIV exposure, following unprotected sex with two women without disclosing his HIV status. And last July, a Canadian court considered and rejected the Swiss statement in the case of a man charged with having unprotected sex with six women.

Following Monday's ruling, however, Geneva’s deputy public prosecutor, Yves Bertossa, believes it is only a matter of time before other jurisdictions realise that prosecutions for HIV exposure should not take place when the accused is on successful antiretroviral therapy. He told Radio Lac: “There are some medical advances which can change the law. I think that in other [parts of Switzerland] or in other countries, the same conclusions should apply to their laws."

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Half Africans Diagnosed Late

posted: 25/11/2008

New figures from the Health Protection Agency show that 42% of African people diagnosed in 2007 in the UK had their HIV diagnosed late.

Late diagnosis leads to increased illness, early death and more transmissions

This means their HIV was only diagnosed when they already had, or were at risk of developing, a serious HIV-related illness. Late diagnosis of HIV leads later to many of the HIV-related deaths still seen in the UK.

"The sooner HIV and other sexually transmitted infections are diagnosed and treated, the less likely it is they will be passed on", said Professor Mike Catchpole, Director of the HPA's Centre for Infections.

The key public health concerns arising from the report were highlighted by Deborah Jack, Chief Executive of the National AIDS Trust, who commented: “The alarming proportion of late HIV diagnoses amongst Africans in the UK results in increased illness and death as well as increasing the risk of onward transmission”.

How late is late?

According to the report, 42% of black Africans who were diagnosed in 2007 with HIV in the UK, had their infection diagnosed late. By late diagnosis they mean either the CD4 cell count was already below 200 cells/mm, or the person already had an AIDS-defining illness). Treatment should ideally start well before this point when CD4 count is typically 350, not 200. A high rate of late diagnosis - 27% - was also seen in black Caribbean people.

Ethnicity and sexuality

The report also showed that black Africans in the UK are the ethnic group with the highest HIV prevalence of any ethnicity in the UK. Prevalence of HIV was 3.7% for black Africans, 0.4% in black Caribbean people, and 0.09% in the general white population. Prevalence among white people who are gay men is similar to that of black Africans – between about 3.4 and 4.2%, depending on whether the men live in a gay hotspot like Manchester, Blackpool, London and Brighton, or in the rest of the country.

2691 black Africans were diagnosed with HIV in 2007, and although this represents a significant fall compared to recent years, 40% of all new HIV infections in the UK were still amongst this population. The fall in diagnoses reflects the recent fall in African migration especially of people who apply for asylum.

The majority acquired the infection heterosexually, and in Africa.

New diagnoses in black Caribbean people remained low at 189, with over half of heterosexuals acquiring their infection in the UK. However, this group was disproportionately affected by bacterial sexually transmitted infections (STIs), such as gonorrhoea.

High rates of other STIs too

The report notes that the higher rates of STIs in both black African and black Caribbean populations means that “even though levels of high risk sexual behaviour may be similar to other communities, there is an increased risk of acquiring an infection”.

Dire Needs

Titise Kode, the new Chief Executive Officer of the African HIV Policy Network, commented: "The HPA report illustrates the dire need for a targeted, well-resourced and evidence-based response that is informed by African people, especially people living with HIV. The fact that a significant number of African people are being diagnosed late also indicates that people are not obtaining the full benefits from the treatment they need to stay alive.”

“Efforts to reinforce testing campaigns and the evaluation of successful strategies lie at the heart of our work to empower Africans affected by HIV," said Kode.

Updated HIV testing guidelines were recently published with the aims of normalising HIV testing and cutting the rate of late diagnosis. Deborah Jack suggested that “GPs in particular need to start testing for HIV and become better at recognising the signs and symptoms of HIV infection.” In addition, to meet the needs of black Caribbean people, she recommends that Strategic Health Authorities and Primary Care Trusts use local HPA data to plan and support HIV prevention strategies.

The HPA report concludes that easy access is critical for both African and Caribbean people to sexual health services that can provide advice, screening and treatment for STIs including HIV. “HIV testing should be promoted extensively to black Africans as early diagnosis benefits the individual, through improved prognosis for those found to be HIV-positive, and the community through reduced HIV transmission,” the report says.

In addition, the evidence base needs to be reviewed to improve interventions, which need monitoring for continuing effectiveness. The report also recommends: “The sexual health needs of black African and black Caribbean men who have sex with men need to be assessed so that services targeted at these groups can be enhanced,” and “an STI prevention strategy should be developed for the black Caribbean communities.”

George House Trust comment
The causes of late diagnosis are many and complex.

• Among Africans the fear and shame of HIV are often very strong and these discourage some people from testing.
• Many Africans migrants don't realise the benefits that come from early testing and treatment. In many sub-Saharan countries knowledge about treatments and their effectiveness is restricted.
• Most Africans in the UK with HIV became infected in Africa before travelling to the UK. Some people will have reached the late stage before they even arrive in the UK.
• Clinicians may not spot signs and symptoms that suggest HIV. Outside HIV and STI clinics, many GPs and hospital clinicians miss HIV symptoms or opportunities for testing – even though black Africans are a high risk group.
• Clinicians too embarrassed or reluctant to raise the issue or ask questions that might prompt a HIV test.

Effective work to end late diagnosis needs to deal with all of these aspects of the problem.

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Reference
Sexually transmitted infections in black African and black Caribbean communities in the UK 2008, Health Protection Agency