* Any views expressed in this opinion piece are those of the author and not of Thomson Reuters Foundation.
Migrants must be a key part of the British Government’s HIV Action Plan to end new cases by 2030Tamara Manuel is policy and campaigns officer at National AIDS Trust
In January 2019, Britain’s Secretary of State for Health and Social Care pledged to end new cases of HIV in England by 2030. Fast forward to 2021 and the Government’s still working on its HIV Action Plan to detail how it will do this.
Today, we’re urging the government to include a key population in its plan: migrants.
Our research has revealed the barriers migrants living with HIV face accessing HIV testing, treatment, and care here in the UK.
In 2019, 62% of all people diagnosed with HIV in the UK were born abroad. Most migrants living with HIV are diagnosed for the first time in the UK, and evidence suggests over half acquire HIV after arrival in the UK.
Despite the fact people born abroad are disproportionately affected by HIV, there is no shared understanding of the policies and interventions needed to combat HIV in the context of migration. Further, many barriers stem from wider immigration policy, including the pervasive ‘hostile environment’. The government must, as the 2030 target approaches, consider the needs of this varied group and address the failures of this system.
It is no secret that a prevalent approach to immigration policy has been to make life more difficult for people without leave to remain in the UK, deterring certain migrants from accessing essential services. Participants told us they delayed accessing healthcare due to fears of being charged for NHS services and reported to immigration enforcement. The results are counterproductive – late diagnoses, increased chance of mortality and more urgent and complex care needs.
People also found it difficult to access reliable information about healthcare entitlements and how the system works. Financial hardship meant some could not afford food and travel (for example, to HIV appointments). And exclusion of people subject to immigration control from working or accessing public funds increased poverty and vulnerability.
There are some specific barriers faced by LGBT+ migrants. Many we spoke to came to the UK fleeing countries where LGBT+ people are criminalised and HIV stigma is prevalent. They had additional concerns about if healthcare settings were LGBT-friendly spaces. One person told us he didn’t feel safe going to his doctor after a receptionist’s hostile reaction when he said he was gay – instead he paid £10 ($14) a time to travel to his HIV clinic in central London for all his health concerns. This was while living on asylum support of £39.63 per week.
Migrants in Britain aren’t a monolith, nor are LGBT+ migrants. We need more granular data on specific groups, including reporting in the published HIV data tables and annual report on all communities with more than 500 cases of new transmissions in the past five years. This would allow us to understand more about the varied impact of HIV on migrant groups and to better target health campaigns through inclusion and co-design.
To meet the 2030 target, no one can be left behind in Britain’s response to HIV. The system also needs to acknowledge the counterproductive impact of hostile environment policies on public health.
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