Overview

NAT has long been campaigning for free HIV treatment and care from the NHS irrespective of residency status.  NHS charging regulations introduced in 2004 required refused asylum seekers, visa overstayers and undocumented migrants to pay for secondary care, including for HIV treatment.

Whilst our campaigning work continues, you can find out about your rights to access free HIV treatment and care in Will I Have to Pay? - (April 2007) developed with THT.  It provides advice on getting NHS sexual health and HIV services for recent migrants and those of uncertain immigration status.  HIV treatment should always be considered ‘immediately necessary’, as outlined by the British HIV Association letter to the Department of Health.  This means it should never be delayed or denied even if you are chargeable.

Last year NAT produced a report, The AIDS Support Grant: Making a Difference? looking at how local authorities are using this Grant to provide social care services for people living with HIV.  Until recently, this funding was 'ring-fenced' which meant local authorities could only use the Grant for this purpose.  The recent news that this ring-fence has been removed is a serious cause for concern - see below for how you can campaign to protect social care services.

NAT has also recently undertaken research into options available for people living with HIV who wish to have a family.  There is more information below on assisted conception for people living with HIV.

Campaign to safeguard social care services

The AIDS Support Grant, introduced in 1989, is funding given by the Department of Health to local authorities to ensure they provide social care services for people living with HIV. Recently, the ‘ring-fence’ for this Grant was removed, so whilst local authorities still receive money specifically for HIV social care, this money is no longer safeguarded.  We want to ensure that local authorities continue to provide these services despite the fact that many councils are being asked to make significant cuts. 

We want as many people as possible to write to their local authority to highlight the importance of continuing to fund social care services for people living with HIV. A letter template to help you write to your Local Councillor will soon be available on SHout Loud, the sexual health campaigning website that helps have a say about local decision making.  You can find out more about how to get involved in this campaign at: http://www.shoutloud.org.uk/node/250

This is only one way to take action.  To find out how else you can campaign to safeguard social care services contact Laura Dunkeyson at NAT (National AIDS Trust): laura.dunkeyson@nat.org.uk.

Important judgment on access to HIV treatment for refused asylum seekers

On 30 March 2009 the Court of Appeal ruled that refused asylum seekers were not 'ordinarily resident' in the UK, overturning a previous High Court ruling in April 2008.  This means that refused asylum seekers, visa overstayers and undocumented migrants are chargeable for secondary treatment including for HIV.
 
However the Court of Appeal did find that the Department of Health (DH) was acting unlawfully in not clearly providing guidance to write off the debt of those who need healthcare but are destitute.  The DH will be issuing stronger guidance on access to healthcare and debt write-off.

To find out more about who may be subject to charges, see NAT's briefing with Terrance Higgins Trust, Will I have to pay?

Campaign for free access to HIV treatment

NAT has been campaigning to exempt HIV treatment and care from NHS charges regardless of residency status. Read the campaign manifesto, Access to Free HIV Treatment and Care for All in the UK (November 2007). It is clear that these regulations actually prevent vulnerable people, including pregnant women, from accessing the vital treatment they need because they cannot afford the charges. Often destitute, those unable to pay such bills have had their treatment delayed, denied, interrupted or withdrawn. Many have been pursued aggressively by debt collectors. Others who are in fact entitled to free treatment have had it mistakenly denied by NHS officials and clinicians confused over the regulations. Read a number of cases related to charging (October 2007).

Safer Conception: Assisted reproduction options for people living with HIV

More than half of people in the UK living with HIV are of an age when they may be considering having a family.  The British HIV Association (BHIVA) reports that an increasing number of HIV positive women and couples are requesting assistance with conception, and that 16% of men and 4% of women attending HIV specialist clinics had enquired about fertility treatment.

Of particular concern for people living with HIV who wish to conceive is serodiscordancy in their relationship: that is, when one partner is HIV positive and the other HIV negative. The standard recommendation for such couples is to practice safer sex to prevent HIV transmission from one partner to the other- naturally, this most often also prevents pregnancy.

 However, there are a range of options available to assist couples to conceive safely, including self-insemination, donor sperm and sperm-washing as discussed in Safer Conception: Assisted reproduction options for people living with HIV.  These assisted reproduction techniques can help achieve safer, successful conception for sero-discordant and -concordant couples alike. However, not all assisted conception options are widely available to people living with HIV across the UK, and in many cases will be prohibitively expensive.
 

Getting advice

For advice or share your experiences related to charging please contact policyandcampaigns@nat.org.uk