The Government’s support for Lord Norman Fowler’s long-standing campaign to allow free treatment in England for foreign nationals infected with HIV is a victory for common sense and the good of public health.
It has long been an anomaly that treatment for people with viral hepatitis has been free for everyone on the NHS whilst HIV treatment has not.
The rationale for free treatment is the same in both cases: that it reduces infectivity and onward spread of the infections in the UK. Early treatment also prevents the need for more expensive treatment if the untreated disease progresses and the patient becomes unwell requiring essential emergency care.
And treatment as prevention is an increasing theme in HIV medicine. Combination therapy reducing HIV viral load to undetectable levels means that individuals on treatment pose a very low risk of transmitting infection, to the extent that there is a current consultation on allowing infected healthcare workers on treatment back to performing exposure-prone procedures.
Estimates suggest that many new HIV infections are acquired from the estimated 25% of infected people who are unaware that they have HIV. Increasing testing for HIV with resultant earlier diagnosis and treatment will reduce the pool of infectious individuals in the community.
This should have an impact on new infections, particularly in the heterosexual population where HIV infection acquired in the UK continues to grow.
Late diagnosis was shown in a British HIV Association (BHIVA) audit to be the single largest cause of death in people with HIV. People diagnosed late are more likely to present very unwell, requiring significant levels of urgent care – at an increased cost – and having very poor outcomes.
Patient organisations helping people with HIV have also long reported that fears about access to treatment and about immigration status have been a major deterrent to asylum seekers, students and others seeking or accepting HIV testing. (Here, we should note that the regulations have been different in Scotland and Wales for some time without an influx of so-called health tourists).
For many GPs, the implications of a positive HIV test for overseas nationals have long been a challenge. They were not entitled to care under the NHS, and so GPs were not able to offer advice or reassurance about care if the test did come back positive.
As a GP I can now offer testing for HIV, Hepatitis B and C to individuals at risk. I will no longer have the dilemma of whether to tell a patient that they have serious treatable condition but no access to treatment or whether to avoid the issue of testing because of the psychological harm that situation may cause.
The Government have promised they will ensure safeguards against abuse of the system – and in the meantime GPs will be able to offer life saving HIV testing and referral to all patients, knowing that we are also helping to reduce the spread of HIV.
Dr Ewen Stewart is Chair of the RCGP Sex, Drugs and HIV Task Group and sits on the British HIV Association’s Primary Care working group