Double the trauma

What could be worse than being an asylum seeker? How about being
an HIV positive asylum seeker? This “dreaded” combination hit the
headlines this week when Conservative shadow health secretary Liam
Fox said that all immigrants entering the UK should be screened for
infectious diseases. Fox said that Britain had experienced a second
Aids wave “largely imported from Africa”.

Last month, an all-party parliamentary group (APPG) on Aids
published its report1 on HIV and asylum seekers and
refugees. The report warned that a “complete lack of communication”
between the Home Office, the National Asylum Support Service (Nass)
and social services could lead to a deterioration in the health of
asylum seekers with HIV (news, page 12, 17 July).

Neil Gerrard, Labour MP for Walthamstow in east London and
chairperson of the APPGs on both Aids and refugees, slammed the
government for developing its position on asylum seekers “in
response to reports based on fear and stigma rather than factual

During the 1990s, HIV moved into heterosexual communities across
the world, especially those in sub-Saharan Africa where medication
to manage the condition was not – and still is not – readily
available. The introduction of combination therapy drugs in the UK
in 1996 resulted in people with HIV living significantly

At the end of 2001, there were 41,200 people living with HIV in the
UK, of these just over one-third are believed to be undiagnosed,
according to the Health Protection Agency. About 80 per cent are
understood to have been infected in sub-Saharan Africa. Statistics
are not kept on how many asylum seekers or refugees have HIV.

Asylum seekers arriving in the UK are not legally bound to declare
whether they know their HIV status. Although health checks are
provided for asylum seekers going through the UK’s first induction
centre in Dover, they are routinely screened for tuberculosis but
not for HIV. If an asylum seeker or refugee wants an HIV test they,
like other UK residents, have to ask for one.

The APPG on Aids opposes mandatory HIV testing of all asylum
seekers and immigrants entering the UK. Instead, it says the
government should support policies that encourage HIV testing “for
the purpose of ensuring more effective access to treatment and

For anyone with HIV, stigma and confidentiality are the big issues.
But for asylum seekers, life can be twice as difficult as they face
being ostracised by their own communities here in the UK and in
their home country. Lisa Power, head of policy at HIV charity
Terrence Higgins Trust, says: “Asylum seekers are heavily
stigmatised in the UK and often only have their own communities to
turn to, who in turn may have issues around HIV.”

The trust’s three offices in the Midlands see about 200
HIV-positive clients who are asylum seekers, refugees or have
uncertain immigration status. Midlands regional director Jackie
Redding says: “The biggest fear for clients is that they will meet
someone who knows their families back home and will tell them. We
often see some members of the same family who are struggling with
HIV but haven’t told each other.”

The Naz Project London, a sexual health agency for people from the
Horn of Africa, the Middle East and south Asia, reports that about
65 per cent of its clients are asylum seekers, refugees or those
with uncertain immigration status. Client support services
co-ordinator Parminder Sekhon says, although asylum seekers and
refugees are willing to discuss their status with social care and
health care professionals, they may not reveal it to Home Office
staff because they fear their asylum claim will be rejected. In
fact, under article 3 of the Human Rights Act 1998 it is a breach
of a person’s human rights to subject them to inhuman or degrading
treatment. This could include returning them to their home country
where appropriate medical help is unavailable.

The traumatic experiences from which they may have fled also reduce
the likelihood of asylum seekers disclosing their HIV status to
organisations seen as part of the “establishment”. They are more
comfortable turning to the voluntary sector.

Faida Iga, asylum worker at HIV charity Positively Women, believes
the areas to which HIV-positive asylum seekers are dispersed often
lack specialist support services. She says: “Provided that there is
medical care for HIV patients around the country, Nass does not pay
much attention to the availability of additional essential
services.” Positively Women recently set up an HIV and immigration
project with Asylum Aid to advise HIV-positive clients with
uncertain immigration status.

Helen Murshali, health policy adviser at the Refugee Council, says
dispersed clients may prefer to receive health care from the clinic
or hospital that originally dealt with them for fear of being
discriminated against by new staff. “One client told me ‘I do not
want my care transferred anywhere because I have to tell my story
from the beginning to people I do not know and go through all the
difficulties again’.”

Terrence Higgins Trust has extensive evidence of clients being
moved in the middle of their medical treatment. One woman had a
HIV-positive baby because she was dispersed days before giving
birth and was not provided with the health care that could have
prevented transmission.

Dispersed asylum seekers with HIV often have to cope with poor
accommodation that is inappropriate for their health. Some even end
up homeless. Section 55 of the Nationality, Immigration and Asylum
Act 2002 – which refers to how fast an asylum claim is made – also
makes life difficult for HIV-positive asylum seekers. Those not
deemed to have made their claim quickly enough receive no support
from Nass and unless they fulfil social services’ criteria, they
can miss out on their services too. If they don’t know they have
HIV they are likely to do so. Social workers can help asylum
seekers with HIV by not underestimating their care needs to avoid
having to provide them with accommodation, Iga says.

Sekhon says Naz Project London has clients who sleep on the streets
because they do not receive Nass support or accommodation. “Section
55 is hugely difficult for a lot of people and there is very little
room for negotiation around it.”

It is vital that professionals accept that these clients have
complex needs, says Sekhon. “Sometimes this is not a cuddly client
group who are cosy to work with and who know their way around the
system. That is the challenge for us to meet.”

1 Migration and HIV: Improving
Lives in Britain, all-party parliamentary group on Aids,

Five years of uncertainty

Birtu Muluneh worked sold coffee in her native Ethiopia. In
November 1997, aged 27, she fled because of political fighting and
claimed asylum in the UK.  A family helped her find a flat through
their church. A few days after she moved in she felt ill: “At
nights I would wake up covered in sweat and hot with fever. I also
had bad diarrhoea.” A friend took her to register with the local
GP, who suggested she test for HIV.  Muluneh says she panicked
because she did not understand much about HIV.

“The doctor told me there are treatments which can help. I kept
thinking what if I am positive? Surely this means I will die.” She
refused the test and at the end of 1998 she became so ill she was
in hospital for three days.  In January 1999 Muluneh took the test
and was diagnosed with HIV. She lost her flat because she was ill
and unable to work. Her local authority asylum team then housed her
with eight others. One evening her social worker arrived and
announced Muluneh would have to move to a flat to live with a
HIV-positive woman from central Africa. 

A few months later the landlord evicted Muluneh, claiming she
had not paid her rent. “I had to leave in such a rush that it was
only when I was outside that I realised I had not even had a chance
to collect my medication from the fridge.” Now she lives in a
hostel and receives help from Naz Project London.  Muluneh’s asylum
claim is still outstanding after more than five years. “Being an
asylum seeker is something you don’t choose,” she says. “You are
labelled as someone who begs and is always a burden.” She believes
the UK is full of barriers. “All the policies and procedures of the
health and legal services are designed to help you but they don’t,”
she says.

More from Community Care

Comments are closed.