An audit of HIV care provision for Immigration Removal Centre patients

This year the BHIVA audit focused on the Immigration Removal Centres (IRCs) linked to Hillingdon Hospital in Uxbridge. It included eleven IRCs in the UK that dealt with people at all stages of an asylum application.

The audit was a retrospective review of medical notes from all patients seen between January 2008 and January 2010 and included all routine clinical data. The audit included patient characteristics, comparisons between practice and BHIVA/NAT advice on care for HIV positive detainees and comparisons between practice and recommended clinical guidelines.

The study included 116 patients referred to Hillingdon Hospital and a further 18 (16%) who were not seen because of deportation, release, transfer to another IRC or delays due to IRC regulations. Of the 18, 50% (9) were HIV positive. A total of 60/116 patients referred were HIV positive. Of these, 85% were on ARVs with prior care in 36 different UK centres. Their median age was 33 years (IQR: 28, 41). The median number of visits was 5 (IQR: 2, 6).

Following detention, 24 patients (39%) were deported, 20 (33%) released, 11 (18%) still detained at the time of analysis and 6 (10%) had unknown outcome. Of the 44 people removed from the IRC (24 deported and 20 released), only 8 (18%) were given prior notice (5 were given 1 week notice, 2 were given 2 weeks notice and 1 was dying). Of the 8 who had preparation for removal, none had a 3-month contingency supply of ARVs, 5 (63%) received information about HIV support facilities in onward destination and 4 (50%) had a medical summary letter.

Aspects of health care in detention centres where information was not available due to lack of records included missed ARV doses at time of arrest and detention, treatment interruption after detention, standards of medical care in detention.

The study concluded that the IRCs audited were not able to meet BHIVA/NAT standards for detainees. These included unbroken access for ARVs, availability of past medical information, preparation for removal of HIV positive detainees. It found that 82% of patients were not given prior notice of removal and of the 18% who were given notice the time was inadequate to meet the standard recommendations.

The authors recommended that data collection become standardised in centres for asylum seekers, that there is a national audit of IRC medical services, and greater advocacy to empower patients and medical staff to make BHIVA/NAT advice mandatory.

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The Detention Centres Services Operating Standards Manual states that asylum seekers must have available to them the same range and quality of services as the general public receives from the National Health Service. This is clearly not happening.

A similar report by Medical Justice looking at the clinical care of detainees with HIV released in 2011 concluded: This report provides evidence to suggest that immigration detainees living with HIV have been subjected to practices which, in other circumstances, would be considered unacceptable. Our records indicate that breaches of the NAT/BHIVA advice are routine; they occur intentionally in some cases, and as a result of inadequacies in others. Taken together, these breaches amount to a system of care, which is frequently detrimental to the health and well-being of those detained for immigration purposes. The UKBA claim that they are neither willing nor able to enforce the provisions of the NAT/BHIVA advice within immigration detention.

How we treat failed asylum seekers awaiting deportation is to our national shame.