HIV and TB co-infection and treatment charges in the UK

Joe Murray, NAT

Treatment for tuberculosis (TB) remains free of charge for all in the UK, irrespective of residency status.

While treatment for TB remains free of charge for all in the UK, the situation for HIV care is different. Since 2004, new NHS regulations mean some of the most vulnerable people living with HIV in the UK – refused asylum seekers and other undocumented migrants – cannot access free HIV treatment.

The National AIDS Trust believes these charging regulations are damaging people’s health. HIV organisations like the National AIDS Trust are hearing stories of people living with HIV, who have not been provided with HIV treatment because of misunderstandings over entitlement, or who disappear from care for fear of HIV-related bills. It is often the most vulnerable who suffer from delayed, denied, interrupted or withdrawn care because they are unable to pay such HIV-related bills for treatment. And many have been pursued aggressively by debt collectors. The consequences for the health and well-being of those affected are grave, and could well result in serious illness and sometimes death.

Even though an individual may be chargeable for their HIV treatment, if that care is needed, they should not be denied it. Clinicians have an obligation to treat all with a serious communicable disease like HIV, irrespective of residency status, if that treatment is ‘immediately necessary’. Where HIV treatment is deemed by a clinician to be necessary, either to save life or to prevent a condition from becoming life-threatening, then Government guidance stipulates that treatment must be given without delay, regardless of whether the patient is, or may be, chargeable for their HIV care. The guidance is explicit on this.

Sadly it is often those most vulnerable that are not entitled to free HIV care. Refused asylum seekers and other undocumented individuals are unable to work legally and, as a result, are often destitute – certainly unable to pay any bill for hospital care or medication. If an individual is charged for their HIV treatment and are unable to pay such a bill, hospitals have the ability to write off debt if they realise that someone simply cannot pay. Support organisations such as the Terrence Higgins Trust can help people negotiate debt write-off – clinicians should have no doubt about providing access to vital treatment. Although the charging regulations can be confusing, treating clinicians have a duty to provide the best possible care for their patients, and at the right time, whether or not they are eligible for free HIV treatment.

Nearly nine million new cases of TB, and nearly two million deaths from TB, are estimated to occur around the world every year. About 8000 new cases of TB are reported each year in the UK, where it is the most common AIDS defining illness among migrant communities.

With these alarming statistics in mind, it is imperative that TB, a serious communicable infection, is diagnosed and treated as early as possible. This is particularly important for patients living with HIV, as co-infection can be a deadly duo. TB does not need to be one of the leading causes of death for people living with HIV. With adequate and timely treatment, patients may fully recover from TB.

‘Will I have to pay?’ by the National AIDS Trust and Terrence Higgins Trust provides further information and advice on getting NHS sexual health and HIV services for recent migrants and those of uncertain residency status.

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