Dispersal of HIV-positive asylum seekers: national survey of UK healthcare providers

Beginning April 2000, the UK National Asylum Support Service initiated a policy of dispersing asylum seekers from London and southeast England to locations around the United Kingdom in an effort to diffuse health care costs.

More than 100,000 asylum seekers to date have been dispersed, many of whom are from regions with HIV epidemics. It is not known how many HIV- positive seekers have been affected by the policy. Asylum seekers may receive only 48 hours notice, and they face immediate cessation of income, housing and legal benefits if they decline dispersal.

In the current study, the authors surveyed lead clinicians working in genitourinary medicine clinics about their experiences and opinions of the dispersal of HIV-positive asylum seekers. Centres that do not treat HIV-positive patients were excluded. In December 2003, anonymous questionnaires were sent to doctors asking about the appropriateness of dispersal in 10 clinical scenarios and about perceived barriers to effective dispersal.

Fifty-six of 75 eligible centres returned questionnaires; 34 of these were outside London, and 20 had had an HIV-positive asylum seeker dispersed to them. A total of 13 centres reported patients dispersed both to and from them.

Of the 56 returned questionnaires, frequentlybarriers to successful dispersal were dispersal at short notice (37) or with no prior arrangement (43). Just three centres had experienced appropriate transfer of care. Additional barriers cited included lack of community support (41), low staffing levels in the receiving centre (40), and lack of facilities to support vulnerable asylum seekers with psychological problems (43).

Some doctors spontaneously listed negative consequences attributed to dispersal, although the questionnaire did not inquire about such. Problems relating to unintentional interruption of antiretroviral therapy (4), mother-to-child HIV transmission (3), and HIV-related death (2) were reported. Many of the 56 returned questionnaires said dispersal of HIV-infected asylum seekers was inappropriate in certain situations – during initiation of HIV therapy (47), in patients receiving salvage treatment (43), in those currently undergoing medical investigations (50), where care involved multiple medical specialties (52), and when patients had progressed to AIDS (45).

Of the potential barriers to safe dispersal of HIV-infected asylum seekers, it is of particular concern that dispersal is done at short notice and frequently without appropriate transfer of medical information, the researchers noted. “Inappropriate dispersal of an HIV infected patient could lead to HIV resistance, onward transmission of HIV infection and avoidable morbidity and mortality for the asylum seeker,” the researchers noted. “Before the decision to disperse, the National Asylum Support Service should seek specialist advice and consider the impact on the infrastructure and staffing of the receiving centre,” they concluded.