1. Immigration Removal Centres and HIV Joe Murray Policy Officer National AIDS Trust

2. Structure  Overview  Survey and key findings  Planned next steps  Key issues for discussion

3. Overview  Research suggests HIV prevalence from certain migrant communities may be higher than in the general population of the UK, although there is no accurate way of knowing  Although, there have been large increases in the number of individuals diagnosed with HIV and many of these were in black and minority ethnic communities  Estimated that 3.6 per cent of black Africans and 0.3 per cent of black Caribbeans are living with HIV in the UK (correlates respectively to 46 and 3.7 times the estimated prevalence in white heterosexuals, which is 0.08 per cent) Source: Health Protection Agency  1 in 20 black African heterosexual men and women with HIV reported unprotected sex with a partner of unknown or discordant HIV status – compared with 1 in 5 gay men with HIV Source: Elford et al, AIDS, 2007 21 S63-S70

4. Detention Profile Q3 2006Q4 2006Q1 2007Q2 2007 Detained in immigration removal centres (IRCs) 1425128513801395 Detained in holding facilities 30255540 Total145513201435 Most common nationalities Sri Lanka Turkey Nigeria India Turkey Afghanistan Sri Lanka Nigeria Sri Lanka Turkey Jamaica Nigeria China Sri Lanka Jamaica Asylum Seekers Detained Under Immigration Act Powers

5. Survey  Healthcare managers in the ten IRCs in the UK regarding the management of HIV and AIDS  Aims of the study:  Collate information about the measures currently undertaken in each IRC to prevent and treat HIV  Gather examples of good practice in the prevention, testing and treatment of HIV and to identify gaps and barriers in these areas  Promote improvements in healthcare for people living with HIV

6. Average Length of Stay  Approximately 18 days (range from 3 to 30 days)  Shortest and longest period of stay for an individual detainee was 30 minutes to 18 months

7. Known HIV Cases  159 detainees were known to healthcare managers as HIV positive  140 of those were diagnosed before entering the IRC  28 were pregnant women  91 received ARVs while detained

8. HIV Testing  9 of 10 IRCs offered testing if requested by the detainee and 4 offered this where it was clinically indicated (none offered routine testing)  Mainly carried out in the IRC, either by clinical staff or by visiting clinical staff  3 IRCs arranged for detainees to visit external medical services for testing  Majority of IRCs reported detainees would have to wait a week or less for an HIV test result (longest was two weeks)  All IRCs provided access to pre- and post-test discussion

9. HIV Treatment  Local PCTs funded ARV treatment  In almost all IRCs, ARVs were provided where clinically indicated  In one case, ARVs were only provided where the detainee was already taking medication prior to detention  Initial health assessment was reported as a fundamental tool for determining the need for continuing medication

10. Access to Community Services  All provided access to NHS services  All provided access to voluntary services such as local HIV support organisations (e.g. Body Positive, Terrence Higgins Trust)

11. HIV Education and Advice  In most cases, GPs or nurses were the primary access point for individual support  Two IRCs described having mental health professionals available via referral

12. Preparation for Repatriation  2 IRCs reported that no arrangements were made to enable a detainee living with HIV to prepare for repatriation  Most reported they tried to enable some continuity of treatment by providing additional supplies of medication, ranging from 1 to 6 months supply  IRCs commonly identified finding ways to link detainees to support services in the destination country as a key concern

13. Harmondsworth  Currently 3 detainees who are living with HIV and all are on ARV treatment  1 has been in the IRC since 30 Sept (although in detention since 30 June), is to be removed to Cameroon and has been given a 3 month supply of medication  1 has been in the IRC since 6 Sept, is to be removed to Uganda and has been given a 6 month supply of medication  1 has been in the IRC since 7 July (although in detention since 24 May), is to be removed to Liberia and has been given a 3 month supply of medication  All have regular follow up with the local clinic  Currently 1 detainee is being tested for HIV (it was requested by the detainee)  Pre- and post-test counselling is provided externally by the local clinic  ARV treatment is available to all detainees who are clinically indicated to require it  Detainees are allowed to have medication in possession (if newly diagnosed, gradually the detainee will be allowed to have medication in possession)

14. Conclusions  Healthcare managers appear to be striving to provide the best care possible for their HIV positive patients within limitations of significant detainee turnover and available resources  Survey highlighted suboptimal care in detention and in preparation for repatriation

15. Planned Next Steps  NAT and BHIVA, in coordination with other stakeholders, to develop advice to support best practice related to the needs of asylum seekers living with HIV during detention and the removal process  Continue to work with the IRC healthcare managers working group and participate in a specific ‘work stream’ on HIV

16. Key Issues  New Asylum Model  HIV prevention and testing  Access to ARV treatment and continuity of care  Access to community services and mental health support  Preparation for repatriation  Clinical advice and delay of removal  Others?

17. Key Resources  NAT Immigration Removal Centre Survey Responses to HIV and AIDS www.nat.org.uk/document/257  Searchable Database of HIV and AIDS Services Across the World www.aidsmap.com/cms1038779.asp  National AIDS Trust Migration Policy webpage www.nat.org.uk/Poverty-and-Social-Disadvantage/Migration-policy  AHPN ‘Destination Unknown’ Campaign www.ahpn.org/campaigns/index.php?campid=7  Joint Committee on Human Rights ‘Treatment of Asylum Seekers’ Report www.publications.parliament.uk/pa/jt200607/jtselect/jtrights/81/81i.pdf

18. Contact Email: joe.murray@nat.org.ukjoe.murray@nat.org.uk Telephone: 020 7814 6767 Direct Telephone: 020 7814 6756