UK compensation for blood Scandal that infected with HIV

 Blood Scandal that infected recipients with HIV and Hepatitis C through blood products from USA in the 1970s and 1980s has finally been recognised and will be recompensed by the UK Government 

After decades of tireless campaigning, this week the government finally published its inquiry into the infected blood scandal, widely acknowledged as the worst treatment disaster in the history of the NHS. Calling the incident a 'catalogue of failures', the chairman of the inquiry, Sir Brian Langstaff, said 'the truth has been hidden for decades' by the NHS and successive governments.

 

Over 30,000 people were infected with HIV and hepatitis C through contaminated blood products or through transfusions as a direct result of clinical decisions and policy made and implemented in the 1970s and early 1980s. At least 3,000 people have already died, with more losing their lives every week. 

                                       

African Institute and other charities ie the Terrence Higgins Trust(THT), we have been supporting those living with and affected by HIV as a result of the scandal. Ahead of the publication of the report, we were proud to stand outside Parliament with hundreds affected by the scandal. In the Evening Standard, THT Chief Executive Richard Angell said: 'Justice for those still with us. But for so many it has come too late.'

 

Apologising for the scandal, Prime Minister Rishi Sunak said it was a 'day of shame for the British state' which had 'mistreated tens of thousands of patients and engaged in a cover-up.'

 

Some details of a long-overdue compensation scheme have been announced for those impacted by the contaminated blood scandal. Those infected and still living will receive interim payments of £210,000 within 90 days of the start of summer and there is a promise of an interim payment for the estates of those who have sadly passed away already, with further compensation to follow. 

There is a lot to welcome in the Government’s announcement, although whether the proposals adequately compensate those infected and affected is yet to be seen. 

We will continue to work with those infected and affected to ensure that everyone who is entitled to compensation sees fair compensation delivered.

The difference between Refugee Status and Humanitarian Protection in the UK

 

The African Institute thanks FreeMovement for this article:

What is the difference between refugee status and humanitarian protection?

Page contents

• When will refugee status be granted?
• What are the terms and conditions of refugee status?
• When will humanitarian protection be granted?
• What are the terms and conditions of humanitarian protection?
• Differences between the two statuses
  • Travel documents
  • Victims of domestic abuse
  • Revocation
• Conclusion

On the face of it, refugee status and humanitarian protection seem like two sides of the same coin. Both are a form of international protection granted to a person in need. Both result in a grant of five years’ permission to remain in the UK on a pathway to settlement after that. They give most of the same rights to work, study and access benefits.

But as we shall see, they are underpinned by different legal frameworks and refugee status is superior to a grant of humanitarian protection in some important ways. 

Before we delve into the advantages of refugee status, we will take a quick look at the circumstances in which a person will be granted one or the other. 

We have updated this article to reflect the end of differentiated treatment. 

When will refugee status be granted?

The Home Office is the government department that assesses an asylum seeker’s claim to international protection in the UK. There are several stages to this process.

First, officials will assess whether refugee status can be granted. If the person is not entitled to refugee status, the decision-maker moves on to assess whether humanitarian protection can be granted. If not, they move on to see whether permission to stay should be granted either under another paragraph of the Immigration Rules or on a discretionary basis.

Refugee status will be granted to an asylum seeker who meets the requirements of paragraph 334 of the Rules:

(i) they are in the United Kingdom or have arrived at a port of entry in the United Kingdom; and

(ii) they are a refugee, as defined in Article 1 of the 1951 Refugee Convention; and

(iii) there are no reasonable grounds for regarding them as a danger to the security of the United Kingdom in accordance with Article 33(2) of the Refugee Convention; and

(iv) having been convicted by a final judgment of a particularly serious crime, they do not constitute a danger to the community of the United Kingdom in accordance with Article 33(2) of the Refugee Convention as defined in Section 72 of the Nationality Immigration and Asylum Act 2002; and

(v) refusing their application would result in them being required to go (whether immediately or after the time limited by any existing leave to enter or remain in the UK) in breach of the Refugee Convention, to a country in which they would be persecuted on account of their race, religion, nationality, political opinion or membership of a particular social group.

Let’s unpack that a little. The person must be inside the UK or at a port of entry in order to be granted refugee status, meaning that a claim for asylum cannot be made from outside the UK. It is not possible to apply to the UK government from abroad for permission to enter the UK as a refugee.

You may well be wondering how an asylum seeker might get to the UK to claim asylum if no visas are available for this purpose. That’s one of the features of our island nation’s immigration and asylum policy. Most people have to either arrive illegally or as holders of valid visas which have been issued for some other purpose, such as tourism. 

As we have seen recently with Honduras and Namibia (and in 2022 with El Salvador and in 2015 with Syria), the Home Office can and will make it more difficult for people coming from countries where an asylum claim may be anticipated to get a standard visa. Those brought here under refugee resettlement programmes (not a straightforward process) are an exception to this general rule.

Once the person is inside the UK or at a port of entry, they must meet the legal definition of a refugee. The Immigration Rules point us to the relevant international treaty which is the Convention Relating to the Status of Refugees done at Geneva on 28 July 1951 and the New York Protocol of 31 January 1967 (often just referred to as the “Refugee Convention” or the “Geneva Convention”). A refugee is defined in Article 1A of the Refugee Convention as a person who

owing to a well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group or political opinion, is outside the country of his nationality and is unable, or owing to such fear, is unwilling to avail himself of the protection of that country; or who, not having a nationality and being outside the country of his former habitual residence as a result of such events, is unable or, owing to such fear, is unwilling to return to it.

There is a lot going on in that definition. Each word has been pored over and analysed by lawyers, judges and academics for decades. Crucially, a person must fear persecution for a specific reason such as their race, religion, nationality or political opinion (this is often referred to as a “Convention reason”). We won’t delve any deeper at this point, but if you are interested, you can check out Colin’s post on this or the asylum training materials in the members’ section of the website.

If a person does fear persecution for one of those reasons, then assuming there are no reasons to regard them as a security risk or danger to the community, the final question is whether refusal of their application would result in their “refoulement” to a country where their life or freedom would be threatened for a Convention reason.

If the answer to that question is yes, then the person will be recognised as a refugee and receive something called refugee status.

What are the terms and conditions of refugee status?

Refugee status gives a person five years of permission to stay in the UK, with permission to work and study, and access to the NHS and benefits. 

Refugees have the right to seek family reunion with family members left behind. After five years they can apply for settlement (aka “indefinite leave to remain”), assuming there has not been a significant change in their circumstances or the circumstances in their country of origin.

When will humanitarian protection be granted?

An asylum seeker who does not meet the criteria for a grant of refugee status will be considered for humanitarian protection. 

The Immigration Rules cover humanitarian protection in paragraphs 339C and 339CA:

339C. An asylum applicant will be granted humanitarian protection in the United Kingdom if the Secretary of State is satisfied that:

(i) they are in the United Kingdom or have arrived at a port of entry in the United Kingdom;

(ii) they are not a refugee within the meaning of Article 1 of the 1951 Refugee Convention;

(iii) substantial grounds have been shown for believing that the asylum applicant concerned, if returned to the country of origin, would face a real risk of suffering serious harm and is unable, or, owing to such risk, unwilling to avail themselves of the protection of that country; and

(iv) they are not excluded from a grant of humanitarian protection.

339CA. For the purposes of paragraph 339C, serious harm consists of:

(i) the death penalty or execution;

(ii) unlawful killing;

(iii) torture or inhuman or degrading treatment or punishment of a person in the country of return; or

(iv) serious and individual threat to a civilian’s life or person by reason of indiscriminate violence in situations of international or internal armed conflict.

To be granted humanitarian protection, an applicant must therefore establish that they would face a real risk of serious harm if returned to their country of origin.

Crucially, it’s not necessary for a person to be at risk of serious harm for a specific reason such as their race, religion, or political opinion. Those at risk of indiscriminate violence can receive protection when they face serious harm for no particular reason other than their mere presence in their country of origin.

A common example is where people are fleeing a conflict zone for the simple reason that their lives may be at risk if they get caught up in the violence. During the Iraqi civil war many asylum seekers were granted humanitarian protection, and likewise many Syrians in the early days of the war there.

What are the terms and conditions of humanitarian protection?

A person granted humanitarian protection will get “humanitarian protection permission to stay”. This involves five years of permission to stay in the UK, with the right to work and study, and access to the NHS and benefits. They have the same rights to family reunion as a refugee. 

At the end of this five-year period, like a refugee, the person will be able to apply for indefinite leave to remain, assuming there has not been a significant change in their circumstances or the circumstances in their country of origin. 

Differences between the two statuses

There are some differences that may not have much practical impact on most people’s lives, but are important to be aware of.

Travel documents

Refugees are entitled to apply for a blue travel document known as a Convention travel document.

This is the equivalent of a passport, but issued to those who have been granted refugee status under the Refugee Convention and enables them to travel internationally to other countries which subscribe to the Convention (still subject to any visa requirements those countries may have).

This travel document is made available to refugees so that they do not have to have any further contact with the country which they have fled from. Indeed, Home Office guidance warns that “a person accepted as a refugee under the terms of the 1951 United Nations Convention relating to the Status of Refugees places that status at risk if they travel on their own national passport”.

Convention travel documents will be issued with an endorsement forbidding travel to the refugee’s country of origin, but beyond that, they offer the refugee a considerable degree of global mobility as they will generally be accepted in lieu of a national passport by other Convention countries.

A person granted humanitarian protection however will not be entitled to apply for a Convention travel document, because their status is not underpinned by the Convention. Instead, they will have to continue to rely on their own national passport. If they cannot get one, they will have to apply for a black travel document called a Certificate of Travel. This is yet another type of travel document issued by the UK government.

In order to obtain a Certificate of Travel, an applicant must normally satisfy the Home Office, with hard evidence, that they have been unreasonably refused a passport by the government of their country of origin. There are some exceptions to this set out in official guidance, but by and large this is a tough test because very often it will be impossible to obtain travel documentation or evidence from the country of origin. Those granted humanitarian protection will not, by definition, be able to travel there safely and are unlikely to be able to use their country’s embassy in the UK.

Even if a person manages to actually get their hands on a Certificate of Travel, due to the very small number of countries that actually allow holders to travel using them, they often prove largely useless.

What about using the passport you came to the UK on, assuming it’s still valid? One set of official guidance states that “an individual with permission to stay on these grounds should in many cases be able to travel on their own national passport”. But elsewhere, the Home Office appears to discourage this. Guidance for officials on granting indefinite leave to remain in the UK for both refugees and recipients of humanitarian protection says:

You must ensure that all relevant checks have been conducted to establish whether the individual has obtained a passport from the national authorities of their country of origin or their country of former habitual residence. Where an individual has obtained a national passport or asked for their conditions of leave to be placed in it (a ‘Transfer of Conditions’ application), then you must consider whether a revocation referral is appropriate.

This is an understandable position to take with refugees: the Immigration Rules at paragraph 339A(i) say explicitly that a refugee who voluntarily re-avails themselves of the protection of their country of origin can face revocation of refugee status. The same rule does not exist for humanitarian protection — yet the Home Office appears to apply that same standard when it comes to settlement applications. 

Victims of domestic abuse

The partners of people with refugee status benefit from visa protections for victims of domestic abuse. Under paragraph E-DVILR of the Immigration Rules, if a refugee subjects their partner to domestic abuse, the partner can apply for indefinite leave to remain in the UK. 

Those with humanitarian protection can still sponsor their partners to join them in the UK, but if they are violent or abusive towards them, those partners do not have the benefit of protection under the rules. This is a considerable lacuna in the law.

Revocation

In cases where the Home Office seeks to revoke a person’s refugee status, paragraph 358C of the Immigration Rules requires the Home Office to notify the United Nations High Commissioner for Refugees and to provide an opportunity for the UNHCR to present views. These views must be taken into consideration.

No such provision exists for those with humanitarian protection, resulting in a more fragile status with less robust international oversight.

Conclusion

Refugee status and humanitarian protection are almost identical for most practical purposes. A person fearing return to their country of origin isn’t immediately going to quibble over a travel document or domestic violence protections.  The differences are less significant than they were in previous years, some still remain as set out above. Indeed it was these differences which led the government to recognise the need to “upgrade” the humanitarian protection status of resettled Syrians to that of refugees in 2017.

This article was originally published in June 2019 and has been updated so that it is correct as of the new date of publication shown above. Sonia Lenegan and CJ McKinney contributed to a previous update.

For more articles on Immigration please go to www.freemovement.org.uk

HIV updates for 12 month to January 2022 in the UK

Dear friend and colleague, I hope that this information finds you well. Welcome to National AIDS Trust (NAT) newsletter. NAT works with the African Institute for Social Development (AISD) and many other charities in the UK. We are members of the HIV Policy Network.   We've been incredibly busy over the past 12 months, and to bring 2021 to a close, we've rounded up our highlights of the year! These successes wouldn't have been possible without your continued support, so a big thank you to everyone who got involved with our work.

Highlights of 2021 At the start of the year, we continued to support people living with HIV who faced workplace discrimination because of their HIV status and COVID guidance. We ensured that people with HIV who had not disclosed their HIV status to their GP could still access the COVID vaccines. We published the 13th HIV COVID-19 Network Briefing, and ensured that appropriate considerations were made in COVID guidance for people living with HIV. It's A Sin launched in late January, which gave UK viewers an insight into the lives of people living with HIV in the 1980s. Our chair, Professor Jane Anderson, reflected on the dramatic changes to HIV treatment and society's attitude. Guy Duncan reflected on living through the '80s in London as a gay man, and Danny Beales, Head of Policy & Campaigns, compared It's A Sin to today's HIV epidemic. In early March, we launched our HIV and the Police report. It explored how two police forces, Merseyside and Avon & Somerset, were tackling HIV stigma and discrimination. As a direct result of this project, Essex Police created a detailed action plan to combat HIV stigma within the force. Later in the month, thanks to our ongoing work with MPs and other HIV sector organisations, we saw a significant increase to PrEP funding, making the preventative pill more accessible to those who need it.  A big win came in the summer when we saw changes from the Government to allow more gay and bisexual men to donate blood in the UK. We also successfully lobbied for the removal of the discriminatory geographical based question on blood donor screening forms which unfairly impacted Black African communities, among other groups. This has resulted in blood donation being more accessible to all. We worked closely with Public Health England, and other LGBTQ+ and HIV charities to push for these changes, so we were delighted to see this agreed in 2021.  Our HIV and Migration report was successfully launched in June. It was our first project that was co-led by peer experts - people living with HIV who had personal experience of migration - which explored the barriers faced by people born abroad who are living with HIV in the UK. We are now working to produce several videos in different languages to inform migrants of their healthcare entitlements in the UK. We are confident that these will help people access the healthcare they need, and we'll keep you updated with how the rest of this project goes. In June, we published our ageing briefings for both Greater Manchester and Newcastle, exploring how to improve care for people ageing with HIV. Through our local HIV Action Plan advocacy, we are working on building influencing efforts around ensuring that older people living with HIV have good quality care that meets their needs. In July, alongside research agency BritainThinks, we published the HIV Public Knowledge and Attitudes report. This continues to help inform debate across the media and throughout the sector, highlighting the vital work that is still to be done around stigma. We also managed to persuade Public Health England to continue its HIV Innovation Fund for another year. The fund supports projects which aim to address inequalities and poor sexual and/or reproductive health and HIV outcomes, and prior to NAT's intervention it was due to come to an end. August saw the launch of our HIV Indicator Conditions good practice guide, calling for increased testing where a condition could indicate a person could be living with HIV. As a result of this work, NICE updated a number of their clinical guidelines to recommend HIV testing, medical professional bodies we engaged with have changed their guidance and a group of professionals has started looking at piloting HIV testing in cervical screening services in London.  We've continued to engage the Crown Prosecution Service (CPS) regarding an update to their legal guidance on sexual transmission of infection. The CPS agree with us that their guidance should reflect up-to-date clinical understanding of HIV and have accepted our proposed changes. These will mitigate the damage of HIV criminalisation, and we will let you know when the new guidance is published. We published our HIV & Mental Health report in October, which explored why we must improve mental health services for people living with HIV. We are still working with providers to implement the key recommendations made in the report, and we saw great coverage of our mental health work in the media around World AIDS Day. As World AIDS Day approached, NICE approved the first long-acting injectable treatment as an option for people living with HIV. In Scotland the SMC also approved this treatment too. We worked closely with NICE and the SMC throughout the approval of this technology, submitting evidence and appearing at their consideration hearings. We are looking forward to the development of this story throughout 2022. We worked closely with other HIV organisations (THT, BHIVA, and BASHH) and MPs in Parliament to influence the decision made by the Ministry of Defence to allow people living with HIV to join the Armed Forces. Announced on World AIDS Day, the decision is a significant step towards realising equal rights for people living with HIV. This decision also enabled people to take the HIV prevention drug PrEP in the armed forces too without fear of expulsion. Throughout 2021 we have been working to influence the Government’s proposed HIV Action Plan. The plan was published this World AIDS Day, December 1, and outlines the steps the Government plans to take by 2025 to end new HIV transmissions by 2030. Whilst not including everything we hoped for, it did make bold new commitments to decrease HIV transmission 80 per cent by 2025 and implement annual reporting to Parliament, as well as agreeing to £20 millions of new funding for opt-out HIV testing. We warmly welcomed the extra funding and commitment to opt-out testing, but as our Chief Executive, Deborah Gold, made clear there is more work to do and 'if we fail to address structural inequality and wider health disparities, we will fall at the final hurdle'. We continue to do lots of other work behind the scenes and none of this would be possible without you! Thanks for rocking the ribbon once again this World AIDS Day, we provided more than 200,000 red ribbons to individuals and organisations throughout 2021. Your support continues to help us in our mission to stop HIV standing in the way of health, dignity, and equality.    We hope you all enjoy the rest of the festive season, and we can't wait to see what 2022 brings. If there's anything you would like to know more about, please do get in touch at admin@africaninstitute.org.uk at AISD, george.westwood@nat.org.uk at NAT

Time to test and defeat HIV

You might wonder why you’re always seeing articles and news stories about HIV testing. Surely everyone knows about it by now? Well, you may not know that if you are diagnosed early and start treatment on time you can expect to live a near-normal lifespan. You can have a career, relationship and a great sex life. You can also have children who are born without HIV. There’s another really good reason to get tested – HIV treatment is now free for everyone whatever their immigration status. This means that if you do have HIV you can take medicine to keep it under control as soon as you need it. So even if your papers aren’t in order, this is no longer a reason not to test. As you might know, African people are in a high-risk group for getting HIV. In fact over a quarter of African men with HIV don’t know they have it. Africans are also more likely to get diagnosed late when treatment will be less effective. At the moment everyone is encouraged to test for HIV to give them the best chance of a long and healthy life if they are HIV positive. It’s never been easier to get a test. For instance did you know you can get your results from some HIV tests in less than a minute? There are a range of places you can get tested – from your GP surgery to a sexual health clinic to a community centre or your local church. It is now also possible to test at home. HIV postal tests are a new way to have an HIV test. The free kit can be ordered from www.tht.org.uk/postaltest and will arrive in a plain package which will fit through your letterbox. The test can detect HIV around four weeks after you have been infected. All you have to do is prick your finger so a few drops of blood appear. Then you blot your finger onto a card, pop it in the post and wait for your result. You should get it around a week later. You’ll be texted if your result is negative and phoned if you need to come in for another test. You will be given all the support you need and be linked in to a local clinic. There really is no better time to test. Treatment means HIV can be controlled and you have every chance of a long and healthy life. Ignoring HIV won’t make it go away – in fact it means it is more likely to cause problems when it is diagnosed. So for peace of mind why not order a postal testing kit today? Where can I get an HIV test? Sexual health clinics These are usually based in hospitals. You can get a full sexual health screen or you may want advice on family planning or contraception. You can also get an HIV test in a sexual health clinic. The advantage of this is that if your test is positive you will be linked straight in to HIV services and offered counselling and other support. GP surgeries Many GPs offer HIV tests at surgeries. As most of us live close to our GP surgery, a test is only a few minutes away. If you get a positive result your GP will link you in to HIV care. In the community African Institute for Social Development(AISD)www.africaninstitute.org.uk Call or text 07572604343 Is a flexible place to get a HIV test Natonally charities such as Terrence Higgins Trust offer HIV testing in all sorts of convenient community locations. This could be your local church, barber shop or community centre. These clinics offer rapid HIV tests where you may get your result in less than a minute. At home Postal tests mean you can now test for HIV in the privacy of your home. The test is posted to you and when you have completed it you just post it back to our lab. You’ll get your result around a week later – by text if it is negative and by phone if it is positive. The service is private and confidential. To order a free postal test visit: www.tht.org.uk/postaltest or call THT Direct on 0808 802 1221 to find out where to test in your area. TAGS: Family, Featured Slide, health, hiv, hiv test, hiv testing, sex, sexual health, testing

Let's Talk about HIV and black Africans in the UK

African Institute takes a closer look at the importance of talking about the impact of HIV Stigma in the black Africans in the UK. We investigate specialist opinion and GP opinion. We also promote the National HIV Testing Week so that you can get the dates saved. 

The specialist opinion

Dr Iain Reeves, consultant physician in genitourinary medicine, Homerton University Hospital NHS Foundation Trust, London

Undiagnosed HIV remains an important problem in the UK. Those who are unaware of their infection cannot access life-prolonging treatment and face a much greater risk of mortality and morbidity because of late diagnosis.

In 2012, about two-thirds of black African adults were diagnosed with a CD4 count is less than 350 , where treatment is recommended, compared with 47% overall.

In its recent report, HIV and Black African Communities in the UK, the National AIDS Trust has called for urgent action to address this health inequality.

HIV-positive people who do not know their status may also be more likely to transmit the virus to others, because they are unable to use this knowledge to modify risk behaviour and importantly, cannot take advantage of the now clearly demonstrated, very significant reduction in the risk of transmission with successful treatment.²

This may be particularly relevant for GPs, who might also be looking after members of the patient's family, or children born in countries where antenatal testing is not routine.

HIV testing

HIV testing broadly falls into two strategies: diagnosing someone with symptoms as part of a set of investigations, and diagnosing asymptomatic individuals in a more routine testing approach.

The 'Time to Test' report summarised the findings of a number of studies investigating routine, opt-out HIV testing conducted outside traditional sexual health settings.³

The main finding from these studies was that routine HIV testing was generally very acceptable to most patients across all settings, including primary care.

The RHIVA2 study, conducted in primary care in inner London, also demonstrated the feasibility of routine, near-patient HIV testing as part of a new patient check when people register with a general practice.⁴

Concerns about the feasibility and acceptability of routine testing are more often voiced by healthcare staff, often focusing on lack of resources, training and fear of giving a positive result. Some of these fears are based on misconceptions about pretest counselling.

A simple pretest discussion, where a patient is made aware that an HIV test is being carried out as part of routine practice, with an opportunity to withdraw consent, is all that is required.

This approach also removes the risk of patients feeling they are being targeted because of their ethnicity or other characteristics.

Including an HIV test as part of a set of investigations for a particular presenting problem is easily done, especially when blood tests are already planned.

However, it does require thinking about the condition and making an HIV test part of the usual order set, when clinicians may not have it at the forefront of their minds.

For example, acute HIV infection presents as a viral illness and GPs are likely to see many of these individuals. In a study in south London, a significant proportion of those investigated for infectious mononucleosis in fact had acute HIV infection.⁵

A list of illnesses and other conditions where HIV may be part of the differential or important to exclude can be found in the UK national HIV testing guidelines.⁶

The use of audit, or case review, to investigate missed opportunities to test for HIV, for example when someone is diagnosed with an opportunistic infection as an inpatient, may also be a helpful tool for reflection and changing practice.⁷

GPs should be clear about support and treatment services available to newly diagnosed patients.

Support around testing should be readily available from local GUM/sexual health services and there must be pathways for rapid access to HIV care. The support that can be provided by voluntary sector agencies is also invaluable.

How to make HIV testing more acceptable

Display confidentiality statements in areas where patients can see them - for example, in the waiting room, on the practice website, in clinic rooms. Confidentiality needs to be observed by all staff. Put up posters explaining the HIV test is offered routinely in the practice, regardless of background. Offer HIV testing to all new patients when they register - this is deemed cost-effective in areas where diagnosed HIV prevalence is >2 per 1,000 population. It also avoids the problem of targeting or stereotyping certain demographics. Include HIV and hepatitis B tests in NHS checks, especially for those who are at risk. This helps to normalise HIV testing.

The GP opinion

Dr Richard Ma, GP with an interest in sexual health, London

GPs often consider gay men or men who have sex with men (MSM) as a key risk group in the context of HIV testing. Despite being a risk group, current evidence suggests there may be unmet needs when it comes to HIV testing for black Africans.

According to 2012 data from the Health Protection Agency (now Public Health England), almost 31,800 black African men and women were living with HIV in the UK.

This represents an overall prevalence of 26 per 1,000 for African-born men and 51 per 1,000 for African-born women. Of the 1,522 black Africans who were newly diagnosed with HIV in 2012, 66% of men and 61% of women were diagnosed at a late stage of infection.¹

Newly diagnosed black Africans reported that in the 12 months preceding their diagnosis, 76% had presented to healthcare services and 15% to inpatient services.⁸

An audit conducted by the British HIV Association found there had been missed opportunities for earlier HIV diagnosis in a quarter of newly diagnosed individuals.⁹

The role of early diagnosis

Earlier diagnosis of HIV can save lives because antiretroviral treatment can rapidly suppress HIV disease, resulting in reduced infectiousness as well as near-normal life expectancy.

This is why NICE has recommended expanded HIV testing for MSM and black Africans.¹⁰

According to the NICE costing template, a shift of 1% of patients being diagnosed at an earlier stage could produce savings of about £0.22m a year for MSM and £0.27m a year for black Africans in England.

There appears to be plenty of opportunities for more HIV testing to be carried out in general practice.

For example, there is evidence to suggest that black Africans attend general practice, especially those who have had undiagnosed HIV.¹¹

Opt-out testing for HIV was also broadly acceptable to a sample of patients in one study which included MSM and black Africans.¹²

We understand that special issues, such as stigma about HIV in black African communities, may deter people from having HIV tests. Black Africans are also less likely to find support in their own communities.

MSM and black Africans mention a perceived lack of confidentiality as one of the main barriers to test for HIV in general practice settings.

Some clinicians may find it difficult to offer HIV testing opportunistically to black Africans for fear of perceived racial stereotyping. There may also be perceived difficulties for those who test positive, for example, lack of support, problems within the community, immigration problems and entitlement to HIV care.

References and on going national campaign logo

1. Public Health England. HIV in the United Kingdom: 2013 Report. London, PHE, November 2013.

2. Cohen M, Chen Q, McCauley M et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med 2011; 365: 493-505.

3. Health Protection Agency. Time to test for HIV: Expanding HIV testing in healthcare and community services in England. London, HPA, September 2011.

4. Leber W, McMullen H, Marlin N et al. Point-of-care HIV testing in primary care and early detection of HIV (RHIVA2): a cluster randomised controlled trial. Lancet 2013; 382: S7 (conference abstract).

5. Hsu D, Ruf M, O'Shea S et al. Diagnosing HIV infection in patients presenting with glandular fever-like illness in primary care: are we missing primary HIV infection? HIV Medicine 2013; 14: 60-3.

6. British HIV Association, British Association of Sexual Health and HIV, British Infection Society. UK National Guidelines for HIV Testing 2008.

7. Whittle A, Wellesley R, Griffiths C et al. Increasing opportunities for HIV diagnosis in primary care: a borough-wide evaluation of HIV testing and pre-diagnosis care in general practice. British HIV Association Spring Conference April 2013. Oral abstract O2.

8. Burns FM, Johnson AM, Nazroo J et al. Missed opportunities for earlier HIV diagnosis within primary and secondary healthcare settings in the UK. AIDS 2008; 22(1): 115-22.

9. Ellis S, Curtis H, Ong EL. HIV diagnoses and missed opportunities. Results of the British HIV Association (BHIVA) National Audit 2010. Clin Med 2012; 12(5): 430-4.

10. NICE. Increasing the uptake of HIV testing among black Africans in England. PH33. London, NICE, March 2011.

11. Rice B, Delpech V, Sadler KE et al. HIV testing in black Africans living in England. Epidemiol Infect 2013; 141(8): 1741-8 doi: 10.1017/S095026881200221X

12. Glew S, Pollard A, Hughes L. Public attitudes towards opt-out testing for HIV in primary care: a qualitative study. Br J Gen Pract 2014; doi: 10.3399/bjgp14X677103

Resources

• The African Institute refers to the National AIDS Trust recent report. click on the link HIV and Black African Communities in the UK. June 2014: a policy report. London, National Aids Trust, June 2014. for more information call or text on 07572604343 or contact us on the website:
• www.africaninstitute.org.uk
• www.nottingham.ac.uk/health4u