Treatment charges for primary care may undermine success of HIV programme

17 December 2012

The introduction in October this year of free HIV treatment to everyone in England is an acknowledgement of the great public health benefit of providing antiretroviral treatment to people living with HIV.  Research has demonstrated a 96% reduction in onwards transmission when someone is on effective treatment. HIV treatment is life-saving and essential to preventing serious illness.

However, there are two major risks to the fight against the spread of HIV infection, according to a report by the National Aids Trust  (NAT) - one is a lack of awareness among people who need screening the most, and the other is the possible introduction of charges for accessing primary care, depending on residency status.

The NAT report says that a quarter of people living with HIV in the UK do not yet know they have it. They are not accessing treatment and may unwittingly pass their infection on to others. The crisis of undiagnosed and late-diagnosed HIV is most severe in migrant communities, many members of which face barriers to accessing primary and secondary care.

In 2010, half of people newly diagnosed with HIV were diagnosed late, meaning they should already have started treatment. When categorised by ethnicity, late diagnosis was highest amongst African-born men (66%) and women (61%), followed by Caribbean women (59%) and men (47%). The crisis is most severe amongst migrant communities, says the report.

In addition, compared with the rest of the population, this group is much more likely to be diagnosed with HIV in a GP surgery or hospital than in a sexual health clinic. Between 2006 and 2009, one in three BME people diagnosed with HIV were tested outside a sexual health setting, compared to one in five newly diagnosed white people.

Reducing migrants’ access to primary care therefore not only excludes them from one possible setting for HIV diagnosis – it keeps them away from one of the settings most likely to encourage them to test. 

The report sets out the evidence for why continued (and improved) universal access to primary care is an essential underpinning to the NHS’s current efforts in HIV testing, treatment and prevention.

Read the full briefing here