New laws could force foreign students and immigrants in UK to pay for healthcare. AIDS activists, Act Up London, think this could increase the spread of HIV.
1. Why should young people be concerned about the health care clauses in the UK’s new immigration bill?
Because they represent a huge change in the 65 year history of the NHS. Up to this point, anyone who came to live in the UK on a settled basis was considered ‘ordinarily resident’ and eligible for free NHS coverage. One of the clauses would change that definition—under the new rules, only people who’ve become ‘permanent’ residents (which generally happens after staying here 5 years or more) would be able to receive free coverage. For the first time, charges are going to be extended to primary and emergency care, which means that, if you’re not a permanent resident, you will have to pay a surcharge to visit a GP and would also have to pay for services in A&E.
These new surcharges will apply to any person from a non-European Economic Area country who comes into the UK on a visa of 6 months or longer. Obviously, that includes a lot of young people, whether they are students or workers.
NHS numbers will be linked to a Home Office database, and presumably medical staff will need to check everyone’s identity, residency status, and payment information before treating them to check that they ‘deserve’ medical care. The UK system would become more like the American system where people need to prove that they’re covered, rather than the old NHS philosophy of universal coverage ‘free at the point of access’.
2. How will these clauses affect foreign students in the UK?
The exact rules about the surcharges are not entirely known. The Government has indicated that they expect the charges would be paid when applicants apply for visas, which may mean that students have to pay an additional £150–200 when they apply to come to the UK. It may be that they need to pay that surcharge on an ongoing basis if they stay longer.
The clauses would also create charges for A&E services—urgent emergency care will not be denied, but the patient may have to pay after the fact.
You can imagine a situation where someone may not even be conscious when they come into A&E and then would face a major bill that they never agreed to. And remember that any unpaid NHS debt of over £1000 means a person could lose their right to apply for further leave to remain here. These unanticipated charges could literally be life-changing in ways that people never bargained for!
3. What are the wider implications of this bill in terms of HIV?
22% of people in the UK living with HIV don’t know their status, and more than half of new infections are passed on by people who don’t know they have the virus. Many people, especially in migrant communities, don’t find out about their HIV by going into a sexual health clinic for a test, they go to visit a doctor for some other health issue and the doctor recommends getting tested.
If the fear of charges or worries about immigration status make people afraid to go to the doctor then there will be many more undiagnosed cases of HIV. People won’t find out their status until much later, when their health has gotten much worse—and after they’ve been much more likely to infect many more people.
HIV+ people who know their status and are on treatment are much less likely to infect others, which is why HIV treatment is freely available to everyone in the UK. However, if people are discouraged from visiting the doctor then they won’t learn that they need to get on treatment in the first place!
HIV charities like the National AIDS Trust are very concerned about the public health impact that these clauses will have. They think that charging for primary care will lead to much higher rates of HIV infection and greater costs to the system in the long run.
4. What is Act Up doing to raise awareness of HIV and the implications of this immigration bill? How can people get involved?
ACT UP is a diverse, non-partisan group of individuals committed to direct action to end the HIV pandemic. We want the wider population to be aware of the dangerous implications of these new measures—not just for migrants, but for the population at large.
HIV doesn’t do borders, so why should the NHS? We all benefit when everyone living in the UK gets easily accessible medical treatment.
We want to make some noise about this issue and to tell the Government to keep the Home Office out of the NHS, through awareness-raising campaigns and major public actions.
In fact, we’re planning a big, fun, creative action coming up soon. Everyone should come to our meeting on Weds, April 30, in London where we’ll be recruiting people to help us.
Anyone who’s concerned about this issue should email us on firstname.lastname@example.org—we’ll send them details of the meeting, and other ways to get involved.
Everyone should also sign on to ACT UP’s petition—and share it widely with all networks—so that we can push the Government to address our concerns.
ACT UP! Fight AIDS! We are STILL not silent!