“If I cannot access services, then there is no reason for me to test”: the impacts of health service charges on HIV testing and treatment amongst migrants in England

Abstract

Policy governing entitlement to access government health care for foreign nationals in England is a subject of debate, controversy and confusion. Of particular concern to health providers has been the impact of National Health Service charges on delaying HIV testing and anti-retroviral treatment uptake and adherence amongst certain migrant groups. Data obtained through focus groups with 70 migrants from southern Africa, suggest that confusion over health care entitlements exists amongst those seeking health care and is reported amongst health service providers. This confusion, as well as financial difficulties and fears over deportation facing some migrants, can in turn be a factor influencing their decisions to avoid formal health services, resort to alternative and often ineffective or potentially adverse forms of therapy, and delay HIV testing and treatment uptake.

Keywords:

• late HIV testing
• African migrants
• England
• southern Africa
• HIV treatment

Notes

1. Most health care provided via the NHS is free at the point of delivery.

2. Primary health care, e.g., access to a GP, is available free at point of delivery for all people at the discretion of the provider.

3. Responsibility for health policy is devolved in Wales, Scotland and Northern Ireland where implementation of rules on health care entitlements is slightly different. This paper focuses on the situation in England.

4. A few were sceptical of the NHS and preferred to use African treatments.

5. All names have been changed to protect participant identity.

6. Not to do so is considered to risk breaching the Human Rights Act 1998.

7. The Court of Appeal decision ruled that patients may be able to access treatment by arguing that it is urgent or immediately necessary and that they cannot return home at present to seek treatment there. They are still liable to be charged, but treatment cannot be refused if they cannot pay (Hundt, 2009).