A number of removals of HIV+ detainees that Medical Justice are involved with have been stopped because the BHIVA guidelines were breached.  Please read the below to find out how you may be able to help an HIV+ ensure they benefit from the guidelines.

The new BHIVA guidelines (page 13) state that ;
1) 3 months supply of anti-retroviral medication should be supplied to people with HIV on removal
2) they should also be  given a letter for their future treating physicians, and             
3) contact details of trusted HIV support organisations in the country the detainee is being removed to.

Page 12 of the guidelines states that ‘Upon notification that an HIV positive detainee is to be removed, IRC [immigration removal centre] healthcare staff should inform the local HIV specialist of the detainee’s pending removal and ensure the detainee is provided with sufficient medication. Normal NHS clinical practice is to dispense three months’ supply of ARV medication. This will cover detainees during the removal process and arrival in their destination country.’

In the case of Yarl’s Wood, the local clinic is Bridge House GUM clinic at Bedford Hospital.

These guidelines are endorsed by Dr Celia Grummit of the IRC Healthcare Steering Group (see page 4 of the guidelines).  Given her position and the Secretary of State's avowed policy to provide NHS equivalent care to immigration detainees (see Home Office Operating Standards Manual for IRCs) if a person facing removal has not been provided with 3 months medication, removal might be stopped on the basis that the guidelines have been breached.

If it is clear that someone needs to start anti-retroviral (ARV) treatment but cannot do so before removal (e.g. because the necessary resistance tests have not been done yet), legal representatives might be able to make representations to the effect that the person should not be removed until it is possible to provide them with 3 months appropriate anti-retroviral medication.

Indications that someone may need to start on ARVs may include ; the person is HIV+, has a low CD4 count, has a letter from a specialist that they need or may need ARVs (this could include a letter following their HIV diagnosis), or they have been on ARVs in the past.  Tests have to be done before someone is started on ARVs.
 
What you can do when someone is scheduled to be removed in breach of the guidelines ;
- Call up the local specialist clinic (listed in the BHIVA guidelines p 20-21) and find out whether they have been informed of the removal and whether they are supplying 3 months of appropriate medications.
- If they have not been informed and can’t provide the necessary medication, provide the detainee's legal representative with a copy of the BHIVA guidelines and information on the person’s medical condition and possible complications, and ask if legal representations can be made.
- If there is no legal representative or the legal representative is not able/willing to make representations on the basis of the BHIVA guidelines, you could contact the MP (either the MP in whose constituency the detainee was living prior to detention or the MP in whose constituency the detention centre is) and/or the detainee could directly make their own representations to the responsible home office caseworker.

Fitness to travel / is the detainee medically stable
Page 10 of  the guidelines says  "At least 95%  adherence to treatment is required , as even one or two missed doses can seriously compromise both the efficacy of therapy and lead to drug resistance.   This means missing no more than one dose a month if  a detainee is taking once-daily therapy, or two doses a month if a detainee is taking twice daily therapy.   IRC healthcare staff should ensure that every detainee in need gets their medication each day."

If medication has been missed then removal may need to be delayed until it has been established that the medication is still effective.

Page 13 says "Final judgement as to whether an HIV positive detainee is medically stable and is fit to travel must be determined on a case-by-case basis and should always rest with the IRC GP in consultation with HIV specialists."  A non exhaustive list of medical issues that should be considered are ;

- the person is pregnant or has given birth less than six months previously
- the person is awaiting an HIV test result or appropriate post-test counselling and a baseline assessment to clarify clinical condition
- the person has had a recent, new HIV diagnosis, or having just started ARV therapy or a new drug regime
- the person has a co-infection with another sexually transmitted infection or tuberculosis
- the person has co-existing mental health issues
- there are ongoing medical complications

Referring a case to Medical Justice / getting advice from Medical Justice
Please complete a referral form (a link to which can be found at the bottom of this webpage ).  Please note that making a referral means you are making a commitment to gather all necessary information and progress the case yourself as far as possible.  So you must ensure that you ascertain all relevant information about the detainee mentioned in "Using the BHIVA guidelines" and include it in the referral form.
 
Contact : This e-mail address is being protected from spam bots, you need JavaScript enabled to view it / 07807 726546

Note on children detained with an HIV+ parent
Some removals of families with a parent who is HIV+ have been stopped by the European Court of Human Rights (ECHR).  Medical Justice has no information on ECHR's basis on stopping these removals, if they are stopping all such removals, or for how long ECHR may stop such removals.  You may want to contact ECHR or make an application to ECHR about such removals - ECHR website.

Medical Justice does not give immigration advice
Medical Justice is not qualified to give immigration advice and suggests that immigration advice is always sought in every case from a qualified advisor.