HIV should be reclassified as a sexually transmitted infection so that treatment would be free to all patients, as it is for other such infections, MPs said this week.
A report on sexual health and HIV services by the House of Commons health select committee said people entitled to HIV treatment were being refused it because doctors were confused over who was eligible under last year's tightening up of the 12 month residency rule. This rule says that illegal immigrants, failed asylum seekers, visa overstayers, and other illegal residents are no longer entitled to free care in the NHS for HIV and AIDS even if they have been in the United Kingdom for 12 months.
In evidence to the committee doctors reported feeling compromised by having to play a “gatekeeper” role in determining a patient's eligibility.
Dr David Asboe, a consultant in genitourinary medicine at the Chelsea and Westminster Hospital, said: “It is clear that the General Medical Council says you must make the primary care of the patient your first concern. That is in direct conflict with some of these decisions that are needing to be made.”
MPs were astonished at the Department of Health's admission that it had not costed the known benefits of the new rules and did not know how many people they applied to. Their report said: “We have received powerful evidence that it would be more cost effective to provide free HIV treatment to all.”
The committee also reported that numbers of HIV and sexually transmitted infections had continued to rise since its last report in 2001 and that genitourinary medicine clinics will find it very hard to meet the 2008 target of a 48 hour access time, as waiting times had worsened. Poor facilities were another barrier to service expansion, it said.
“We welcome the extra investment of £130m ($250m; €190m) over three years, but estimates provided suggest that around £150m of capital funding would be needed to modernise GUM [genitourinary medicine] and up to £30m per year revenue funding,” the report said. By not mobilising GPs to prioritise sexual health through the general medical services contract, the government had wasted an opportunity to ease pressure on hospital services, it said.
New Developments in Sexual Health and HIV/AIDS Policy is available at www.parliament.uk