Why barriers at the UK border won’t work for HIV

The Guardian, UK

10/10/2014

Sarah Boseley, health editor

Nigel Farage may want to suggest otherwise – with his proposal that people with HIV be barred from entering the country – but most people who have the virus in the UK were born here. According to Public Health England, which has collected and analysed the statistics ever since HIV emerged over 30 years ago, 62% of those who were newly infected with the virus in 2012 were born in the UK.

The actual numbers are fairly small. There are 98,400 people living with HIV infection in the UK, of whom about 53,000 (the numbers are all estimates) are heterosexual.

There are 41,000 infected men who have sex with men, or MSM, and it is in this group that numbers are rising, to the alarm of HIV specialists.

Public Health England does not give the figures for people in this group who came to Britain from another country; most are assumed born here.

Its latest report, however, says that among the 53,000 heterosexuals with HIV, 11,000 were African-born men and 20,700 were African-born women.

The figures suggest the HIV epidemic in the UK is not being massively fuelled by immigrants from sub-Saharan Africa, where the incidence is so much higher.

Turning back people with HIV who want to live and work in the UK could be a problem. Some who arrive do not know they are infected. People can be well for a decade before they begin to get symptoms. That is one of the main issues doctors are trying to address in the UK and rest of the world.

Globally, we need to know who has HIV for this important reason: there is now clear evidence that if people with HIV are given antiretroviral drugs they not only stay alive and well and can get on with a normal life, they stop being infectious; the level of virus in the body drops so low it is not passed on to sexual partners.

So, one of the big focuses of the international effort against Aids is getting people tested. For that to happen, the stigma of HIV and Aids has to go, but it has proved hard to shift. Two years ago the ban on people with HIV entering the US was lifted. It had kept out only those who were open about their infection; they tended to be brave and vociferous campaigners – who ensured the US got regular doses of bad publicity for closing its borders to them.

A ban will never keep out those who do not know, or those who do not want to admit it. HIV testing is voluntary, worldwide. No one is going to set up booths with testing kits at Heathrow and Gatwick airports, let alone at the  Channel ports. Anyone with HIV who wanted to come in would still be able to do so. But they would feel unwelcome and they would be secretive and probably they would not seek a voluntary test and treatment. And that would keep the UK epidemic – now declining slightly year on year – going.