HIV services expanded for displaced migrants in wake of Ukraine war and regional turmoil

Navigating HIV services during migration crisis in Eastern Europe and Central Asia

Countries affected by the migration crisis in Eastern Europe and Central Asia, prompted by the war in Ukraine and other turmoil in the region, have had to put in place measures so that all displaced people have access to essential HIV services.

Key Figures:

In 2022, Europe was confronted by the largest refugee crisis since World War II.
As of February 2024, nearly one-third of Ukraine’s population remains displaced, with 6.3 million Ukrainian refugees globally, primarily concentrated in Europe, 62% of them are women.
In 2022, around one million Russian citizens emigrated, with many choosing prolonged stays abroad.
Central Asian countries witnessed the biggest influx of international migrants since their independence.
Up to 300,000 Belarusians left their country since May 2020.
Migration from Central Asia to Russia surged in 2023, with notable increases in Uzbek, Kyrgyz, and Tajik nationals entering for work purposes. (ICMPD Migration Outlook Eastern Europe and Central Asia 2024)
The HIV epidemic is growing in Eastern Europe and Central Asia, with Russia, Ukraine, Uzbekistan, and Kazakhstan accounting for 93% of new infections in the region combined.

Surviving the devastating events of March 2022 in Mariupol, Ukraine, uncertain of what the future held, Svetlana fled her hometown.

“Mariupol was a scene of utter destruction. I had a packed suitcase, but I left it behind, only taking with me a dog and a cat,” recalls Svetlana. “With assistance, we managed to reach the Polish border, eventually finding refuge in Lithuania.”

Living with HIV since 2000, Svetlana relies on anti-retroviral treatment (ARV) to keep the virus at bay by taking a tablet a day. In haste, she had only taken one pill box.

Upon her arrival in Lithuania, she connected with an online organization that within days helped her to obtain her life-saving medicine from a doctor.

Svetlana is one of 70 participants in 6 countries in the Regional Expert Group on Migration and Health (REG) study that assessed the healthcare access for Ukrainian refugees using qualitative methods. According to Daniel Kashnitsky, the lead REG expert, “insights from specialists and service recipients revealed that all HIV-positive refugees had access to treatment across EU host countries.”

After recovering from the initial shock, the European Union activated the Temporary Protection Directive, establishing legal guidelines for managing mass arrivals, offering humanitarian aid, and ensuring access to life-saving antiretroviral treatment and basic HIV services to those in need.

Outside the EU, in countries like Moldova and Georgia, special regulations ensure free access to HIV services. Moldova’s National AIDS Coordinator, Yuri Klimaszewski, underscored that Moldova provided HIV services to refugees like it does for its citizens.

The study also revealed that some refugees struggled in host countries, leading to challenges maintaining treatment adherence. Tatyana (name changed) left Odessa along the Black Sea in April 2022.

But she returned home because she could not find adequate support under the opioid maintenance therapy program in Poland. She found it complicated to reach the service point, the language barriers prevented her from communicating her needs with medical staff, and she lacked community support.

“Despite the unprecedented support shown by European countries to Ukrainian refugees, systemic issues, particularly bureaucratic complexities, require proactive intervention by social workers, community organisations and volunteers to effectively address these challenges,” said Mr Kashnitsky. Additionally, he added, “there is a pressing need to tackle the stigma faced by people living with HIV and other key populations, such as people who use drugs.”

Uladzimir, who left Belarus for Poland in the first days of the war in Ukraine, needed about a month to start receiving ARV treatment. First, he had to obtain “international protection”, then confirm his HIV status and wait for an appointment with a doctor. But once all that was cleared, he had access to all the necessary services. For many accessing services is not as straightforward as it is for Ukrainian refugees, according to the REG study “Forced migrants with HIV status: social psychological and medical aspects of adaptation”

Legislation in some countries makes accessing HIV prevention and treatment for migrants challenging. And in some cases, national healthcare systems may lack resources to meet the influx of people and their needs.

As the Russian Federation continues to deport migrants living with HIV, those who remain in Russia due to the inability to return home or for family reasons are compelled to stay in the country illegally. They are deprived of HIV treatment and health services. Some have succeeded by receiving treatment remotely (ARVs sent to them with the help of countries of origin).

Recommended strategies, as outlined by the REG study, include improving the system of informing people about potential risks and available HIV services abroad, establishing health insurance protocols, and supporting community organizations that provide HIV services.

Removing legal provisions that discriminate against migrants living with HIV will also reduce barriers to accessing antiretroviral therapy, resulting in significant improvements for public health in the region.

Eamonn Murphy, UNAIDS Regional Director for Asia Pacific and EECA regions, praises the collaborative efforts involving various stakeholders, including governments of countries of origin and host countries, community organizations, the Joint UN Programme on AIDS, and donors.

However, he says more needs to be done. “There is an urgent need to work on the legalization and standardization of such approaches to ensure all people on the move can access essential services and remain on treatment wherever they are.”

The Golondrinas strategy connects HIV positive migrants to medical care in LAC region

Golondrinas’ project seeks to guarantee care for migrants with HIV

Translated with Deepl.com; For original article in Spanish, please scroll down.

It is a strategy for people arriving in another country to continue with the necessary treatment.

A person with HIV who leaves his or her country may experience difficulties with treatment or care elsewhere. While anyone can access the Universal Health Insurance (SUS) in Bolivia, the issue is made difficult due to forms and other issues; however, access to medicines for migrants carrying the virus has been achieved, according to the head of Health and Human Rights Projects at the Institute for Human Development (IpDH) in Cochabamba, Karina Rojas.

The ‘Golondrinas’ strategy seeks to ensure health care for migrants with HIV in the countries through which they pass or stay.

The Americas and Caribbean Platform of Coalition Plus held its annual meeting earlier this year in Cochabamba. The director of the Institute for Human Development (IpDH), Edgar Valdez, explained that the Platform’s members are Colombia, Guatemala, Argentina, Dominican Republic, Canada, Ecuador and Bolivia.

The meeting is a space to address issues such as policies, human rights in each country, budgets and how to work together on this issue, as each country has differences and similarities regarding access to treatment, the vulnerability of people with HIV, stigma and discrimination.

Another issue that stands out is related to migration and the ‘Golondrinas’ strategy.

The head of IpDH’s Health and Human Rights Projects explained that the ‘Golondrinas’ project was born in one of the meetings of the Platform of the Americas and the Caribbean, because it is a necessity for this vulnerable population; migrants with HIV.
‘People who migrate, sometimes do so irregularly and, therefore, it is very easy to violate their rights’.
She said that, in response to this situation, they submitted a project to the French Development Agency, which is currently providing funding. It consists of providing sexual health services along the route taken, in the case of Bolivia, by people arriving from Venezuela, as well as Haiti, Peru, Colombia and other countries.
Valdez explained that the project is integrated between French Guiana, Ecuador, Guatemala, Colombia, Bolivia and Argentina.

‘In other words, we want to provide health care and their rights as immigrants. It is a health support to all people with HIV, to all migrants of sexual diversity and to all women who also come here to Bolivia. In general, they are in transit, but some of them also stay. So there is legal support.

She added that there are organisations, such as Caritas and the government, which also work on other aspects.
‘We are seeing how we can articulate how to respond to this population that is extremely vulnerable because of their migrant status, because of the discrimination they may suffer and the stigma. So it is a space for them to consult, receive care and, of course, medicines.

Rojas described how they have seen cases where it has been possible for people with HIV from other countries to access treatment.

‘By advocating and explaining that health comes before the legal situation, people with HIV who need treatment have been able to access and collect from Cdevir (Centro Departamental de Vigilancia y Referencia para casos de VIH), for example.
In Cochabamba, Bolivia, there is still not much progress. But there is a need.
‘We are contacted by people who migrate, who have HIV; they have contacted us because they want to pick up their retroviral treatment or they don’t want to stop taking their medication.

He stressed that the right to health comes before documents.

The director of the Red Somos de Colombia Community Medical Unit, Jhon Ramirez, said that his country receives Venezuelan migrants who are in transit through Colombia to South or Central America.

‘The project consists of being able to approach migrants, identify their HIV status, get them into treatment and, if they are passing through, refer them to the organisations that are part of the Americas and Caribbean Platform of Coalition Plus, which have resources from the Golondrinas strategy.

The risk in ‘survival sex’ practices
For a migrant person, in their need to move from one place to another, to have sex with a trailer driver, as an example, is a survival sex practice.

The director of the Red Somos de Colombia Community Medical Unit, Jhon Ramirez, explained that there are also known cases of migrants agreeing to sex in exchange for food or a room with a bathroom or other basic necessities.
Valdez described that countries such as Colombia and the Dominican Republic receive migrants from Haiti; in addition, people from Venezuela also arrive in Colombia and Ecuador. However, in most cases they are in transit to Chile, Argentina and others.

‘We are also trying to see if there are people who want to stay in Bolivia; we protect their rights to see how they can be legal, what Bolivian laws protect these people.

Karina Rojas, head of IpDH’s Health and Human Rights Projects, stressed the importance of offering sexual health services, that is, that they can access HIV testing, ‘women can access family planning’, and treatment for sexually transmitted infections.
‘As they are a vulnerable population, sometimes they do sex work. We want to partner with other organisations that work on migration from another point of view; for example, Caritas here in Cochabamba has a shelter, so we can refer them to the shelter and they can refer us to the health services.

The IpDH director explained that ‘Golondrinas’ is related to access, above all, to universal health care.
‘We focus specifically on people with HIV, sexual diversity and, of course, sex workers as well, so everything related to sexuality, violence (…). We are always reflecting on these issues, the issue of migration.
For Ramírez, there are complex issues.

‘But the most complex part of the situation is that people do not have access to condoms, access to antiretrovirals, access to combined prevention strategies, such as access to PREP (pre-exposure prophylaxis), access to post-exposure therapy, and this is closely linked to issues of survival sex practices,’ he said.

Aiming for a single international code for patient access to treatment
The director of the Red Somos de Colombia Community Medical Unit, Jhon Ramirez, said that the ‘Golondrinas’ strategy aims to ensure that migrants with HIV have access to a single code that allows them access to treatment in other countries, if they leave their own.

‘The strategy is to let the migrant population know that in Bolivia there is the IpDH, that here they can access prevention services, that they can access medical treatment, counselling; this is the most important thing we have to do (…), so that the person knows that on the route to South America they will find Kímirina in Ecuador, the IpDH in Bolivia and the Fundación Huésped in Argentina’.
These organisations will be able to guarantee some kind of medical support in their migratory transit, in order to be able to successfully refer people.
‘The idea is to have a referral and counter-referral system so that, if I give a doctor in Colombia, in Ecuador they can see what medication this person has and there are no barriers to access.
The aim is to have a system at international level, and that each person has a unique code to be used at the time of the interview with the doctor or nurse in the programmes.
‘The code will be for the professional to access their medical history, so that the doctor in Colombia can see the treatment in Bolivia, to continue the same treatment, because they can sometimes open the entire clinic; and also so that the person has a reference code so that they can access this information.

DATA IN COLOMBIA Ramírez explained that in his country there are 7 million Venezuelan migrants. Of these, according to Colombian immigration data, two million have a vocation to stay, and the rest are migrants who are passing through to other countries in the region.

‘We seek to address 3,700 migrants and refer them to sexual health, reproductive health and HIV prevention services, as a strategy to control indicators of public health interest in our countries. An important part of the Golondrinas strategy is to establish the needs of the migrant population in terms of sexual health, reproductive health and other pathologies.
He added that it is estimated that in Colombia there are around 22,000 Venezuelan migrants who could be living with HIV.
‘We have identified 4,500, who are in the health system in Colombia. We still need to look for another 18,000 people who may be living with HIV and do not know it at the moment.

She added that a study carried out with George Hawkins University showed an HIV prevalence rate of 0.9% and 5% for syphilis.
The head of IpDH’s Health and Human Rights Projects explained that in Cochabamba there are still no statistics available.
‘We have also tried to incorporate this nationality data, for example, into the Simone (Computer System for Monitoring and Evaluation of the National HIV Programme), which is the monitoring system of the Ministry of Health, but there is still no data that we can reflect,’ said Rojas.

However, he assured that the doors of the IpDH are open for those who need antiretroviral treatment if they have HIV; for those who had risk situations, sexual violence; for testing and others referred to sexually transmitted infections.
‘What we want is that they don’t cut off the health services they need along the way.

Proyecto ‘Golondrinas’ busca garantía de atención a migrantes con VIH

Se trata de una estrategia para que las personas que llegan a otro país puedan continuar con los tratamientos necesarios.

Una persona con VIH que deja su país puede atravesar dificultades en torno a su tratamiento o atención de salud en otros lugares. Si bien, cualquier persona puede acceder al Seguro Universal de Salud (SUS) en Bolivia, el tema se dificulta debido a los formularios y otros; sin embargo, se ha conseguido el acceso a medicamentos para migrantes que portan el virus, según describió la responsable de Proyectos de Salud y Derechos Humanos del Instituto para el Desarrollo Humano (IpDH) en Cochabamba, Karina Rojas.
La estrategia ‘Golondrinas’ busca que se garantice la atención en cuanto a salud a personas migrantes con VIH en los países por donde pase o permanezca.

La Plataforma de las Américas y el Caribe de Coalition Plus realizó su reunión anual en días anteriores, en Cochabamba. El director del instituto para el desarrollo Humano (IpDH), Edgar Valdez, detalló que son miembros de la Plataforma los países de Colombia, Guatemala, Argentina, República Dominicana, Canadá, Ecuador y Bolivia.
El encuentro es un espacio para abordar temas como las políticas, los derechos humanos en cada país, los presupuestos y cómo trabajar de manera conjunta frente a esta problemática, ya que cada país tiene diferencias y semejanzas respecto al acceso al tratamiento, a la vulnerabilidad de las personas con VIH, al estigma y discriminación.
Otro de los temas que resalta es el relacionado con la migración y la estrategia denominada ‘Golondrinas’.
La responsable de Proyectos de Salud y Derechos Humanos del IpDH expuso que el proyecto ‘Golondrinas’ nació en una de las reuniones de la Plataforma de las Américas y el Caribe, porque es una necesidad para esta población vulnerable; los migrantes con VIH.
“Las personas que migran, lo hacen, a veces, irregularmente y, por lo tanto, es muy fácil vulnerar sus derechos”.
Dijo que, ante esa situación, presentaron un proyecto a la Agencia Francesa de Desarrollo y, en la actualidad, otorga financiamiento. Consiste en dar servicios de salud sexual a lo largo del recorrido que hacen, en el caso de Bolivia, personas que llegan de Venezuela, además de Haití, Perú, Colombia y otros países.
Valdez detalló que el proyecto está integrado entre Guyana Francesa, Ecuador, Guatemala, Colombia, Bolivia y Argentina.

“Es decir que, queremos brindar atención de salud y sus derechos como inmigrantes. Es un apoyo de salud a todas las personas con VIH, a todas las personas migrantes de diversidad sexuales y a todas las mujeres que vienen también aquí a Bolivia. En general, son en tránsito; pero, algunas se quedan también. Entonces hay un apoyo jurídico”.

Agregó que existen organizaciones, como Cáritas y la Gobernación, que también trabajan en otros aspectos.
“Estamos viendo cómo articulamos para responder a esta población que es extremadamente vulnerable por su condición migrante, por la discriminación que pueden sufrir y el estigma. Entonces, es un espacio para que ellos puedan consultar, recibir atención y, por supuesto, los medicamentos”.
Rojas describió que atendieron casos en los que fue posible que personas con VIH de otros países accedan a sus tratamientos.
“Haciendo incidencia y explicando que antes que la situación legal está la salud, las personas con VIH que necesitaban tratamiento, han podido acceder y recoger del Cdevir (Centro Departamental de Vigilancia y Referencia para casos de VIH), por ejemplo”.
En Cochabamba, Bolivia, todavía no existen muchos avances. Pero, hay necesidad.
“Nos contactan personas que migran, que tienen VIH; nos han contactado porque quieren recoger su tratamiento retroviral o no quieren dejar de tomar sus medicamentos”.
Remarcó que por encima de los documentos está el derecho a la salud.
El director de la Unidad Médica Comunitaria Red Somos de Colombia, Jhon Ramírez, expresó que su país recibe migrantes venezolanos, que van de tránsito por Colombia hacia Suramérica o Centroamérica.
“El proyecto consiste en poder abordar a las personas migrantes, identificar su estatus serológico a VIH, entrarlos en tratamiento y, si van de paso, poderles referenciar a las organizaciones que hacen parte de la Plataforma de las Américas y el Caribe de Coalition Plus, que cuentan con recursos de la estrategia Golondrinas”.

El riesgo en las “prácticas de sexo por supervivencia”
Que una persona migrante, en su necesidad de traslado de un lugar a otro, tenga relaciones sexuales con un conductor de un trailer, como ejemplo, es una práctica de sexo por supervivencia.

El director de la Unidad Médica Comunitaria Red Somos de Colombia, Jhon Ramírez, explicó que también se conocen de casos de personas migrantes que acceden a relaciones sexuales a cambio de comida o de una habitación con baño u otros enseres o elementos básicos.
Valdez describió que países como Colombia y República Dominicana reciben migrantes de Haití; además a Colombia y Ecuador también llega gente de Venezuela. Aunque, en la mayoría de los casos son de tránsito a Chile, Argentina y otros.

“Nosotros estamos también tratando de ver si hay alguna persona que quiere quedarse en Bolivia; le protegemos sus derechos para ver cómo puede ser legal, cuáles son las leyes bolivianas que le protegen a esas personas”.
La responsable de Proyectos de Salud y Derechos Humanos del IpDH, Karina Rojas, remarcó la importancia de ofrecer servicios de salud sexual, es decir, que puedan acceder a pruebas de VIH, “las mujeres a planificación familiar”, tratamiento de infecciones de transmisión sexual.
“Como es una población vulnerable, a veces, hacen trabajo sexual. Entonces, es un riesgo también de violencia sexual en ese trayecto (…). Queremos asociarnos a otras organizaciones que trabajan la migración desde otro el punto de vista; por ejemplo, Cáritas de aquí de Cochabamba tiene un albergue; entonces, nosotros podemos referir al albergue y ellos pueden referirnos a los servicios de salud”.
El director del IpDH explicó que ‘Golondrinas’ tiene relación con el acceso, sobre todo, a salud a nivel universal.
“Nosotros nos concretizamos de manera específica en las personas con VIH, en las diversidades sexuales y, por supuesto, las trabajadoras sexuales también; entonces, todo lo relacionado a la sexualidad, la violencia (…). Siempre estamos reflexionando en esas temáticas, el tema de migración”.
Para Ramírez, existen temáticas complejas.
“Pero, lo más complejo de la situación es que las personas no tienen en su tránsito migratorio acceso a condones, acceso a antirretrovirales, acceso a estrategias de prevención combinada, como el acceso a la PREP (profilaxis previa a la exposición), el acceso a la terapia postexposición, y esto va ligado mucho a temas de prácticas de sexo por supervivencia”, sostuvo.

Apuntan al código único internacional para acceso al tratamiento de pacientes
El director de la Unidad Médica Comunitaria Red Somos de Colombia, Jhon Ramírez, expresó que la estrategia ‘Golondrinas’ apunta a que las personas migrantes con VIH tengan acceso a un código único que les permita el acceso a tratamiento en otros países, si es que sale del suyo.

“La estrategia es poder que la población migrante sepa que en Bolivia está el IpDH, que aquí pueden acceder a servicios de prevención, que pueden acceder a tratamientos médicos, a orientaciones; es lo más importante que tenemos que hacer (…), para que la persona sepa que dentro de la ruta hacia Suramérica va a encontrar en Ecuador a Kímirina, en Bolivia al IpDH y en Argentina a la Fundación Huésped”.
Estas organizaciones en su tránsito migratorio podrán garantizar algún tipo de soporte médico, para poder referenciar de manera exitosa a las personas.
“Se trata de tener un sistema de referencia y contrarreferencia que, si yo lo medico en Colombia, en Ecuador puedan ver qué medicación tiene esta persona y no tenga barreras de acceso”.
El objetivo es contar con un sistema a nivel internacional, y que cada persona tenga un código único para ser utilizado al momento de la entrevista con el médico o enfermero en los programas.
“El código será de acceso del profesional a su historia clínica, para que pueda ver el doctor de Colombia el tratamiento en Bolivia, para continuar el mismo tratamiento, porque pueden hacer apertura, a veces, de toda la clínica; y también que la persona tenga a la mano un código de referencia para que puedan acceder a esa información”.
DATOS EN COLOMBIA Ramírez detalló que en su país hay 7 millones de personas venezolanas migrantes. De ellos, según datos de inmigración Colombia, 2 millones tienen vocación de permanencia, y el restante son migrantes que van de paso hacia otros países de la región.
“Buscamos poder abordar 3.700 migrantes y poder referenciarlos hacia servicios en salud sexual, salud reproductiva, prevención del VIH, como una estrategia de control de los indicadores de cifras de interés en salud pública en nuestros países. Algo importante que tiene la estrategia Golondrinas es poder establecer las necesidades de la población migrante en cuanto a salud sexual, salud reproductiva y también en otras patologías”.
Agregó que se estima que en Colombia hay alrededor de 22 mil personas migrantes venezolanas podrían estar viviendo como VIH.
“Tenemos identificadas 4.500, que están ingresadas al sistema de salud en Colombia. Nos falta buscar esas otras como 18 mil personas que pueden vivir con VIH y en el momento no lo saben”.
Acotó que un estudio realizado con la Universidad de George Hawkins mostró una prevalencia para VIH en el 0.9%, para sífilis, un 5%.
La responsable de Proyectos de Salud y Derechos Humanos del IpDH explicó que en Cochabamba todavía no se cuenta con estadísticas.
“Hemos tratado también de incorporar este dato de nacionalidad, por ejemplo, al Simone (Sistema Informático de Monitoreo y Evaluación del Programa Nacional de VIH), que es el sistema de monitoreo del del Ministerio de Salud, pero todavía no hay datos que podamos reflejar”, expresó Rojas.
Sin embargo, aseguró que las puertas del IpDH están abiertas para quienes necesiten el tratamiento antirretroviral si tienen VIH; para quienes tuvieron situaciones de riesgo, violencia sexual; para hacerse pruebas y otros referidos a infecciones de transmisión sexual.
“Lo que queremos es que no corten los servicios de salud que necesitan en el trayecto”.

Poland: Ukrainian refugees struggle with stigma and treatment gaps

Ukrainian refugees with HIV adjust to care abroad

On top of housing, work and schooling, Ukrainian refugees with HIV face an additional, urgent difficulty: how to access the antiretroviral medicines they need to suppress the virus. In Poland, they face a particular stigma, causing many HIV positive refugees to conceal their health status.

When Anna Aryabinska fled from Kyiv in March 2022 with her ex-partner’s children, she had little idea that she would end up supporting not only his family, but many HIV-positive Ukrainians in Poland. Until Russia’s full-scale invasion, Aryabinska had been an activist for the Ukrainian organisation Positive Women, supporting women with HIV. Now she is one of a group of volunteers assisting fellow Ukrainian refugees to keep taking medication for HIV, as well as integrate into healthcare systems in European countries which have very different epidemic profiles and standards of treatment.

Ukraine has the second-largest HIV epidemic in Europe after Russia, with an estimated 260,000 people living with the disease. Over six million Ukrainians are now refugees from Russia’s full-scale invasion, according to the UNHCR. In Poland, the top destination, 1.6 million Ukrainians have applied for temporary protection schemes (the vast majority are women and children as martial law bans most men aged 18 to 60 – like Aryabinska’s ex-partner – from leaving Ukraine). On top of issues around housing, work and schooling, people with HIV face an additional, urgent difficulty: how to access the antiretroviral (ARV) medicines they need to take every day to suppress the virus.

Difficult adjustment

Anna Aryabinska left Kyiv in March 2022, when Russian forces were just a few kilometres from the city. Better prepared than many, she took a three-month supply of ARVs and a medical note from Kyiv doctors with her. When she reached Poland she registered right away at the local AIDS centre. Since then, she has been guiding others through a similar process as part of an online service, HelpNow, supported by the Ukrainian NGO Alliance for Public Health.

‘People are in such a panic,’ she says. ‘And they have no one else to ask.’ HelpNow has set up hubs in Poland, Germany and the Baltic states, and has helped Ukrainian refugees in 47 countries with online support, as well as in-person assistance in major refugee hubs like Warsaw. HelpNow volunteers teamed up with local NGOs to help refugees baffled by practical issues like finding translators for medical records or doctor’s appointments, receiving necessary documentation, or simply reaching the nearest AIDS clinic – there are only 16 in Poland, compared to 300 in Ukraine.

UK: A guide for migrants on how to access the National Health Service (NHS)

Access to the NHS for migrants

Key points

Refugees, current asylum seekers and those who have paid the Immigration Health Surcharge are entitled to free NHS health care.
Some types of treatment are free to all people in the UK, including GP services and HIV prevention, testing and treatment.
Even if you are receiving free HIV treatment, you may be charged for hospital treatment for other health conditions.
Although some information is shared between the NHS and the Home Office, this does not include information about people’s medical conditions.

The National Health Service (NHS) is the government-funded medical and healthcare service in the UK. Understanding which NHS services are freely available for people born outside of the UK can be confusing. Some NHS services are always free and some people (because of their experiences, residency or type of visa) always receive free health care. It is important to know which NHS services could be free to you and what documents you may need to show to receive them.

People who always receive free treatment

There are groups of people who are always entitled to free NHS health care. You should not be charged for most NHS care if you are considered to be ‘ordinarily resident’. You have ordinarily resident status if you are living lawfully in the UK “on a properly settled basis for the time being”. This may include:

British citizens. However, British citizens who are no longer living and settled in the UK are not ordinarily resident.
People who have ‘settled’ or ‘pre-settled’ status from the EU Settlement Scheme.
People who have indefinite leave to enter or remain in the UK.

Other groups who are entitled to free NHS care include:

A refugee: a person who has been forced to leave their country (in order to escape war, persecution, or natural disaster) who has been given permission to remain in the UK by the government.
An asylum seeker: a person who has been forced to leave their country (in order to escape war, persecution, or natural disaster) who has applied for permission to remain in the UK and whose case is still being assessed.
A refused asylum seeker (Northern Ireland, Scotland, Wales only).
A refused asylum seeker receiving support from the Home Office or a local authority (under the Care Act).
A victim (or suspected victim) of trafficking or modern slavery. To confirm this, during your appointments, you may be asked if you have experienced violence or abuse (now or in the past).
A child under the care of a local authority.
A detainee in immigration detention, prison or young offenders institution.
A full-time student (Scotland only).
A person who has paid the Immigration Health Surcharge (also known as NHS Surcharge).

There are some differences depending on whether you live in England, Northern Ireland, Scotland, or Wales.

If you are entitled to free health care, you can get it immediately. It does not matter how long you have been in the UK.

If you are seeking primary care (e.g. GP practices, NHS walk-in centres, dentists, pharmacists and opticians) you should not be asked about your immigration status, as this is not relevant. It is clearly explained on the NHS website (under the heading If you have no proof of address or identification) that you do not need to show proof of address or ID.

But in reality, people trying to register at primary care services are often asked for immigration status and official documents – and may be turned away if they do not have them. If a GP practice refuses your registration you can get support and advice from Doctors of the World Clinic advice line: 0808 1647 686 (freephone) or email clinic@doctorsoftheworld.org.uk

Treatment that is always free

Certain health treatment is always free, meaning your immigration status does not matter. These services include:

Primary care at GP practices and NHS walk-in centres.
Accident and Emergency services.
Diagnosis and treatment of communicable diseases (diseases that can be passed from person to person). These include HIV, coronavirus (COVID-19), tuberculosis (TB) and malaria.
Diagnosis and treatment of sexually transmitted infections (STIs).
Contraception and advice (not including pregnancy terminations or maternity care).
Treatment for conditions that have been caused from torture, female genital mutilation (FGM), domestic violence, or sexual violence. To confirm this, during your appointments, you may be asked if you have experienced violence or abuse (now or in the past).
Compulsory psychiatric treatment – if you have a mental disorder that puts you, or others, at risk (under the Mental Health Act or Mental Capacity Act).
Services provided through NHS 111 (a telephone advice line).
Services provided by health visitors and school nurses.

HIV prevention, testing and treatment is free across the UK, regardless of your immigration status. This includes pre-exposure prophylaxis (PrEP) and antiretroviral therapy. This is because HIV is a communicable and sexually transmitted infection.

It is important to know your HIV status to stay healthy. If you do take an HIV test and the result is positive, HIV medication will help to keep you well and healthy. If you take a test and it is negative, you may wish to consider taking PrEP (a drug that is highly effective in preventing HIV being passed on during sex). PEP is available to people who may have been exposed to HIV sexually. All of these services are free.

Most people need to pay for NHS prescriptions, eye tests and dental treatment. The charges are the same regardless of immigration status. As explained later on this page, the charges can be waived for people on low incomes.

Secondary care

Secondary care refers to services provided by health professionals who generally do not have first contact with a patient. Treatment for conditions such as heart disease, diabetes and cancer are examples of secondary care. People tend to be referred to secondary care by another healthcare professional. If you do not have ‘ordinarily resident’ status or are not part of the groups of people who always receive free care, you may be charged for secondary care.

Even if you are receiving free treatment for HIV, you may be charged for other secondary care services. For example, if you are living with HIV and need hospital treatment for heart disease or maternity care, you may be issued a bill.

Nonetheless, some secondary NHS care is considered immediately necessary or urgent, so will not be refused to you (even if you cannot pay).

Health treatment is considered immediately necessary when it:

is lifesaving
prevents a condition from becoming immediately life-threatening
prevents permanent serious damage from occurring.

This includes maternity care. In order to protect lives, all maternity services (from pregnancy to after birth) must be treated as ‘immediately necessary’. NHS maternity care is only free to those who are listed above as always receiving free treatment. If you do not fall within any of these groups you may be asked to pay for your care, but you cannot be refused maternity care if you cannot pay because it is ‘immediately necessary’.

‘Urgent’ care is something that doctors do not think is immediately necessary but which cannot wait until the person can be reasonably expected to leave the UK. If your doctors consider your care to be urgent, you can still receive treatment even if you cannot pay straight away. They will take into account a range of factors, including:

the pain or disability the condition is causing
the risk that delaying treatment might lead to a more expensive medical treatment being needed
the likelihood of the condition becoming life-threatening because treatment was delayed.

Non-urgent treatment will not be given until a full payment is made.

If you are ordinarily resident or otherwise eligible for free secondary healthcare, you may be asked to prove this. This is something likely to disproportionately affect ethnic minorities, non-British/non-EEA nationals, or those with non-British accents or names.

If you cannot afford to pay

It is very important not to ignore hospital bills. You should contact the hospital even if you cannot pay. The hospital should be able to offer you a repayment plan in which you pay a little bit of the bill each month. Citizens Advice or a local debt advice service can advise you on this.

Concerning prescriptions, dental care and eye tests, you may be able to pay a lower fee or receive exemptions via the NHS Low Income Scheme. You will not be asked about your immigration status on the forms. You will be asked for your name, address, who you live with, your income and savings. Fill out the HC1 form or the HC5 form to claim back charges you have already paid. It is important to keep receipts of any payments you have made. For advice, contact the NHS Low Income Scheme helpline on 0300 330 1343.

There are concerns about what information is shared between the NHS and the Home Office.

In 2018, the UK government agreed to stop the NHS sharing personal information (information that can be used to identify someone – such as a name, address etc.) with the Home Office for immigration enforcement purposes. The Home Office cannot ask the NHS for your address to investigate immigration offences. Nonetheless, the Home Office can still ask the NHS for your address if they are investigating a ‘serious crime’ such as murder or rape.

There are still two circumstances in which NHS staff may share information about you with the Home Office. Firstly, if they have not been able to establish your immigration status (and healthcare entitlement) they may make an enquiry to the Home Office. NHS charges vary according to a person’s immigration status. There are six different payment groupings based on a person’s experiences, residency and/or type of visa. Secondly, if you have a hospital bill that is over £500 and has not been paid for over two months, they will pass on details to the Home Office. This information could be used to update Home Office records and possibly for immigration enforcement. Your application for leave to remain or enter can be refused if you are in debt to the NHS.

The information shared might include your name, any aliases, date of birth, gender, nationality, National Insurance number, Home Office reference number, and any other reference numbers (for example passport number or Immigration Health Surcharge Number).

The NHS does not need your permission to share non-medical information with the Home Office. Medical information – such as your HIV status and details of your treatment – cannot be shared unless you have given permission.

If you are worried about giving personal details to your GP or another healthcare provider, you have the right to register using someone else’s home address (called a ‘care of’ address). You can also say you have ‘no fixed’ address.

If you have a problem with the service you receive, there are steps you can take to address this. This should not impact your immigration status.

Paying before you arrive in the UK

If you apply for a UK visa from outside of the EEA or Switzerland, you will likely have to pay the Immigration Health Surcharge (also known as the NHS Surcharge). This gives you access to NHS hospital treatment on the same basis as people who are ordinarily resident.

The Immigration Health Surcharge is included in the UK visa fee (if you are planning to stay for over six months but are not applying to remain in the UK permanently). The annual fee is £624 for adults and £470 for children, students and those on the Youth Mobility Scheme. Some applicants are exempt from paying this fee.

When you have paid the surcharge, you will receive a reference number. It is important to make a note of that reference number as it proves you have paid the fee and may be requested when registering for primary care (and possibly when accessing other health care). This number is different from the NHS number that everyone who is registered for NHS health care has. When your Immigration Health Surcharge reference number is linked to you NHS number, NHS computer systems will show that you are eligible for free health care. This means you may not need to show your surcharge number after you are registered at a GP.

Additional support

Understanding the NHS system can be confusing. You can contact the organisations listed below if you need general or specific advice about:

filling in paperwork (for free prescription, dental care and eye tests)
requesting an interpreter during your appointments
what to do if a GP practice refuses to register you
paying hospital bills or debt
getting support if you think you have been charged unfairly.

Doctors of the World (clinics in Bethnal Green and Hackney, London). Clinic advice line: 0808 1647 686 (freephone) or email clinic@doctorsoftheworld.org.uk

Freedom from Torture (for survivors of torture). Clinics in: London, Manchester, Newcastle, Birmingham and Scotland.

Maternity Action (information and a telephone advice)

Citizens Advice

Botswana: Following free ARV programme for non-citizens, adverse birth outcomes improve

Free antiretroviral therapy for non-citizens in Botswana: a further step towards the elimination of HIV

Following the expansion of antiretroviral therapy to migrants and non-citizens in Botswana, gaps have narrowed in the uptake of antenatal care and antiretroviral therapy during pregnancy between citizens and non-citizens living with HIV. Disparities in adverse birth outcomes were no longer observed after the change in policy, according to a report in the Journal of the International AIDS Society.

In Botswana, approximately 25% of female citizens aged 15 to 49 are living with HIV. Back in 2002, the government of Botswana launched a free universal antiretroviral therapy programme, which has proven to be very successful, including by improving birth outcomes of infants born to women with HIV. However, access to this programme was restricted to citizens of Botswana only, although non-Botswanan citizens represent as high as 7% of the country’s total population. Many are migrants from neighbouring countries with large HIV epidemics, such as Zimbabwe, Zambia and South Africa, with 13%, 11% and 19% HIV prevalence, respectively.

Only 29% of migrants in Botswana had personal health insurance or could afford to pay for HIV care, and research has shown that migrants had worse health outcomes than citizens of Botswana. Evidence has also shown that stigmatisation by healthcare and security staff in medical facilities were barriers to receiving care. Furthermore, pregnant non-citizens were less likely to receive antenatal care and more likely to receive care later in pregnancy, deliver at home and experience adverse birth outcomes than pregnant citizens of Botswana.

At the end of 2019, the government of Botswana drastically shifted its policy by authorising the free distribution of antiretroviral therapy to non-citizens living with HIV.

Dr Christina Fennel from Harvard University, with colleagues in Botswana and the US, evaluated the impact of this major policy change on antenatal care, antiretroviral therapy use and adverse birth outcomes among infants. For this, they compared outcomes in infants born to citizens and non-citizens living with HV, before (2014-2019) and after (2019-2021) the policy change. They used data from the Tsepamo Surveillance Study, a large birth outcomes surveillance programme that collects data from maternity sites in Botswana, including about 72% of all births in the country.

More specifically, the impact analysis was based on data from maternal records. Adverse birth outcomes analysed were preterm delivery, very preterm delivery, stillbirth, neonatal death, small for gestational age (babies smaller than usual for the number of weeks of pregnancy) and very small for gestational age. Because multiple births may be associated with adverse birth outcomes, only singleton births were included in the analyses of adverse birth outcomes.

Results

During the entire analysis period – 2014 to 2021 – there were 47,576 live deliveries and stillbirths among pregnant women with HIV recorded in the Tsepamo study, including 47,443 with known citizenship status – 45,917 (97%) Botswanan citizens and 1,516 (3%) non-citizens.

The proportion of non-citizens with unknown HIV status decreased significantly in the post-expansion period, from 6% to 1% (p < 0.001), whereas it remained the same (0.5% vs 0.4%; p = 0.02) for citizens.

The proportion of non-citizens with HIV attending antenatal care increased from 79% in the pre-expansion period to 87% following expansion, whereas attendance among citizens with HIV remained constant through both periods at approximately 96%. (Non-citizens can attend antenatal care by paying a modest fee, which did not change through the study period).

In the pre-expansion period, 65% of non-citizens received antiretroviral therapy, of whom only 7% had a dolutegravir-based regimen. After 2019, the proportion on antiretroviral therapy increased significantly to 90%, narrowing the gap with citizens (97%). Also, the proportion of non-citizens and citizens receiving dolutegravir almost equalised (42% vs 44%), showing a decrease in the use of old antiretrovirals such as nevirapine, which have a higher risk of adverse birth outcomes.

Regarding adverse birth outcomes, in the pre-expansion period infants born to non-citizens with HIV had significantly greater risks of preterm delivery (aRR = 1.28; 95% CI: 1.11, 1.46), very preterm delivery (aRR = 1.89; 95% CI: 1.43, 2.44) and neonatal death (aRR = 1.69; 95% CI: 1.03, 2.60) when compared with infants born to citizens with HIV. For reasons that are not clear, non-citizens had a reduced risk of having an infant who was small for gestational age (aRR = 0.75; 95% CI: 0.62, 0.89).

After the expansion of antiretroviral therapy, none of the adverse birth outcomes were significantly higher among infants born to non-citizens with HIV than infants born to citizens with HIV. Also, there were declines in adverse birth outcomes among infants born to non-citizens, including preterm delivery (23% in 2014-2019 vs 14% in 2019-2021) and stillbirth (4% vs 3%). At the same time, no changes in birth outcomes for HIV-negative non-citizens were observed.

According to Fennel and colleagues, their findings suggest that greater access to antiretroviral therapy – including modern regimens – may have reduced adverse birth outcomes. They also underscore the substantial decrease of the proportion of pregnant non-citizens with unknown HIV status, as well as increased linkage to HIV therapy and antenatal care after the policy change.

In 2022, Botswana was praised for reaching, ahead of the 2025 target, the UNAIDS goals of 95% of all people living with HIV to be aware of their status, 95% of those aware of their status to receive sustained antiretroviral therapy, and 95% of people receiving this therapy to achieve viral load suppression. The results of this study further confirm that Botswana has become a model for other countries that may still hesitate to scale-up access to antiretroviral therapy and HIV care for all minorities, including migrants, not to mention those countries that might be tempted to introduce new restrictions.

References

Fennell C et al. The impact of free antiretroviral therapy for pregnant non-citizens and their infants in Botswana.Journal of the International AIDS Society 2023, 26:e26161 (open access).

https://doi.org/10.1002/jia2.26161

UK: The hostile environment policies have a devastating impact on migrant access to healthcare

The tribulation of Zimbabweans living with HIV in the diaspora

As the world celebrated the World AIDS Day on December it is imperative to look at how Zimbabweans are living with disease in the UK and Diaspora at large.

In the United Kingdom, many Zimbabweans are being left behind in the UK’s response to the disease, despite being disproportionately affected by HIV.

Georgina Mandebvu is a Zimbabwean nurse living with HIV. When she arrived in the UK she was already widowed.

Her husband died in a car accident while she was in Zimbabwe. She has a child aged 15 but who was of poor health.

In 2015 Georgina who was ten years in the UK fell very ill. She was admitted to Luton and Dunstable hospital. She tested HIV positive. Her son was also brought in the same hospital very sick. He too tested positive.

The two were diagnosed with HIV and were diagnosed late, putting them more at risk of becoming seriously ill.

Most people don’t know it when they’ve been infected with HIV. But they may develop symptoms within 2 to 4 weeks a!er they’ve gotten the virus. This is when the body’s immune system puts up a fight. It’s called acute retroviral syndrome or primary HIV infection. HIV infection happens in three stages. Without treatment, it gets worse over time and eventually weakens the immune system.

The only way you can know for sure if you have HIV is to get tested. Although the virus can develop symptoms, they’re not a reliable way to tell if you’re infected. In fact, some people won’t have any symptoms at all. So even if you don’t have any of the typical signs of an infection, you should always get tested if you think you are at risk.

A number of major barriers for migrants trying to access HIV testing and treatment in the UK includes lack of access to appropriate information about healthcare entitlements; migrants’ poor understanding of healthcare entitlements; ‘hostile environment’ policies; and restrictions on being able to work or claim financial support.

The National Aids Trust, funded by Trust for London, interviewed migrants living with HIV in the UK and found that they are being left behind in the UK’s response to HIV, despite being disproportionately affected by HIV.

Those living with AIDS while in diaspora face a number of major barriers trying to access HIV testing and treatment, including:
lack of access to appropriate information about healthcare entitlements; migrants’ poor understanding of healthcare entitlements and fear and confusion over possible charging for NHS services;

Hostile environment’ policies – such as data sharing between the NHS and Home Office – deterred people born abroad from accessing care and contributed to their late HIV diagnoses; restrictions on being able to work or claim financial support for some migrants forced some migrants into destitution, unable to afford food or travel to appointments.

The UK Health Security Agency does not consider migrants a key population and collect and publish more granular data on specific groups, including reporting in the published HIV data tables and annual report on all communities with over 500 cases of new transmissions in the last five years HIV is a public health challenge which disproportionately affects migrants in the UK.

Despite this, there is currently no shared understanding of the policies and interventions needed to combat HIV in the context of migration. London is where the highest proportion of migrants living with HIV access care.

However, there is also wider relevance and learning for the whole of the UK and much of the data provided is UK-wide.

To end new transmissions of HIV by 2030, a UK goal, must make progress for all population groups, including migrants. In order to do this, all migrants in the UK should have access to the HIV prevention, treatment and care they need.

Migrants must be considered a key population in the UK’s response to HIV by the Government, UK Health Security Agency and wider healthcare and HIV sectors.

Taguta Matambo was among the 62 percent of all new HIV diagnoses in the UK (including people previously diagnosed abroad). When he arrived in the UK he settled in an area where many Zimbabweans were staying.
He started a relationship with Mavis who had left her family in Zimbabwe.

After some time Mavis became infected but without realising it. Within a month the broke up as Mavis’s family was coming to join her.

Mavis’s husband was infected the moment he became intimate with Mavis.
In the meantime Taguta had moved on and found himself a new girlfriend whom he infected as well.

Because Mavis was always busy and limiting her husband on the pleasures of the velvet cake the husband got himself a girlfriend.
The net became more and more intense and intricate

There was infections and re-infections. Within six months the number of Zimbabweans in one community infected with HIV was alarming. In the meantime the migrant community was not receiving treatment.

Zimbabweans in the UK are not very promiscuous but the HIV rate is ravaging.
People who are diagnosed late have a 10-fold risk of mortality within one year of diagnosis, are more at risk of ill-health and this also increases the risk of onward transmission.

While the quality of care and support they received through HIV clinics and support services is the best in the world, there are barriers to accessing primary care services through GPs, as well as concerns about understanding of HIV among GPs.

The devastating impact of hostile environment policies on migrant access to healthcare is also startlingly clear.

US: Find out where to go for free, or low-cost, HIV services, regardless of immigration status

Free Healthcare and Support for Immigrants Living with HIV/AIDS in New York

In New York, care for HIV and AIDS is free or low-cost for anyone, regardless of immigration status.

In New York, care for HIV and AIDS is free or low-cost for anyone, regardless of immigration status. People from the age of 12 can have walk-in free HIV tests in services at NYC sexual health clinics.

Only two clinics, Fort Greene Express at 295 Flatbush Extension in Brooklyn and Chelsea Express at 303 Ninth Avenue in Manhattan, offer appointment scheduling. You can schedule an appointment in one of these two locations. Parental consent is not necessary for tests and assistance.

The NYC Health Department asks for a fee for sexual health services given to adults (age 19 and over). They can use their insurance plan to pay for the visit. Those without health insurance or who don’t want to use it will be asked to pay a sliding scale fee based on their family size and yearly income. They will not be asked for proof of family size or yearly income.

But, without insurance and money, you will still get services. Payments are not collected at the clinics. Get more information about the billing fees.

What kind of AIDS and HIV-related services do New York City sexual health clinics provide?

HIV post-exposure prophylaxis (PEP)
Individuals who have received an HIV diagnosis and wish to commence HIV treatment for the first time can initiate their treatment.
People who suspect they may have HIV-related symptoms can receive a medical evaluation to determine their condition.
Medical evaluation for people who might have or have been exposed to HIV
Individuals aged 12 and above can have HIV testing, even with no symptoms.
HIV pre-exposure prophylaxis initiation and counseling are available by appointment only through the NYC Sexual Health Clinics hotline at 347-396-7959

NYC Sexual Health Clinics in New York:

Morissania Sexual Health Clinic

1309 Fulton Avenue, Bronx