Why is the NHS giving free condoms to asylum seekers?

Reports that asylum seekers are being provided with free condoms by the NHS have prompted criticism and debate over why taxpayers should fund sexual health provision for people waiting for decisions on their immigration status.

However, free contraception is not a special benefit created specifically for asylum seekers. NHS sexual and reproductive health services provide contraception free of charge, including condoms through participating services, while government rules state that family planning and the diagnosis and treatment of sexually transmitted infections are free regardless of a person’s immigration status.

The issue has attracted renewed attention following reports about healthcare provision for asylum seekers housed in accommodation around the UK. In one example involving plans for up to 300 asylum seekers at Cameron Barracks in Inverness, NHS Highland proposed sexual health provision that included monthly blood-borne virus screening clinics and condoms being made available on site. The sexual-health element formed part of a much larger healthcare package that also included vaccinations, mental health support, interpreting services and additional NHS staffing.

Providing condoms is fundamentally a public-health intervention rather than simply a contraceptive benefit. Condoms reduce transmission of sexually transmitted infections including HIV, while access to contraception can prevent unintended pregnancies. Preventing infections can also reduce the subsequent need for testing, treatment and more expensive healthcare interventions.

NICE recommends that condom distribution schemes should be targeted towards populations at greater risk of sexually transmitted infections and made available through locations those groups are likely to use. Its guidance specifically supports free condom distribution alongside information about sexual and reproductive health and access to local testing and treatment services.

The same principle applies to people born in Britain. NHS sexual-health clinics provide free contraception, STI testing and treatment, and condoms can be available through clinics, pharmacies, health centres and other community schemes. The NHS also provides an online service to help people locate free condom provision in their area.

There are additional public-health considerations when people arrive in the UK from different parts of the world. Government guidance for healthcare professionals working with migrants recommends assessing sexual health according to an individual’s circumstances and offering appropriate screening to sexually active people who may be at risk. It also recommends providing safer-sex and contraception advice and emphasises that preventing and treating sexually transmitted infections helps reduce wider transmission, including HIV.

This does not mean asylum seekers are assumed to have sexually transmitted infections or to pose a particular sexual-health risk simply because of their immigration status. Screening and preventative healthcare should instead be based on individual risk, sexual history and clinical need, just as it should be for other patients.

Asylum seekers are also entitled to broader NHS healthcare while their claims are being considered. Government guidance confirms that people seeking asylum can access GP and NHS hospital care without charge, while specific services including STI diagnosis and treatment and family planning are exempt from overseas visitor charges irrespective of immigration status.

The cost of providing condoms also has to be considered alongside the potential cost of treating preventable infections or dealing with unintended pregnancies. Sexual-health prevention programmes are designed partly around intervening before somebody needs more substantial medical treatment, making relatively inexpensive measures such as condoms one component of wider preventative healthcare.

That does not mean questions about NHS spending or the additional healthcare costs associated with accommodating large numbers of asylum seekers are illegitimate. Local health services can face genuine additional demand, and taxpayers are entitled to scrutinise how public money is allocated. In the Cameron Barracks proposals, for example, sexual-health provision represented only one part of a healthcare package estimated at around £1.3 million, with substantially larger amounts allocated to staffing, vaccination clinics, mental health services and translation.

The specific question of free condoms, however, is less unusual than some of the headlines suggest. The NHS is not operating one contraception policy for asylum seekers and another for everybody else. Free contraception and sexual-health services are longstanding public-health measures available much more widely, based on the principle that preventing sexually transmitted infections and unintended pregnancies benefits both the individual receiving the service and the health system responsible for treating the consequences.

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