1 December 2018
ASHM and Queensland Positive People (QPP) along with an Expert Working Group are pleased to announce two new resources to support both health providers and patients to navigate the Australian health and immigration system.
“The release of the Medicare Ineligible Factsheet and the HIV and Immigration template represent an important step towards equity in HIV care in Australia” said ASHM Vice President Dr Nick Medland.
“Patients living with HIV or at risk of HIV who are Medicare ineligible are highly vulnerable and at risk of poorer health outcomes, discrimination in the health care and immigration systems and represent an “Achilles heel” in Australia’s HIV health response. Clinicians face many challenges working with these individuals, including adequately responding to their health care needs, seeking to avoid being in the position of having to withhold essential services like PrEP or ART and responding to requests for reports in the immigration process.”
- Australia issues almost 2 million temporary visas annually, almost all holders of which are Medicare ineligible
- Visa conditions include the requirement to purchase private health insurance, which rarely covers HIV treatment or PrEP
- International students alone are now worth $30 billion to Australia’s economy every year
- 25% of MSM in urban centres are estimated to be Medicare ineligible
- Newly arrived Asian born men who have sex with men are four times more likely than their long term resident peers to become HIV positive in the years after they arrive in Australia
“As Australia becomes an increasingly popular place for people from overseas to live, study and work, clinicians will increasingly face these challenges. In the vast majority of cases, people on temporary visas are not able to access Australia’s universal health care system. Young sexually active adults and men who have sex with men are over-represented in this group.”
“This group is more likely to experience delayed HIV diagnosis. Once diagnosed, they have to find their way to a limited number of services which are able to offer access to affordable ART. Many have informal medication supplies which are highly susceptible to disruption and discontinuity including self-importing or even fly back and forth between their home countries to access treatment. All this exacerbates high levels of psychological and financial stress.”
“With these documents, ASHM offers guidance and support to clinicians as they attempt to adequately serve some of Australia’s most vulnerable communities. They provide guidance in finding services and advice on responding to request for immigration reports.”
“Through the implementation of the Peer Navigation program since 2016, QPP has been able to provide peer-led services for PLHIV in Queensland, including those without Medicare. We support PLHIV ineligible for Medicare to navigate the health care system, make an informed decision relating to access to HIV treatment, improve their HIV literacy, and develop resilience. It is through the evaluation of Medicare Ineligible Peer Navigation that we were able to identify the need for a factsheet on access to HIV care and treatment that is available in languages other than English and a guide for clinicians who have HIV-positive patients applying for Permanent Residency,” said Satrio (Tiko) Nindyo Istiko, Peer Navigation Team Leader, QPP.
“As we reach the global targets of 90:90:90 set by UNAIDS, the collaboration between QPP and ASHM in developing these resources further emphasised the importance of using both clinical and lived experience to address the challenge in ensuring that we are not leaving the remaining 10% behind.”
Medicare Ineligible Factsheet
This factsheet is for overseas visitors (working, studying or holidaying in Australia) who are not eligible for a Medicare Card to assist in considering their options for obtaining HIV treatment and medical care during their stay in Australia. In Australia, only Medicare Card holders may gain access to subsidised (low cost) HIV medicine through the Pharmaceuticals Benefits Scheme (PBS). ASHM’s position remains that all people living with HIV in Australia should have access to affordable, effective and appropriate treatment, regardless of their Medicare status.
Access the factsheet available in 6 languages:
- Medicare Ineligible Factsheet — English [PDF]
- Medicare Ineligible Factsheet — Amharic [PDF]
- Medicare Ineligible Factsheet — Swahili [PDF]
- Medicare Ineligible Factsheet — Chinese [PDF]
- Medicare Ineligible Factsheet — Spanish [PDF]
- Medicare Ineligible Factsheet — Portuguese [PDF]
HIV and Immigration template for health providers
The information in HIV and Immigration has been developed to support clinicians treating patients with HIV who are applying for an Australian permanent residence (PR) visa. The provision of a ‘positive’ medical report in support of a patient’s PR visa application can help to support a favourable outcome for the applicant. It is recommended that the applicant seeks advice from an appropriate migration agent/lawyer. Clinicians are recommended to make use of this provided information in conjunction with the advice of the applicant’s migration agents/lawyers, who will be able to advise in regards to the application or health waiver.
This resource also follows on from ASHM's published resource for clinicians with patients who have chronic hepatitis B that are in the process of applying for a permanent visa, released in May 2018.
Access the template:
With thanks the Expert Working Group
The members of the Expert Working Group were:
- Satrio Nindyo Istiko (Peer Navigation Team Leader, QPP)
- Katelin Haynes (ASHM Queensland Program Manager)
- Dr Julian Langton-Lockton (Clinical Director, Sexual Health & HIV Service, Metro North HHS)
- Dr Andrew Redmond (Infectious Diseases Unit, RBWH, Metro North HHS)
- Dr Diane Rowling (Senior Staff Specialist, Sexual Health & HIV Service, Metro North HHS)
- Dr David Siebert (Princess Alexandria Sexual Health (PASH), Metro South HHS)
- Dr Mekala Srirajalingam (Ipswich Sexual Health Service, West Moreton HHS)
- Dr Caroline Thng (Gold Coast Sexual Health, Gold Coast HHS)
- Dr Ken Koh (General Practitioner/S100 Prescriber, Holdsworth House)