Australia, migration and HIV: an evolving policy landscape

HIV Australia | Vol. 12 No. 2 | July 2014

By Linda Forbes and Michael Frommer

Planning for AIDS 2014 in Melbourne, Australia, has focused attention on how people with HIV navigate Australia’s complex migration system.

There is a perception that Australia tests people for HIV with the aim of banning the entry of HIV-positive people.

While this is not the policy rationale for testing, this perception nevertheless can lead to alienation among potential residents, and perpetuate HIV-related stigma among new migrants and the Australian community more broadly.

HIV and the Australian migration process

All people aged 15 years or more seeking permanent visas for Australia are subject to compulsory screening for HIV.

Under Australia’s migration ‘health requirement’, anticipated future costs associated with any health condition or disability are assessed – including the cost of HIV antiretrovirals.

Migrants have immediate access to subsidised health care and medicines in Australia and the rationale for the Health Requirement is stated to be economic – aimed at ensuring that migration does not place undue pressure on public health costs.

As the lifetime cost of providing HIV antiretrovirals to a person inevitably exceeds the threshold for passing the Health Requirement – currently AUD$40,000 – prospective residents with HIV generally fail the Health Requirement in the first instance.

While waiver is available for some visa categories, waiver requires provision of supporting evidence, including medical evidence and evidence regarding the potential fiscal benefit the applicant may bring to Australia.

Waiver is, of course, of only limited relevance given that waiver is only available for a few specified visa types and, for those who can seek waiver, people with means are advantaged over people without the capacity and the finances to organise evidence and/or legal advice.

Proposed reforms to the Health Requirement whereby applicants’ potential economic contributions would offset future healthcare cost assessments are welcome.

However, such changes would represent a limited reform given the challenges associated with providing evidence of the economic contribution an individual applicant would bring to Australia.

How to make migration policy fairer

Health Requirement assessments regarding HIV pose real and perceived barriers for people with HIV seeking Australian residence.

The economic rationale for the Health Requirement is lost in the policy’s complexity and is not generally understood.

The perception of prospective migrants – and of the Australian community and international commentators – is that Australia screens prospective migrants for HIV due to a desire “keep them out”.

The perception that HIV-positive migrants and their families are not welcome in Australia can feed perceptions that migrants from countries with high HIV prevalence are vectors for disease.

This stigmatises people with HIV within migrant communities – with HIV-positive people labelled by some as bringing shame on their community – and feeds HIV-related stigma in the wider Australian community.

This stigma undermines affected migrant communities’ engagement in the development of HIV prevention, care and support strategies targeting communities of people from high HIV-prevalence countries.

Reform of Australian migration policy is required to bring Australia into line with international human rights standards and public health best practice.

Australia has ratified the United Nations Convention on the Rights of Persons with Disabilities (CRPD); however, as the Migration Act 1958 is exempt from the application of the Disability Discrimination Act 1992, the legal framework, perversely, facilitates discrimination against people with HIV.

There should be no compulsory HIV-testing of people applying for Australian residence.

Mandatory testing for HIV should be replaced with voluntary testing of applicants and of permanent visa holders upon arrival in Australia, with appropriate counselling and support provided to all applicants who undertake HIV testing for migration purposes.

It is now time for long overdue migration reform.

Linda Forbes is Manager, Policy and Communications, at AFAO.

Michael Frommer is Policy Analyst at AFAO.