In 2022, the Australian Government significantly reduced the barriers for those living with HIV to access treatment, announcing that these treatments would be free of charge for everyone regardless of Medicare eligibility.
It was a momentous day in the field of healthcare, bringing us one step closer to the global target of ending transmission of HIV by 2030.
Yet two years later, people living with HIV (PLHIV) remain demonised by the government’s archaic permanent residency laws—laws which automatically reject PR applications from PLHIV regardless of their circumstances.
“The main hurdle for anyone applying for PR in Australia is this thing called the Significant Cost Threshold,” Dr Jason Ong of the Melbourne Sexual Health Centre tells Not Safe For Queers. “And what this basically says is that you must not cost the Australian Government more than $51,000 over 10 years.”
So, in a bid to circumvent these outdated rules (and increase their chances of receiving a PR) some PLHIV in Australia have started using older, cheaper, and less effective antiretroviral treatments. But with that comes risks to the individual, and to Australia’s goal of ending HIV transmission by 2030.
“If people opt to be on these older medications—the ones considered second, or third line even—they’re at risk of more side effects, and potentially a less effective medication that controls their virus,” says Dr Ong.
“So, they’re actually putting their health at risk.”
However, despite their efforts to stay under the $51,000 threshold, the outcome remains the same: their applications are automatically being rejected. And that’s because the government compares everyone with HIV to a ‘hypothetical person’ rather than assessing each applicant on a case-by-case basis.
“But these people are so desperate to try to get their permanent residency that they’ll do anything—including continuing to stay on these drugs—even though we keep telling them it doesn’t affect their outcome,” says Dr Ong.
It’s a strange (see: nonsensical) Catch-22 that PLHIV are forced to endure. How can the government be prepared to subsidise antiretroviral treatments for everyone regardless of their Medicare eligibility, yet deny those same people the opportunity to become permanent residents due to the costs of these same treatments?
It’s unfair and contradictory at best, and outright discriminatory at worst.
Thankfully, however, there are two simple solutions to the issue: we either increase the Significant Cost Threshold to allow PLHIV to receive the treatments they need and still become permanent residents, or we consider them exempt from the threshold altogether.
As for when (or if) this will ever happen, Dr Ong says, “I’ve had the opportunity to talk to the Minister for Immigration about this directly, and he seems quite open and aware of the issue. But whether he will be the one to initiate that change, I guess it’s left to be seen.”
In the meantime, it’s important that we—as a community—continue to raise awareness of the issue, apply pressure to the government to make significant changes, and show PLHIV that we do want them in our communities.
You can read Dr Jason Ong’s full research paper on the effects of suboptimal antiretroviral therapy in the journal Sexual Health.