The use of suboptimal antiretroviral therapy when applying for migration to Australia: a case series

Daniel Tran; Brent Allan; Alexandra Stratigos; Darryl O’Donnell; Dash Heath-Paynter; Aaron Cogle; Jason J. Ong

doi:10.1071/SH24028

RESEARCH ARTICLE (Open Access)

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The use of suboptimal antiretroviral therapy when applying for migration to Australia: a case series

Daniel Tran

^A , Brent Allan ^B , Alexandra Stratigos ^C , Darryl O’Donnell ^D ^E , Dash Heath-Paynter ^D ^E , Aaron Cogle ^F and Jason J. Ong

^G ^H ^I ^*

+ Author Affiliations

- Author Affiliations

^A Melbourne Medical School, The University of Melbourne, Melbourne, Vic., Australia.

^B QThink Consultancy Services, Malmsbury, Vic., Australia.

^C HIV/AIDS Legal Centre, Surry Hills, NSW, Australia.

^D Health Equity Matters, Sydney, NSW, Australia.

^E Kirby Institute for Infection and Immunity in Society, UNSW, Sydney, NSW, Australia.

^F National Association of People with HIV Australia, Newtown, NSW, Australia.

^G Central Clinical School, Monash University, Melbourne, Vic., Australia.

^H Melbourne Sexual Health Centre, Melbourne, Vic., Australia.

^I Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.

^* Correspondence to: Jason.ong@monash.edu

Handling Editor: Ian Simms

Sexual Health 21, SH24028 https://doi.org/10.1071/SH24028

Submitted: 1 February 2024 Accepted: 8 April 2024 Published: 29 April 2024

© 2024 The Author(s) (or their employer(s)). Published by CSIRO Publishing. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)

Abstract

Background

Australia imposes restrictions for people living with HIV (PLHIV) applying for permanent residency (PR), including spending less than AUD51,000 on medical costs over 10 years. Some PLHIV opted for suboptimal and cheaper antiretroviral therapy (ART) regimens to increase their chances of receiving PR. We collated a case series to examine PLHIV on suboptimal ART because of visa issues.

Methods

We identified all patients applying for a PR in Australia who obtained nevirapine, efavirenz or zidovudine between July 2022 and July 2023 from the Melbourne Sexual Health Centre. Pathology results and records detailing psychological issues relating to the patients’ wishes to remain on suboptimal ART were extracted from clinical records by two researchers.

Results

We identified six patients with a mean age of 39 years migrating from Asian and European countries. Three patients used efavirenz, and three used nevirapine. All desired to remain on cheaper, suboptimal ART to stay below visa cost thresholds, which they considered to aid favourably with their application. Four displayed stress and anxiety arising from visa rejections, appeal deadlines and the lengthy visa application process.

Conclusions

Despite access to more effective and safer ART, we identified patients who chose to remain on cheaper ART to improve chances of obtaining an Australian visa, potentially putting their health at risk. We found significant evidence of stress and anxiety among patients. There is a need to review and revise current migration policies and laws in Australia that discriminate against PLHIV and jeopardise public health.

Keywords: Australia, HIV, immigration, laws, mental health, migration, PLHIV, visa.

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