The impact of visa status and Medicare eligibility on people diagnosed with HIV in Western Australia: A qualitative report

Abstract

Background: In Australia, temporary visa holders are ineligible for Medicare and subsidised antiretroviral drugs. Additionally, HIV testing is not mandatory for visas unless applicants seek work in the health sector. We sought to understand the impact of HIV and issues of access and adherence to antiretroviral therapy (ART) in people holding temporary visas and permanent residents. Methods: Data were gathered from interviews with 22 participants. Information concerning medication adherence, side effects, CD4 T-cell count, viral load and rate of response to generic drugs were collected. Results: The mean age was 33.4 years (±s.d. = 6.0), 21 out of 22 were from HIV-prevalent areas in East Africa and Asia, 14 out of 22 were on temporary visas, 12 were ineligible for Medicare, 14 out of 22 were diagnosed during health screening, 19 out of 22 risk exposures were in country of origin, 8 out of 17 were taking generic ART at an average cost of $180 per month, adherence was excellent and self-reported side-effects were relatively infrequent. Participants applying for visa continuations and permanent residency were fearful, believing their HIV serostatus would prejudice their applications. Patients cited belief in ART efficacy, were motivated to maintain therapy and were anxious about lack of access to treatment in their countries of origin. Conclusion: Adherence to antiretroviral drugs in Medicare-ineligible HIV-infected individuals is excellent despite limited access to treatment. The threat of visa non-renewal and the likely failure of applications for permanent residency result in considerable anxiety and confidentiality concerns.