Accessing HIV Treatment and Care for Medicare Ineligible People
If there was a global mandate obligation that everyone living with HIV should have immediate access to HIV treatment regardless of where they live or who they are, then The WHO Updated Guidelines1, released in late 2015, are peak. The 
WHO guidelines mandate and obligate a new world order for immediate HIV treatment for the health of all people living with HIV, and as a preventative measure for the elimination of new HIV infections. The updated WHO guidelines form their basis on the evidence for commencing treatment early, at high CD4 counts, along with its preventive benefit, with a call-to-action to all countries of the world to “treat all” by making treatment accessible and available for all.
Politically, these guidelines follow many of the world’s former mandates upon expanding antiretroviral access to the globe – such as the UN Political Declaration on HIV/AIDS (2011), to which Australia a signatory in the reduction of new HIV infections through the provision of accessible testing and treatment. The Melbourne Declaration (2012)3 also followed this mandate, as does the Australian National HIV Strategy (2014-2017)4. Devolving this further, Queensland State (under the former LNP government) is also signatory to the joint memorandum of understanding with The British-Columbia Centre for Excellence in HIV/AIDS (BC-CfE)5 for the expansion of HIV testing and treatment for everyone.
Despite these global, federal and state mandates, not everyone has been considered, highlighting major flaws in the guidelines and strategies, particularly within Australia. The most significant group of people being left behind are those without Australian Medicare Cards (Medicare Ineligible People) who must either pay the full market cost for treatment or afford generic medicines (imported online). To do so puts many people in this category under difficult financial strain in absence of substantial income, such as those residing in Australia on temporary visas.
Despite former efforts to support Medicare Ineligible People amidst the Australian HIV Observations Database (AHOD) Temporary Residents Access Study (ATRAS)6 – which achieved unilateral support for drug supply from all the major HIV Pharmaceutical companies – at the conclusion of that study (in late 2015) some 61 people (of the initial 180 enrolled in this trial) are now once again without HIV drug access. A number of people from the trial have since become Medicare eligible, or returned to their home country temporarily or permanently. Those still residing temporarily in Australia, without Medicare access, now need to afford or access treatment (and healthcare) independently – as part of the estimated 464 temporary residents living with HIV in Australia without Medicare access.
In Australia, only Medicare Card holders may gain access to subsidised (low cost) HIV medicine through the Pharmaceuticals Benefits Scheme (PBS). Given this situation, QPP have produced a fact sheet 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 healthcare monitoring during your stay in Australia, with a focus on support available in Queensland. The resource explores options and methods for obtaining more affordable generic medicines online, or the seeking of compassionate access sponsorship, or engaging in a clinical trial for free treatment access during the trial time period (should a trail be available in the person’s location), and the final option of emergency financial assistance for people with limited or no income. The resource does not explore immigration visa pathways that may lead to Medicare eligibility, but QPP can also assist in helping foreign visitors living with HIV to navigate the Australian visa system, and further reading links for this are shown below. The QPP resource has a focus upon gaining access to treatment and healthcare support without a Medicare Card, and this resource is available here: https://www.qpp.org.au/treating-hiv/can-get-treatment
References:
- The WHO Updated Guideline on When to Start Antiretroviral Therapy and on Pre-Exposure Prophylaxis for HIV: http://www.who.int/hiv/pub/guidelines/earlyrelease-arv/en/
- UN Political Declaration on HIV/AIDS (2011) http://www.unaids.org/sites/default/files/sub_landing/files/20110610_UN_A-RES-65-277_en.pdf
- The Melbourne Declaration https://www.afao.org.au/__data/assets/pdf_file/0017/25523/The-Melbourne-Declaration-2012.pdf
- Seventh National HIV Strategy (2014-2017) http://www.health.gov.au/internet/main/publishing.nsf/Content/ohp-bbvs-hiv
- BC Centre for Excellence in HIV/AIDS memorandum of understanding with the Queensland Government Treatment as Prevention Strategy http://www.cfenet.ubc.ca/news/releases/queensland-adopt-british-columbia-treatment-prevention-strategy
- 2 year follow-up analysis report of ATRAS http://napwha.org.au/home/atras-20
Further Reading:
HIV/AIDS Legal Centre (HALC) Positive Migration Guide: http://halc.org.au/wp-content/uploads/2012/10/positive-migration-guide.pdf
Department of Immigration and Border Protection Visa Finder: https://www.border.gov.au/Trav/Visa-1
The National Association of People Living with HIV in Australia (NAPWHA) guide to accessing HIV care and treatment: http://napwha.org.au/health-treatment/hiv-treatment/how-access-hiv-care-and-treatment-australia
