New Publication on HIV and Migration: How Information Can Support Better Health Outcomes
Imagine uprooting your entire life to move to a new country. A process where you’ll be orienting to a new geography of landscapes, people and public amenities. At the same time, you might be seeking connections and finding supports in a place where you don’t have established family, friends and community. All while taking steps to navigate new rules and processes in a foreign system of education, health care, social services and more, perhaps while grappling with a new or second language.
Now imagine doing all that while living with a chronic health condition like HIV, with only little guidance on how or where to get the support you need.
In Australia, pathways to migration or even temporary stay for people living with HIV is often marked by uncertainty, experiences of stigma and discrimination, and gaps in access to HIV care. This can lead to major challenges to maintaining good health and wellbeing. In response to these challenges, the National Association of People with HIV Australia (NAPHWA) commissioned Health+Law to find out what resources and information exist for people living with HIV, and where there is a need to push for extra or different, and more up-to-date information, supports, programs and other resources that are in line with community need.
This scoping review – a kind of national stocktake of the tools, services and information currently available for HIV-positive migrants and visitors – was conducted to better understand how well current resources address people’s need, and how to better equip community and clinical workers to respond. The review was the first stage in a larger project funded through the Gilead Community Grants Program, with project contributions from the HIV/AIDS Legal Centre (HALC) and ASHM Health, that will next seek to start addressing the gaps so that we can better support people in these communities.
Led by Health+Law researchers Cara Bruce and Scientia Associate Professor David Carter, the review identified 289 relevant resources through direct sector engagement, email outreach and desktop research. It captured everything from factsheets and peer-led programs to legal services and clinical tools. The existing resource base offers a strong foundation of information and support for people born overseas who are living with or affected by HIV. However, there are opportunities to make the resource base more accessible, migration-specific and person-centred. By building on the sector’s existing knowledge and experience, those migrating to Australia can be supported by the right support and information at the right time, ultimately improving both individual wellbeing and public health outcomes.
Many in the HIV and migration sectors recognise that current information can be difficult to access. There is also a clear opportunity to adapt and develop resources tailored to different stages of the migration journey – whether people are considering migrating, at the state of applying for a visa, or already living in Australia. The scoping report found that:
Information about access to health care is uneven for many people living with HIV who were born overseas, especially those who aren’t eligible for Medicare.
There are few migration-specific materials, with limited information for people with low levels of English proficiency.
There is no centralised hub for people living with HIV and those supporting them to find accurate, reliable, up-to-date, Australia-wide information.
Legal advice is critical, but hard to get. Specialist HIV-related migration legal services are limited to a handful of states and exclude people who don’t meet strict financial hardship criteria – this creates a “missing middle”, which includes many people living with HIV.
Resource design rarely reflects the stages of migration, which can leave people unsure of what applies to them and when.
In response to these gaps, the report makes five key recommendations to better support people living with HIV who are visiting or migrating to Australia:
Create targeted resources so that people living with or affected by HIV, including those who might be at risk of HIV acquisition during migration, can access clear, tailored materials to help them access care when they need it, both before they arrive and after they are here.
Equip peer workers, who play a vital and unique role in HIV support, to confidently and safely provide information in relation to legal or migration-related questions, or to male referrals. Additional training and support could supercharge their impact.
Expand access to specialist HIV-related migration services, which we know are extremely helpful – if not, in some situations, essential – but are not available in all states and territories. Broader access would reduce stress on individuals and communities, and boost efficiency across health and legal systems.
Build a centralised, multilingual resource hub that acts as a ‘one-stop-shop’ of accurate, translated, up-to-date information.
Train and upskill the health workforce to identify migration-related issues and refer patients to the right supports. As healthcare workers are often the first to encounter migrants living with HIV who need support with legal challenges, more tools and training for this workforce could mean the difference between someone falling through the cracks or getting the help they need.
Migration is a public health and human rights issue. More than just a sweep of national resources, NAPWHA’s work in this area is a reminder that migration isn’t just about visas and paperwork – it’s also about health, connection to community, human rights and inclusion. When people fall through the cracks of migration and health systems, the effects can be severe. But with connection to community through responsive resources and information, we can collectively create the legal environment that enables individuals and communities to exercise control over their health.
The results of the scoping review are available to read on our publications page and on the ‘HIV and the law’ page of NAPWHA’s website, where you can also find other useful resources on HIV and migration in Australia, including a webinar overview of migration law issues related to HIV, links to the HIV/AIDS Legal Centre (HALC)’s guides to HIV and the law, a national audit of HIV and the law in Australia, and more.