Published: 27 June 2018

Medicare ineligibility: Beyond AHOD (Australian HIV Observational Database) Temporary Residents Access Study (ATRAS)

By Aaron Cogle, Executive Director, National Association of People with HIV Australia (NAPWHA)

Information in this blog was originally presented at the Australia Federation of AIDS Organisations (AFAO) Members Meeting, 24-25 July 2018.

Australia’s world class public health system is built on universality and solidarity. It is high time we amplified these values by embracing people who are either living with HIV or at risk of it, but ineligible for Medicare.

Common humanity is always at the centre of successfully treating and preventing HIV.

Approximately 450 people with HIV (PWHIV) are Medicare-ineligible in Australia at any one time, mainly in NSW and Victoria. Many thousands more are at risk of HIV.

Medicare ineligible people in Australia include those on temporary student, business, bridging, spousal, or employer sponsored visas.

To treat or prevent HIV, these people either import generic medicine, take part in compassionate

access schemes (from pharmaceutical manufacturers or State/Territory governments) or pay the full unsubsidised price. However, the commercial cost of HIV prevention and treatment medicines can run into tens of thousands of dollars.

This means many Medicare-ineligible people endure gaps in their access to medicine. This is both unfair and unwise.

New HIV diagnoses in NSW highlights a diverging epidemic with Australian-born gay men having declining rates of transmission and overseas-born gay men with increasing transmission rates.  Your passport or ethnicity should not stand in the way of looking after your health.

ATRAS, the AHOD (Australian HIV Observational Database) Temporary Residents Access Study started in 2012 as a program run by NAPWHA, the Kirby Institute and pharmaceutical companies and was very successful in finding Medicare ineligible people and giving them access to treatment. Of the 180 people living with HIV who took part, 53 per cent had a detectable viral load when they enrolled. After 24 months only 6 per cent were still detectable.

The study established that about two-thirds of people transition to Medicare eligibility or return to their country of origin within two years. It also found that providing HIV medicine to those who are Medicare ineligible could avert 81 transmissions. While this came at an initial cost of $29 million, it would also generate savings of $26 million.

This shows that the financial impost of making HIV treatment and prevention available to all is close to cost neutral. However, the real argument for expanding HIV treatment and prevention medicine to all is moral, rather than financial.

When less-stigmatised threats to public health such as active tuberculosis loom we don’t hesitate. We treat it, we fix it and the state pays for it, regardless of Medicare eligibility.

A patchwork of agreements and access regimes for Medicare-ineligible people exist across Australia, both for HIV antiretrovirals and also PrEP. What we really need is a simplified national system built on principles of universality and evidence-based public health.