An asylum seeker is a person who has fled their own country, applied for protection status, and is awaiting a decision on their refugee application (14). Depending on how they arrived in Australia, their date of arrival and their stage in the asylum claim process, asylum seekers may reside in immigration detention onshore or offshore, in community detention, or be living in the community on a temporary visa.
A refugee is a person who ‘owing to a well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group or political opinion is outside the country of his [sic] nationality and is unable or owing to such fear is unwilling to avail himself [sic] of the protection of that country’ (15). The 1951 Refugee Convention aims to protect the human rights and treatment of people forced to flee their own countries.
Asylum seekers over the age of 15 years receive a health screen including HIV testing. Increasing numbers of asylum seekers with HIV were reported in Darwin, Northern Territory following the introduction of HIV screening for those arriving by boat without a visa (from 18 diagnoses in 2011-2012 to 30 in 2012-2013) (16).
Access to services including Medicare, medicines and work rights varies according to visa status. Importantly, asylum seekers and refugees are eligible for most health and community services in some states and are categorised as a Priority 1 group for community health services (17). Some states have arrangements in place to improve access to health services. People who are ineligible for Medicare can now access free antiretroviral treatment (18). However, it is important to note that there is a co-payment in some states/territories.
Nurses and midwives may be involved in the care of HIV-positive refugees and asylum seekers in any setting. While it is important to understand the legal situation around seeking asylum and eligibility, the nurse’s role in keeping with the International Council of Nurses Code of Ethics for Nurses is to advocate and facilitate, support and promote health for all, especially those most vulnerable (19). In Australia, HIV specialist nurses are accessible to asylum seekers and refugees with HIV and early referral to nursing services is advisable, though often overlooked. Refugee health nurses are also involved in caring for people with HIV.
Refugees and asylum seekers in Australia come from a wide range of countries including, but not limited to, Iraq, Iran, China, Afghanistan, Sri Lanka, Sudan, Burma, and Sierra Leone. In recent years, greater numbers have arrived from Afghanistan, Iran, Iraq, Sri Lanka, Syria, Ukraine and Palestine (for current data, see Refugee Council of Australia).
They may experience specific clinical problems relating to epidemiology in their country of origin. For example, people with HIV from some countries may be prone to reactivation of latent infections not generally screened for in Australian populations such as schistosomiasis and strongyloidiasis (20). Recent reports from Germany indicate that tuberculosis and hepatitis B may be more common in Ukrainian refugees with HIV than in PLHIV in Germany (21).
Children from refugee backgrounds may be at greater risk of blood-borne viruses transmitted iatrogenically (through blood transfusions and contaminated injections and surrogate breastfeeding or milk banks) (22). There is a higher prevalence of HIV in children who have come from central Asia, Southeast Asia, and Sub-Saharan Africa for example (23).
Close collaboration with refugee health nurses, social workers, caseworkers and community health, housing and other services optimises the care of people with HIV who are refugees or asylum seekers. Refugee health clinics are available in most states and territories. See Refugee Heath Australia