Some immigrants with HIV are applying for refugee status because they're worried the government will kick them out.
Immigration rules mean people with HIV applying for visas will be assessed on a case-by-case basis, with applicants of visas longer than 12 months requiring a medical check.
This rule was introduced in October 2021 but prior to that there was a blanket ban because people with the virus were seen as being likely to impose significant costs or demands on health services.
A computer-generated illustration of HIV. Photo: AFP/ SCIENCE PHOTO LIBRARY
It was a Friday in July 2020 when Liam's* doctor called to tell him he had HIV.
"I did not know what it meant to me and I was just completely shocked. I had to ask for a day off at work," he said.
Although Liam is speaking anonymously, he is nervous about being identified but agreed for it to be known he's from a South East Asian country and also has ties to the Middle East.
"It added a layer of stress and anxiety to my life," he said.
Very few people outside of New Zealand know he has HIV, including his parents who don't even know he's gay.
He would get a sexual health check-up every three months and, at the time, New Zealand's borders had also been closed since March due to the Covid-19 pandemic.
Immigration rules then also meant he wouldn't be able to get another visa so he applied for refugee status.
"I was definitely infected here in New Zealand."
Photo: 123RF
Liam originally moved to New Zealand in 2014 on a student visa, studied towards a diploma and moved onto a work visa - something he now needs to renew.
He has applied for one of the government's one-off 2021 Resident Visas, a residency pathway that was set up due to Covid-19, and withdrew his refugee application as a result.
He's seeking some clarification from his lawyer but is positive about his chances of the visa being approved.
However, it plays on his mind that nothing is yet certain partly because of his HIV status.
"I've been advised that if that [the residency visa] doesn't work, just in case, then I could always claim back my refugee status again."
Liam wants better security to stay in New Zealand "on compassionate or humanitarian grounds" because he was infected here.
"I didn't acquire this medical condition intentionally ... I don't know how or accidentally or whatsoever, maybe the person did not know their status."
His home country and another where his family are have both, historically, not tolerated homosexuality to the point he can't think about returning there.
"That's not an option for me," Liam said.
In one of the countries, Liam said he could be stoned to death just because he's gay - even before thinking about the likelihood of being able to access treatment for his HIV.
If that became his reality, he said life would be "miserable, vulnerable" and being there alive as his true self would be "basically like being dead".
HIV peer support organisation Body Positive's executive director Mark Fisher said the one-off resident visa was a unique offering. "It'd be great if that does work."
But he spoke with caution because he knew "lots of people" - not all are gay men; anyone can be infected with HIV - who have been denied access to visas and sent home, even since the change to immigration rules.
Overall, Fisher lambasted the immigration rules. "That's not good public health policy."
Immigration New Zealand enablement general manager Stephen Dunstan confirmed there had been refugee and protection claims involving people with HIV.
He said the rule change last year was supported by all parties that the Immigration and Health ministries engaged with, noting that "HIV is still a serious chronic illness and can present a risk to public health in some circumstances".
RNZ sent separate questions to Minister of Immigration Kris Faafoi's office, but was told the Minister was away.
'We didn't do everything to keep them safe'
Green Party immigration spokesperson Ricardo Menendez-March has dealt with a number of people concerned about getting a visa rejected because of their HIV status.
He said it was "not acceptable" that some people felt a need to consider applying for refugee status and wanted the government to look at removing the mandatory health testing.
Fisher said those tests were when a lot of immigrants would find out their HIV status.
He thought some of this group were not being connected to HIV support services quick enough to get them engaged in care.
New Zealand needed to bear some of the burden and responsibility "because we didn't do everything to keep them safe" and were sending people back to countries where they would face increased stigma and discrimination, Fisher said.
Mark Fisher says New Zealand needs to do better in connecting new migrants with HIV support services. Photo: Supplied
This was echoed by Menendez-March, who said the current approach "clearly" compounds existing stigmas relating to HIV.
"People are fearing that our own government agencies may discriminate against them based on their HIV status."
Immigration NZ's Dunstan said doctors on the Immigration panel had a duty of care to inform patients of "any abnormal test results" and refer them on for treatment.
Liam* said he has experienced HIV stigma in New Zealand. "It does hurt," he said.
"I don't know if that's as bad as what it's going to be back home because back home people are not well educated [about sex and sexuality]."
He wants people to know that HIV is manageable - "it's not what it used to be 30, 40 years before" - including the fact that someone on regular treatment that reaches undetectable HIV viral loads cannot sexually transmit the virus to another person.
"I could still live a healthy life and a normal life."
Everyone in New Zealand - from citizens through to people on tourist visas - receives HIV care free of charge .
'We've targeted the gay white guys'
Fisher said there was an issue of immigrants being infected with HIV in New Zealand rather than bringing it with them.
A large contributor to that was the lack of education relating to safe sex, particularly of a homosexual nature, among people arriving from non-Western countries.
"We need to make sure that they're educated the same way that we expect New Zealanders to be educated around their health," Fisher said. "They come here and they can totally do whatever they want but we don't tell them to be safe."
He is trying to get education made available for international students when they arrive in New Zealand because some students don't have a medical check.
"The problem with what we've done historically, with like 30 years of HIV, is we've targeted the gay white guys ... we haven't targeted the other ethnicities where people aren't out and connected to the [LGBTQI+] community."
Fisher said health officials and support services needed to get specific in reaching minority communities. "We're not giving them the education, we're not giving them the tools - such as the condoms and PrEP - easily and in an appropriate format that's culturally relevant to them."
The government is developing a National HIV Action Plan, which RNZ understands is due to be published mid-2022.
Menendez-March said it had to include migrant communities "and not just take a normative approach to how HIV is tackled in our communities".
He noted there were a lot of intertwined nuances in immigration and health issues.
"We need broader reform so that people are feeling supported."
*Name has been changed for privacy reasons.