Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1697633739980.pdf (Australia)
LIVING POSITIVE VICTORIA JOINT COMMITTEE OF PUBLIC ACCOUNTS AND AUDIT Inquiry based on Auditor-General’s report 18 (2015-16) Qualifying for the Disability Support Pension December 2016 1 of 3 Commonwealth Risk Management—Inquiry based on Auditor-General’s report 18 (2015-16)Submission 41 About Living Positive Victoria is a not for profit, community based organisation representing all people living with HIV in Victoria since 1988 and is committed to the advancement of human rights and wellbeing of all people living with HIV.
Living Positive Victoria works closely in partnership with a range of HIV-sector and other organisations to deliver a comprehensive and coordinated response to the needs of PLHIV in Victoria, nationally and internationally.

We welcome the opportunity to provide this submission to the Joint Committee of Public Accounts and Audit.

People living with HIV People living with HIV (PLHIV) who receive disability support pension (DSP) face a range of complex health needs.
This cohort includes people who: • have been living with HIV long-term have health complications relating to the physical impact of early treatment and/or comorbidities associated with AIDS and immune suppression; • have been recently diagnosed but for whom diagnosis was late (currently classified at greater than four years between acquisition and diagnosis).
The longer HIV remains undiagnosed, the more likely HIV impacts negatively on the immune system which may lead to comorbidities including bioindicators of AIDS (CD4 <200).

Data from the Kirby Institute show that for 2015, 29% of all new diagnosis were considered to be late;i and • have pre-existing or undiagnosed mental health or other health conditions that were exacerbated after the acquisition of HIV.
PLHIV in receipt of DSP have come to rely on the DSP as their main source of income and have adopted routines in daily/weekly lives in accordance with living on a reduced income.

Their capacity for meaningful involvement in paid or volunteer work is guided by their health and can fluctuate from week to week and is often unpredictable.
Some people living long term with HIV have already drawn on their superannuation funds, as was recommended by their HIV specialist upon advice of short term life expectancy experienced during the AIDS epidemic.

Furthermore, because of their limited ability to participate in the workforce, PLHIV in receipt of DSP have not benefited from employer paid compulsory superannuation, further increasing their reliance on the DSP.
Case study A number of members approached LPV recently, having received advice from Centrelink/the department about a review of their DSP.

This was extremely distressing for all parties who received such letters.

Some of our members indicated that had stopped HIV treatment so that their HIV viral load increased the effect of which would be a decline in their immune system (decreased CD4 counts).
This was essentially self- harm in order to increase the complexities of their health needs in an attempt to guarantee their continued (perceived) suitability for the DSP.

Thankfully, through peer- support, these individuals came to understand the nature of the review and were encouraged to continue adhering to their HIV treatment regime.
2 of 3 Commonwealth Risk Management—Inquiry based on Auditor-General’s report 18 (2015-16)Submission 41 Recommendations Exemption from review for PLHIV As has been the example provided in other submissions to this inquiry, for some categories of health conditions that have no likelihood of improvement or for which no cure currently exists, it is unsustainable for Centrelink/the department to be undertaking routine reviews of these cases.
LPV understands that not all people living with HIV should qualify for the DSP, individuals in receipt of DSP on the basis of their HIV should be exempt from review.

Nuanced and clear communication from Centrelink and the department LPV acknowledges that some communication from Centrelink and/or the department are automatically generated and that this is required to achieve system efficiencies.
However, it is not clear that the communication used to notify individuals of a DSP review is in plain English, is clear that the review is routine and that in most cases the review won’t affect people’s eligibility for the DSP, particularly for people who have life- long conditions such as HIV.

Communications could be improved by utilising existing community networks.
This would be achieved by Centrelink/the department developing resources for agencies that assist and support people who are in receipt of DSP.

It could also include ‘information navigators’ who would be trained by the department to go out into communities with relevant information to affected individuals and groups.
Systematic change Without further significant reforms to the DSP and social security system more broadly, the continued complexity of the system will impact upon those people who rely on the DSP as their only source of income.

Due to the increasing size of the social security system, considerable bureaucracy will need to be employed to administer the system.
LPV therefore strongly recommends the consideration of a negative tax income system (or similar universal living income scheme) as the only way to reduce administrative burden (and therefore cost to the taxpayer) of the social security system.

We welcome a public discourse about the merits of such reform at a national level.

JM/BA i The Kirby Institute, ‘HIV, viral hepatitis and sexually transmissible infections in Australia: Annual Surveillance Report 2016’, The Kirby Institute, UNSW Australia, Sydney.
p. 11.

3 of 3 Commonwealth Risk Management—Inquiry based on Auditor-General’s report 18 (2015-16)Submission 41