'If I had my residency I wouldn't worry':: Negotiating migration and HIV in Sydney, Australia

Objective. To describe the interrelationships between migration and resettlement, the Australian immigration system and living with HIV. Method. Data were collected through semi-structured, in-depth interviews with clients of the Multicultural HIV/AIDS and Hepatitis C Service and a sexual health clinic in the Sydney metropolitan area over an 18-month period in 2003-2004. Results. Three major themes interwoven with migration were identified: HIV diagnosis, access to care and support, and forming social relations. Participants who applied for permanent residency in Australia rather than off-shore were usually diagnosed as HIV-positive as part of the health requirement for permanent residency. This jeopardized their prospect of staying in Australia and was at the same time a barrier to returning to the country of birth. It was also a barrier to accessing health care and support services and a major source of uncertainty. The meaning of an HIV-positive diagnosis was grounded in participants' knowledge about HIV from their country of birth: HIV infection was perceived as a terminal illness. Because of the stigma associated with HIV/AIDS, many had little or no contact with their ethnic communities in Australia. At the same time, they found it difficult to form new social relations in the Anglo-Celtic mainstream culture. A further problem was feeling torn between Australia and the promise of a better future, and the close emotional relationships with family and friends in the country of birth. Conclusion. New migrants with HIV need to negotiate two major life disruptions and two major uncertainties simultaneously: migration and HIV infection. In the Anglo-Celtic mainstream, language, cultural and financial barriers to health and support services should be removed or minimized. In ethnic communities, HIV-related stigma needs to be addressed to enable new migrants to form social relations in these communities and to rebuild their lives.