Australia’s HIV success isn’t reaching everyone. The overlooked barriers for queer migrants.
Australia has made extraordinary progress against HIV. But new research reveals how racism, Medicare eligibility and social connections can shape access to prevention and care — and why making medication available is only part of the challenge.
When Youngjoon first visited a sexual health clinic in Australia, he had been looking forward to it.
A gay man who had migrated from Asia and was living in Queensland, Youngjoon understood sexual health clinics to be a familiar part of Australian gay life. Visiting one offered another way to participate in a community he was getting to know.
“I feel like I’ve just finally joined the club,” he told researchers.
His account appears in a study published in October 2026, which examined how 11 Asian-born gay migrants in Queensland navigated relationships, racism and HIV prevention after moving to Australia.
For Youngjoon, visiting the clinic offered a sense of belonging. Other participants described a more complicated welcome within predominantly white gay social and sexual networks.
Brian, another man interviewed for the study, experienced exclusion within a gay sporting group. Yet it was through members of that same group that he learnt about HIV testing and PrEP, a medication used to prevent HIV.
Their experiences reveal something national HIV statistics can’t easily capture: how the communities people find, or struggle to find, can shape their access to prevention and care.
According to the Kirby Institute’s latest national surveillance figures, Australia recorded 753 HIV diagnoses in 2025, a quarter fewer than a decade earlier. Preliminary estimates also suggest the country has achieved the United Nations’ 95-95-95 targets for diagnosis, treatment and viral suppression.
Yet more than half of gay and bisexual men diagnosed with HIV in Australia in 2025 were born overseas.
Between 2016 and 2025, annual diagnoses among Australian-born gay and bisexual men fell from 442 to 229, almost halving. Among overseas-born men, they declined more slowly, from 316 to 255.
And over the past five years, 49 per cent of diagnoses among gay and bisexual men born in Southeast Asia were classified as late, compared with 23 per cent among Australian-born men.
These figures tell an important, if incomplete, story. The comparisons focus on gay and bisexual men, offering little insight into how trans and non-binary migrants are experiencing Australia’s HIV prevention progress.
And being born overseas, of course, doesn’t tell us where someone acquired HIV, how long they’ve lived in Australia or what access they’ve had to healthcare
Still, the disparities are difficult to ignore. And behind the national figures are experiences that rarely make it into a surveillance report.
Finding community, encountering racism
The Queensland study, led by researcher Satrio Nindyo Istiko, explored how 11 Asian-born gay migrants formed social and sexual relationships in Australia, and how those connections shaped their experiences of HIV prevention.
Some participants associated moving to Australia with greater freedom to explore their sexuality and form relationships. However, some also described feeling unwelcome in predominantly white gay communities.
Brian described a clique of younger white Australian men in his sporting group who avoided eye contact or ignored him during conversations. He found himself speaking mostly with older white men.
Other participants encountered racialised sexual stereotypes and fetishisation. The researchers also documented accounts of sexual violence, including non-consensual sexual activity and condom removal without consent.
Yet the same social spaces could also provide a route to sexual-health information.
Despite the exclusion Brian experienced, the sporting group introduced him to conversations about PrEP, HIV testing and sexual healthcare.
The contradiction is striking. The relationships through which someone encounters discrimination may also be the ones through which they discover support.
The study involved just 11 university-educated men interviewed in 2021 and 2022, so their experiences cannot represent those of all Asian-born gay migrants. But they offer a revealing glimpse into the importance of social connections, particularly when it comes to finding information about HIV prevention.
The gap between wanting PrEP and taking it
Knowing someone who takes PrEP might seem like a small thing. But when it comes to navigating Australia’s sexual healthcare system, those connections can be valuable.
A February 2026 study published in AIDS and Behaviour found that people who wanted PrEP but had never started taking it were less likely to know someone already using the medication.
A friend on PrEP could recommend a clinic, explain how to get a prescription or simply make the process feel less unfamiliar. For someone new to Australia and its healthcare system, those conversations may be particularly useful.
The researchers drew on a 2023 national online survey of gay, bisexual and queer men, including trans men, and non-binary people. They compared 947 current PrEP users with 228 respondents who were willing to use it but never had.
Recently arrived migrants from countries outside the study’s high-income English-speaking category were more likely to be among those willing non-users. Among recently arrived participants in that group, 87.5 per cent had no Medicare coverage.
PrEP (pre-exposure prophylaxis) reduces the risk of acquiring HIV through sex by around 99 per cent when taken as prescribed. Since 2018, eligible people with Medicare have been able to access the medication at a subsidised price through the Pharmaceutical Benefits Scheme.
Those without Medicare have historically faced higher costs and a more complicated process, sometimes relying on private prescriptions or importing generic medication.
The study identified other differences, too. People who wanted PrEP but hadn’t started were more likely to be younger, live outside major cities or identify as bisexual, queer or another sexuality rather than gay.
They were also less likely to be in paid employment and reported less recent sexual activity than those already taking PrEP.
Finances, personal circumstances and perceptions of HIV risk may all influence whether someone starts. And while knowing another PrEP user doesn’t necessarily mean someone will start taking the medication themselves, the research raises questions about how easily people outside established prevention networks can find their way into care.
The survey also highlights some of the gaps in our understanding. Although trans men and non-binary people were included, they represented a relatively small proportion of respondents.
Australia’s national PrEP guidelines recognise PrEP as an option for trans and gender-diverse people where clinically appropriate. But there’s still limited research into how trans and non-binary migrants experience access to prevention, particularly when Medicare eligibility and unfamiliar healthcare systems are part of the picture.
When access depends on Medicare
Australia has begun addressing one of the biggest barriers to PrEP access.
Under a $26 million federal funding agreement, states and territories are expanding access to PrEP for people without Medicare.
In NSW, eligible international students, temporary visa holders, working holidaymakers and people seeking asylum can now access the medication free through participating public sexual health services.
It’s a significant change. People without Medicare have historically been excluded from PBS-subsidised PrEP, leaving many to navigate private prescriptions and other options at their own expense. The new programme offers eligible people another way to access the medication, free of charge. But making PrEP free doesn’t automatically mean everyone who could benefit knows where to get it.
Someone navigating an unfamiliar healthcare system may have questions about confidentiality, struggle to find information in their preferred language or worry about whether seeking care could affect their visa.
Others may be looking for services that understand their sexuality or gender identity, particularly if previous experiences of discrimination have made approaching healthcare more difficult.
The NSW HIV Strategy 2026–2030 acknowledges these challenges, calling for more culturally responsive services, multilingual health promotion and stronger partnerships with migrant communities.
And Australia’s HIV response has long been shaped by queer communities themselves. Decades of activism, peer education and collaboration with health services have made prevention and treatment far more accessible.
But the networks built through that work may be less familiar to someone newly arrived in Australia, living outside major queer communities or encountering the local healthcare system for the first time.
Making medication affordable is one part of closing the gap. Making sure people know where to find it, and feel comfortable accessing it, is another.
Bringing sexual healthcare into everyday life
For an international student unfamiliar with Australia’s healthcare system, a conversation about sexual health might be easier to have on campus than in a specialist clinic.
That’s the thinking behind a programme developed by Sydney Local Health District and the NSW Multicultural HIV and Hepatitis Service, which has been bringing sexual health information and support into universities, student accommodation and services students already use.
Between January 2024 and March 2026, the programme reached more than 5,000 international students through health promotion activities, according to an evaluation published in Sexual Health in August 2026.
It also trained 106 student peer leaders, bringing sexual health conversations into student communities.
At the University of Sydney in October 2025, the initiative went a step further, setting up a one-day sexual health screening clinic on campus.
Twenty-two students received testing, identifying one previously undiagnosed case of syphilis, while around 500 others spoke with staff about sexual healthcare and navigating local services.
Student peer leaders and multilingual health workers helped answer questions about sexual health and navigating a healthcare system many students were still getting to know.
For some newly arrived students, those conversations were their first contact with the NSW health system.
It’s a small but significant shift: rather than expecting students to find their way to sexual healthcare, the programme brought it into their everyday lives.
Beyond Australia’s HIV success story
Australia’s HIV response is one of the country’s great public-health achievements. But the latest figures are a reminder that its progress hasn’t been experienced equally.
When the Kirby Institute released its findings, epidemiologist Dr Skye McGregor highlighted the need for more timely testing, particularly among heterosexual people and gay and bisexual men born in Southeast Asia.
Scott Harlum, president of the National Association of People with HIV Australia, also drew attention to the period between newly arrived overseas-born men entering Australia and becoming connected to healthcare and support.
A late HIV diagnosis can mean years spent living with the virus unknowingly, without treatment that protects someone’s health and prevents sexual transmission once their viral load becomes and remains undetectable.
Expanded free PrEP access is a significant step forward. But removing the financial barrier doesn’t necessarily remove the social and practical ones. People still need to know where to find prevention, understand how to access it and feel comfortable approaching the services available to them.
That’s the thread running through the research. Racism can complicate the search for community. Friendships and social networks can shape someone’s introduction to HIV prevention. And for some international students, a conversation on campus may be their first encounter with Australia’s sexual healthcare system.
For Youngjoon, visiting a sexual health clinic offered a sense of belonging. Brian found information about HIV prevention through a sporting group where he didn’t always feel welcome.
Their experiences are different, and neither can speak for every queer migrant. But both reveal something the national figures alone cannot capture: how much the journey to care can be shaped by the people and communities around us.
Australia’s achievements against HIV were built through decades of work by people living with HIV, LGBTQ+ communities, health professionals, researchers and advocates.
The question now is how to build on that community-led success while reaching people who aren’t already connected to the networks that helped create it.
How to access free PrEP in NSW without Medicare
If you live in NSW and don’t have Medicare, you may be eligible for free PrEP through participating public sexual health clinics or the NSW Sexual Health Infolink.
This includes eligible international students, temporary visa holders, working holidaymakers and people seeking asylum. Access is based on your circumstances and clinical suitability, not your sexual orientation or gender identity.
You don’t need to know whether PrEP is right for you before getting in touch. A nurse or doctor can talk you through your options.
For advice, clinic locations and telehealth options, call the NSW Sexual Health Infolink on 1800 451 624 (option 5), Monday to Friday, 9 am–5.30 pm.
If you’d prefer to speak in another language, call TIS National on 131 450 for interpreting support.
Find out more: NSW Health — Free PrEP if you don’t have Medicare.
