{"id":"F2018L01841","name":"Statement of Principles concerning human immunodeficiency virus infection (Reasonable Hypothesis) (No. 5 of 2019)","slug":"statement-of-principles-concerning-human-immunodeficiency-virus-infection-reasonable-hypothesis-no-5","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":439891,"registerId":"F2018L01841-fast-fetch-1775955740201","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning human immunodeficiency virus infection (Reasonable Hypothesis) (No. 5 of 2019)","content":"---\nmeta-content-style-type: text/css\nmeta-content-type: application/xhtml+xml; charset=utf-8\nmeta-generator: Aspose.Words for .NET 20.2\n---\n\n?xml version=\"1.0\" encoding=\"utf-8\" standalone=\"no\"?>\n\n![RMA-Red](image.001.jpeg)\n\n \n\nStatement of Principles\n\nconcerning\n\nHUMAN IMMUNODEFICIENCY VIRUS INFECTION   (Reasonable Hypothesis)\n\n(No. 5 of 2019)\n\nThe Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) of the Veterans' Entitlements Act 1986.\n\n \n\nDated 21 December 2018\n\n \n\n \n\n \n\n \n\n \n\n| The Common Seal of the  Repatriation Medical Authority  was affixed to this instrument  at the direction of:<br> |\n| --- |\n| ![](image.002.png)<br> <br>Professor Nicholas Saunders AO<br>Chairperson<br> |\n\n\n \n\n   \n\n\nContents\n\n1 Name\n\n2 Commencement\n\n3 Authority\n\n4 Repeal\n\n5 Application\n\n6 Definitions\n\n7 Kind of injury, disease or death to which this Statement of Principles relates\n\n8 Basis for determining the factors\n\n9 Factors that must exist\n\n10 Relationship to service\n\n11 Factors referring to an injury or disease covered by another Statement of Principles\n\nSchedule 1 - Dictionary\n\n1 Definitions\n\n \n\n\n\n\n1               Name\n\nThis is the Statement of Principles concerning human immunodeficiency virus infection (Reasonable Hypothesis) (No. 5 of 2019).\n\n2               Commencement\n\n              This instrument commences on 28 January 2019.\n\n3               Authority\n\nThis instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986.\n\n4               Repeal\n\nThe Statement of Principles concerning human immunodeficiency virus No. 5 of 2010 (Federal Register of Legislation No. F2010L00012) made under subsection 196B(2) of the VEA is repealed.\n\n5               Application\n\nThis instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act 2004 applies.\n\n6               Definitions\n\nThe terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument.\n\n7               Kind of injury, disease or death to which this Statement of Principles relates\n\n(1)          This Statement of Principles is about human immunodeficiency virus infection and death from human immunodeficiency virus infection.\n\nMeaning of human immunodeficiency virus infection\n\n(2)          For the purposes of this Statement of Principles, human immunodeficiency virus infection means an infection that is caused by one of the human retroviruses, human immunodeficiency virus-1 (HIV‑1) or human immunodeficiency virus-2 (HIV‑2).\n\n(3)          While human immunodeficiency virus infection attracts ICD‑10‑AM code B20, B21, B22, B23, B24 or Z21, in applying this Statement of Principles the meaning of human immunodeficiency virus infection is that given in subsection (2).\n\n(4)          For subsection (3), a reference to an ICD-10-AM code is a reference to the code assigned to a particular kind of injury or disease in The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM), Tenth Edition, effective date of 1 July 2017, copyrighted by the Independent Hospital Pricing Authority, ISBN 978-1-76007-296-4.\n\nDeath from human immunodeficiency virus infection\n\n(5)          For the purposes of this Statement of Principles, human immunodeficiency virus infection, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's human immunodeficiency virus infection.\n\nNote: terminal event is defined in the Schedule 1 – Dictionary.\n\n8               Basis for determining the factors\n\nThe Repatriation Medical Authority is of the view that there is sound medical‑scientific evidence that indicates that human immunodeficiency virus infection and death from human immunodeficiency virus infection can be related to relevant service rendered by veterans, members of Peacekeeping Forces, or members of the Forces under the VEA, or members under the MRCA.\n\nNote: MRCA, relevant service and VEA are defined in the Schedule 1 – Dictionary.\n\n9               Factors that must exist\n\nAt least one of the following factors must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting human immunodeficiency virus infection or death from human immunodeficiency virus infection with the circumstances of a person's relevant service:\n\n(1)          being exposed to HIV-1 or HIV-2 before the clinical onset of human immunodeficiency virus infection;\n\nNote: being exposed to HIV-1 or HIV-2 is defined in the Schedule 1 - Dictionary.               \n\n(2)          having:\n\n(a)           a genital ulcerative disease; or\n\n(b)           a non-ulcerative anogenital sexually transmitted infection with clinical symptoms or signs, excluding genital warts; or\n\n(c)          herpes simplex virus type 2 anogenital infection;\n\nwithin the 30 days before the clinical onset of human immunodeficiency virus infection;\n\n(3)          using depot medroxyprogesterone acetate contraception at the time of the clinical onset of human immunodeficiency virus infection;\n\n(4)          having an infection from the specified list of infections at the time of the clinical worsening of human immunodeficiency virus infection;\n\nNote: specified list of infections is defined in the Schedule 1 - Dictionary.\n\n(5)          inability to obtain appropriate clinical management for human immunodeficiency virus infection.\n\n10           Relationship to service\n\n(1)          The existence in a person of any factor referred to in section 9, must be related to the relevant service rendered by the person.\n\n(2)          The factors set out in subsections 9(4) and 9(5) apply only to material contribution to, or aggravation of, human immunodeficiency virus infection where the person's human immunodeficiency virus infection was suffered or contracted before or during (but did not arise out of) the person's relevant service.\n\n11           Factors referring to an injury or disease covered by another Statement of Principles\n\nIn this Statement of Principles:\n\n(1)          if a factor referred to in section 9 applies in relation to a person; and\n\n(2)          that factor refers to an injury or disease in respect of which a Statement of Principles has been determined under subsection 196B(2) of the VEA;\n\nthen the factors in that Statement of Principles apply in accordance with the terms of that Statement of Principles as in force from time to time.\n\n \n\n \n\nSchedule 1 - Dictionary  \n\nNote:               See Section 6\n\n1               Definitions\n\nIn this instrument:\n\n                               being exposed to HIV-1 or HIV-2 means:\n\n(a)           having percutaneous exposure (intravenous, intramuscular, subcutaneous or intradermal) or permucosal exposure to a specified body substance which is derived from a person infected with HIV-1 or HIV-2; or\n\n(b)           having a tissue or organ transplant, where the tissue or organ is derived from a person infected with HIV-1 or HIV-2.\n\nNote: specified body substance is also defined in the Schedule 1 – Dictionary.\n\n                               helminthic infection means soil-transmitted helminths, schistosomiasis, onchocerciasis, lymphatic filariasis, and visceral and cutaneous leishmaniasis.\n\n                                human immunodeficiency virus infection—see subsection 7(2).\n\n                               MRCA means the Military Rehabilitation and Compensation Act 2004.\n\n                               relevant service means:\n\n(a)          operational service under the VEA;\n\n(b)          peacekeeping service under the VEA;\n\n(c)          hazardous service under the VEA;\n\n(d)          British nuclear test defence service under the VEA;\n\n(e)          warlike service under the MRCA; or\n\n(f)           non-warlike service under the MRCA.\n\nNote: MRCA and VEA are also defined in the Schedule 1 - Dictionary.\n\n                               specified body substance means:\n\n(a)          blood, blood products or any body fluid containing blood; or\n\n(b)          semen or vaginal secretions.\n\n                               specified list of infections means:\n\n(a)           helminthic infection; \n\n(b)           herpes simplex virus type 2;\n\n(c)           human T-cell lymphotropic virus type-1; \n\n(d)           malaria; or\n\n(e)           tuberculosis.\n\nNote:                             helminthic infection is also defined in the Schedule 1 – Dictionary.\n\n                               terminal event means the proximate or ultimate cause of death and includes the following:\n\n(a)           pneumonia;\n\n(b)           respiratory failure;\n\n(c)           cardiac arrest;\n\n(d)           circulatory failure; or\n\n(e)           cessation of brain function.\n\n                               VEA means the Veterans' Entitlements Act 1986.\n\n \n\n \n","sortOrder":0}],"analysis":{"flash_summary":{"complexity_score":3,"scope_assessment":{"changed":false,"description":"This instrument replaces the 2010 Statement of Principles on HIV infection (s4) and refines definitions and a set of medical/exposure factors that raise a reasonable hypothesis (s7–s9, Schedule). The change appears to be an update/clarification of criteria rather than a substantive expansion beyond the original legislative purpose of providing medical criteria to connect conditions to relevant service under the VEA/MRCA. It keeps the same statutory framework and purpose (s3, s5, s8) and does not add new categories of persons or new legal entitlements beyond those already contemplated by the VEA and MRCA."},"complexity_factors":["Relatively short instrument (11 main sections plus a short Schedule).","About 12 defined terms in Schedule 1 (e.g. being exposed to HIV-1 or HIV-2, specified list of infections, specified body substance, terminal event, relevant service).","A small number of conditional rules — notably s10(2) limits the operation of s9(4) and s9(5).","Cross-reference to other Statements of Principles (s11) creates external dependency but not deep nesting within the text.","References external documents/codes (ICD-10-AM) but only for identification (s7(3)-(4)).","Repeal of an earlier 2010 Statement (s4) — procedural change but not a complex transitional regime."],"plain_english_summary":"**What this instrument does (mechanics first)**\n\n- This is a Statement of Principles made by the Repatriation Medical Authority (RMA) that sets the medical criteria used to decide whether human immunodeficiency virus (HIV) infection — or death from HIV infection — can be connected to a person’s military or peacekeeping service for the purposes of veterans’ compensation law (see s3, s5).  It replaces the 2010 Statement (s4) and commenced on 28 January 2019 (s2).\n\n- The Statement does not itself pay benefits.  Instead it supplies a legal-medical test used by decision-makers under the Veterans’ Entitlements Act 1986 (VEA) and the Military Rehabilitation and Compensation Act 2004 (MRCA) to decide whether a reasonable hypothesis exists that the person’s HIV infection is related to their relevant service (s5, s8, s9).\n\n- To raise that “reasonable hypothesis”, at least one of the specific factors listed in section 9 must be present and related to the person’s relevant service (s9, s10).  Those factors include: exposure to HIV-1 or HIV-2 (for example via percutaneous or permucosal contact with specified body substances, or a tissue/organ transplant) (Schedule definition); recent genital sexually transmitted infections or genital ulcerative disease within 30 days before clinical onset (s9(2)); use of depot medroxyprogesterone acetate contraception at clinical onset (s9(3)); certain infections present at the time of clinical worsening of HIV (s9(4) and Schedule); and inability to obtain appropriate clinical management for HIV (s9(5).)  (See s7 for the Statement’s working definition of HIV infection.)\n\n- The Statement clarifies how some factors operate.  For example, the factors in s9(4) and s9(5) only apply when the person already had HIV before or during service (but the infection did not arise out of service) and the factor materially contributed to or aggravated the condition (s10(2)).  If a factor involves another disease covered by a separate Statement of Principles, the rules in that other Statement also apply (s11).\n\n**Who it affects**\n\n- Primary effect: veterans, former or current members of the Australian Defence Force (including those who rendered operational, peacekeeping, hazardous or nuclear-test defence service under the VEA, and warlike or non-warlike service under the MRCA) who claim that HIV infection or death from HIV is connected to their service (Schedule definition of relevant service; s5). \n\n- Administrative effect: the Department of Veterans’ Affairs and decision-makers who apply the VEA and MRCA will use this Statement as the medical benchmark to test whether a “reasonable hypothesis” of service connection exists for HIV-related claims (s3, s8).\n\n**Why it matters (stated purpose, then practical implications and trade-offs)**\n\n- The RMA states it has sound medical‑scientific evidence that HIV infection and death from HIV can be related to relevant service (s8).  Concretely, the Statement defines the minimal set of medical or exposure-related facts that, if present and linked to service, are sufficient to raise a reasonable hypothesis of service connection (s9).  That affects whether claimants proceed to merits assessment and potential entitlement under the VEA/MRCA.\n\n- Practical effects and incentives: by listing specific exposure pathways and clinical risk factors (s9 and Schedule), the Statement lowers the required factual threshold in some cases from broad epidemiological proof to discrete documented events (for example, documented percutaneous exposure, transplant, or a qualifying anogenital STI within 30 days of clinical onset).  This changes what evidence claimants and the Department need to collect (medical records, treatment histories, incident reports), and it can speed or broaden access to review/benefits when those factors are present.\n\n- Costs and who pays: the Statement itself does not allocate money.  If decision-makers accept that a reasonable hypothesis is raised and the other legal elements under the VEA or MRCA are satisfied, the Department may be required to provide medical and/or monetary entitlements.  That creates a potential increase in administrative and benefit costs borne by the Department proportional to successful claims that rely on the Statement’s criteria.\n\n- Implementation and evidentiary risks: some items on the list are straightforward to prove (e.g. documented exposure to an infected body substance, transplant records), while others are more subjective or record-dependent (e.g. proving inability to obtain appropriate clinical management, or documenting an STI within a 30‑day window before clinical onset).  The conditional rule in s10(2) — limiting s9(4) and s9(5) to cases where HIV existed before/during service and did not arise out of service — introduces an additional evidentiary step.\n\n- Effects on private actors and markets: the Statement is a claims-assessment rule.  It does not regulate private healthcare providers, pricing, competition, or treatment options directly.  Where it refers to specific medications (e.g. depot medroxyprogesterone acetate at s9(3)), it may influence how claim evidence is framed, but it does not change clinical standards of care.\n\n**Concrete mechanics to watch (where administrative discretion and cost arise)**\n\n- The RMA’s list of qualifying factors is the trigger for a “reasonable hypothesis” — once one is present and linked to service, claim assessment proceeds (s9, s10).  Decision-makers must therefore evaluate documentary proof of exposure, timing of infections, contraception use, clinical worsening with listed co‑infections, and whether appropriate clinical care was available.\n\n- Cross-references: the Statement incorporates other Statements of Principles where a factor refers to another disease (s11).  That creates a dependence on the text and timing of those other Statements when assessing some factors.\n\n**Bottom line (concise)**\n\n- This instrument defines the medical and exposure-related facts that can establish a reasonable hypothesis that HIV infection (or death from HIV) is connected to a person’s relevant military or peacekeeping service.  It guides claim assessment under the VEA and MRCA by naming specific exposures, infections and service-related conditions that, if evidenced and linked to service, are sufficient to move a claim forward (see s9, s10, Schedule)."},"flash_summary_failed":{"failed":true,"reason":"A positive credit balance is required for all requests, including BYOK, so fallback providers remain available. Add credits at https://vercel.com/d?to=%2F%5Bteam%5D%2F%7E%2Fai%3Fmodal%3Dtop-up to continue.","source":"analysis-cron"},"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"This is a standard Statement of Principles instrument that operates within its intended scope under section 196B(2) of the Veterans' Entitlements Act 1986. It replaces a 2010 version concerning the same condition (HIV infection) without expanding beyond the statutory purpose of determining medical factors for veterans' compensation claims. The structure and content align with the standard template for such instruments."},"complexity_factors":["Multiple cross-references to defined terms in Schedule 1 (12 defined terms including nested definitions)","Conditional logic in section 10(2) restricting application of factors 9(4) and 9(5) to pre-existing conditions worsened by service","Technical medical terminology requiring specialist knowledge (ICD-10-AM codes, specific drug names, disease classifications)","Dual legislative framework requiring understanding of both VEA and MRCA schemes","Incorporation by reference to external medical classification system (ICD-10-AM Tenth Edition)","Note references creating secondary definitional layers (e.g., 'being exposed to HIV-1 or HIV-2' defined in terms of 'specified body substance' which is separately defined)"],"plain_english_summary":"The Repatriation Medical Authority’s Statement of Principles sets medical criteria for when HIV infection (or death from HIV-related conditions) can be presumed related to defence service, affecting veterans and current/former defence members claiming under the VEA 1986 or MRCA 2004.  \n\nIt lists medical factors (any one can suffice) that must be linked to service — including exposure events, co‑infections, a specific contraceptive, or lack of treatment — and clarifies that worsening of pre‑existing HIV only counts if service caused the deterioration."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-human-immunodeficiency-virus-infection-reasonable-hypothesis-no-5","history":"/api/acts/statement-of-principles-concerning-human-immunodeficiency-virus-infection-reasonable-hypothesis-no-5/history","analysis":"/api/acts/statement-of-principles-concerning-human-immunodeficiency-virus-infection-reasonable-hypothesis-no-5/analysis","conflicts":"/api/acts/statement-of-principles-concerning-human-immunodeficiency-virus-infection-reasonable-hypothesis-no-5/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-human-immunodeficiency-virus-infection-reasonable-hypothesis-no-5/important-cases","documents":"/api/acts/statement-of-principles-concerning-human-immunodeficiency-virus-infection-reasonable-hypothesis-no-5/documents"}}