Tribunal decision
11 The Tribunal's decision is careful and fulsome. After first summarising the procedural history and setting out the criteria for a protection visa, the Tribunal recorded its key findings in a section titled "Assessment of the applicant's claimed circumstances": see [9]-[67]. Although information is interwoven throughout that section, the Tribunal there set out:
(a) the material before it;
(b) the appellant's background;
(c) the appellant's claims for protection; and
(d) the Tribunal's assessment of those claims.
12 Relevantly to the grounds of appeal, the Tribunal summarised the appellant's claims in the following way (at [19]-[20]):
[The appellant's] 2014 Declaration is to the following effect:
a. he fears returning to Nepal due to his HIV positive status and his history of drug use;
b. he fears for his health, safety and wellbeing in Nepal "to the extent that my capacity to subsist will be threatened if forced to return to Nepal";
c. he fears ostracism from his family and community; and that he will not be able to earn an income "which will impact upon my capacity to subsist". He fears that if he cannot access treatment and becomes sick in Nepal "it is only a matter of time before my whole family find out about my condition. My father, who is a former policeman, will be very angry if he finds out that I am HIV positive and he will cut me off from the family both financially and socially". He states that only his wife, doctor, counsellor and some close friends who he met through [the HIV charity] know of his HIV status. At another point he adds that he fears that "my brother and my father may even try to physically harm me or even kill me";
d. he also fears that his wife and children will face harm in connection with his HIV status and history of drug [use], which will cause him significant psychological harm. He fears that they will be assumed by the community to be HIV positive even though they are not;
e. people living with HIV/AIDS (PLWHA) in Nepal are treated badly by their families and communities;
f. HIV treatment is difficult to get in Nepal with limited free treatment available which is subject to long queues. Generally people need money to access treatment in Nepal;
g. he fears that "without adequate access to treatment I will develop an AIDS defining illness leading to being hospitalised and eventually death".
[The appellant's] 2014 Declaration … also details the situation regarding access to HIV treatment in Nepal. Relevantly he states:
a. he was not on any HIV treatment from 2003 until 2011 but would occasionally see a doctor to monitor his HIV condition. However, he attended an AIDS conference in Vienna in 2010 and "understood more clearly from my attendance at the conference the importance of being on treatment";
b. in 2011 "an aid agency in Pokhara made funds available for the purchase of HIV medication";
c. he "arranged for a friend to buy HIV medicine for me. My friend was also HIV positive however he came from a different town. I would arrange the treatment by telling the clinic that I was sending someone else to collect my medication";
d. his treatment in Nepal involved taking two tablets twice a day, which gave him headaches, loss of energy and made him feel unwell. In Australia his treatment involves a single tablet and no side effects;
e. there are "strict criteria" for accessing free HIV treatment in Nepal and if you can pay for some or all of the treatment access is more readily available. [The appellant] was not put on HIV treatment when he was diagnosed with HIV due to the high costs of treatment, the limited availability of treatment and the additional travel costs and time. He could not ask his parents for money despite them providing "me with financial support on a daily basis". Eventually he got money from an aid agency to access treatment;
f. when he started treatment he had to travel two hours to see a doctor but for viral load testing he would have had to travel six hours to Kathmandu. He states "I did not check my viral load";
g. he worries that the aid funding he had access to in Nepal will not be available to him on his return which will adversely impact his ability to access HIV treatment on his return to Nepal. He also notes that there are other costs including travel and clinic attendance fees he would need to pay;
h. he adds that "due to fears of stigma and discrimination he was always careful not to let anyone see me go to a clinic in case someone recognised me and discovered that I was HIV positive. I did not even access the treatment myself but instead had a friend attend the clinic for me".
i. he also fears breaches of confidentiality amongst medical service providers in Nepal which could lead to community knowledge of his HIV status;
j. he notes that ignorance about HIV transmission is also present amongst medical service providers such that he may be denied treatment for non-HIV related matters.
(Footnotes omitted.)
13 After noting the appellant's submissions in the 2014 Declaration that relocation to Kathmandu to access treatment would lead to ostracism from his family and community (at [21]), the Tribunal summarised the claims raised in the 2015 submissions; relevantly (at [22]):
The 2015 submissions…are to the following effect:
…
e. [the appellant] has not revealed his HIV status to "most of his family, his friends and his co-workers" as he relied and will continue to rely on his family for support should he return to Nepal;
f. people living with HIV/AIDS (PLWHA) in Nepal experience severe discrimination and ostracism from family, friends, employers, colleagues and the community at large. Knowledge of [the appellant]'s HIV status would lead to discrimination and ostracism of [the appellant], his wife and children which could impact their ability to work and study;
g. [the appellant]'s family has deep respect in the local community, and should [the appellant]'s HIV status become known [the appellant] fears his brother and father will "cut him off from the family and even harm him physically";
h. between 2003 and 2011 [the appellant] did not receive any HIV treatment because of the high costs and limited publicly funded treatments. In 2011 he accessed funding from a local aid agency which enabled him to access treatment;
i. [the appellant] enlisted the help of an HIV positive friend to attend a clinic around two hours from his home. He enlisted this friend's help to avoid being discovered attending the clinic himself;
j. the medicines he took in Nepal gave [the appellant] headaches, created lethargy and made him feel generally unwell, impacting him physically and mentally;
k. [the appellant] was unable to travel six hours to Kathmandu for viral load testing as he was worried that people would ask why he was going and his HIV status would become known;
l. HIV treatment facilities in Nepal are limited and poorly resourced, and free treatment requires satisfaction of "strict criteria" and placement in a long queue/waiting list. Treatment is more readily available if an individual can pay for treatment;
m. there is no guarantee he will have access to funding needed to access treatment on his return to Nepal;
n. disruptions to treatment, including missing even one dose of medication, can have serious implications for an HIV sufferer, allowing a virus to mutate into a drug-resistant form;
o. there is no state welfare in Nepal so should [the appellant]'s health deteriorate in Nepal he will have no one to turn to for financial support and accommodation should he become unable to work;
p. the impact of such consequences together with the impact on the [the appellant]'s wife and children will cause severe psychological harm to [the appellant].
14 At [24], the Tribunal summarises the delegate decision, noting the finding that despite the existence of grassroots discrimination in Nepal, the appellant had not been harmed by anyone in the past; that he had been able to access HIV treatment in the past; and that he and his wife and children had been able to maintain employment and live with the support of family members.
15 At [25]-[28], the Tribunal summarises the Outline of Claims, January 2017 submissions and the February 2017 submissions, noting a concern raised in the latter as to a global reduction in funding for the HIV sector and its implications for the appellant's future employment prospects.
16 From [30], the Tribunal sets out what it accepts about the appellant's background, and the course of the Tribunal member's discussion with the appellant at the Tribunal hearing. At [37], the Tribunal records the appellant's oral evidence that while he has never publicly mentioned his HIV status, there are rumours in the community due to his past drug use and his work in HIV awareness and education programs. At [38], the Tribunal records asking the appellant whether any problems had arisen as a result of the rumours, and noted that:
[the appellant] did not indicate that he, his wife or his children have been harmed, ostracized or mistreated in any way by any members of the community, school or anyone else in connection with these rumors or in connection with his past drug use which, on his own evidence, appears to have been known within his local community.
17 At [39], the Tribunal finds that the appellant's wife's employment had not been affected "despite community awareness that her husband was a former drug user and potentially HIV positive", and goes on to find:
[the appellant]'s evidence that his wife has been able to retain a local job looking after local children aged two to four years, despite community awareness that her husband is a former drug user who may be HIV positive, does not suggest that her employment has been adversely impact by that awareness or those rumours, or that it will be in the reasonably foreseeable future. Nor does this evidence support the applicant's claim that he or any member of his family has faced or faces social or familial ostracism or mistreatment of any kind in connection with the applicant's HIV status or prior injecting drug use being known, rumoured or suspected in Nepal.
18 From [40]-[44], the Tribunal records its discussion with the appellant about his family's awareness of his HIV status "given the presence of community rumors". The Tribunal records the appellant's oral evidence that:
(a) his brother had heard the rumours and "asked him … if he was taking drugs and if he is HIV positive" and had said that "it is not good to be around such people";
(b) the appellant had been living at his parents' home when using intravenous drugs and his parents had been aware of his addiction since around 2003/4, including his father having seen him under the influence of drugs on one occasion; and
(c) his mother does not really know what being HIV positive means but has heard the rumours and when someone told her that people who are HIV positive only live for ten years she asked the appellant tearfully if this was true.
19 The Tribunal goes on to summarise at [44] what it put to the appellant:
The Tribunal put to [the appellant] that his evidence overall seems to indicate that his parents and siblings, including his brother do know of [the appellant]'s HIV positive status linked to his prior intravenous drug use. [The appellant] responded that others might guess this because he has worked in that field for many years. The Tribunal explained that while his work may contribute to such rumors/[speculation] and to the Tribunal's view that his family must know he is HIV positive, other factors, detailed above, compound that view and suggest that despite this, his entire family has remained supportive of himself, his wife and children. The Tribunal explained to [the appellant] that his evidence overall makes it very difficult to accept that his father and/or brother or any other member of his family has had in the past or will have in the reasonably foreseeable future, any intention to stop supporting [the appellant], to ostracise him, harm him in any way or kill him if his HIV status and/or prior drug use is known to them or anyone else.
20 After summarising its discussion with the appellant that his sister is aware, but his wife's family are not aware of his condition, at [47] the Tribunal summarised a further series of factual propositions that it put to the appellant and the findings it made:
The Tribunal also asked [the appellant] whether, other than hearing of community rumors that he is HIV positive in connection with his prior drug addiction, he has ever personally experienced any other type of harm in Nepal in connection with his prior drug addiction or his actual/assumed HIV status. He responded that he was never the direct recipient of the rumors and he only heard about them through his wife and children. He did not identify being harmed in any other way in Nepal in connection with either his actual or rumored prior drug addiction or his ongoing HIV status. This evidence does not support his claimed fears of future harm in Nepal in the reasonably foreseeable future nor his claims that he experienced social harassment in the past. Nor does it support his claims that he will be rejected by society and deprived of his basic human rights in Nepal in the reasonably foreseeable future should his HIV status become known in his community and/or to his family.
21 The Tribunal then sets out its conclusions at [49]-[51]:
Conclusions regarding family support
On the basis of the above evidence and considerations cumulatively the Tribunal does not accept that [the appellant]'s parents or siblings or his local community more generally in Nepal do not know of his former drug addiction/injection and/or his current HIV status. While the Tribunal accepts that [the appellant]'s father hit him on one occasion before 2004 when [the appellant] was in the family home under the influence of drugs, the Tribunal does not accept that the conduct of his family members to date supports his claim that his father or brother or any member of his family would ostracise or disown him or attempt to harm or kill him in connection with his prior known drug use and/or his HIV status, including in the reasonably foreseeable future. Further, [the appellant]'s evidence does not reveal his brother to have given any indication of any intention to harm [the appellant] at any time, despite the Tribunal finding that his brother has been aware of [the appellant]'s HIV status linked to prior drug use for some time. [The appellant]'s family has, contrary to the [the appellant]'s claims that they may disown him, not support him, harm him or kill him should they know of [the appellant]'s HIV status, continued offering [the appellant], his wife and children a home to live in as well as other support, including financial. His own written evidence is that "my mother, father and brother have provided financial assistance that has helped supplement the income of my wife and the money that I have been able to make from conducting programs for [the HIV charity]". Further, his family's sources of financial support are further supplemented by [the appellant]'s wife who, despite the existence of community rumors and speculation linking her husband to HIV infection from prior drug use, has maintained stable employment at a local school/child care facility for some four years. There is no persuasive evidence before the Tribunal that [the appellant] will not have access to strong family support from his parents, siblings and wife in the reasonably foreseeable future even if his illness progresses to a point where he is unable to support himself, contribute to the family income, or look after his own daily needs. The Tribunal finds that, should [the appellant]'s illness progress to a point where he is unable to source employment, support himself, contribute to the family income, or look after his own daily needs, he will continue to be supported by his parents, siblings and his wife in terms of his general capacity to subsist. The Tribunal is not satisfied that [the appellant]'s family contributes in any way to a real chance of [the appellant] facing serious or significant harm as contemplated by the relevant law, in Nepal, in the reasonably foreseeable future.
Conclusions regarding social stigma and ostracism
Regarding social stigma and ostracism, while the Tribunal accepts that stigma and misunderstanding around HIV/AIDS persists in Nepal [the appellant]'s evidence regarding his own and his family's experiences to date suggest that he/they have not and will not, in the reasonably foreseeable future, experience stigma and ostracism to a degree which rises to the level of serious or significant harm as contemplated by the relevant law in connection with [the appellant]'s HIV status and prior drug use being known. Rather, [the appellant]'s evidence reveals that, despite rumours and speculation that [the appellant] is HIV positive due to his generally known prior injecting drug use, [the appellant] has: maintained sound employment at [the HIV charity]; has cited only one example of hostility which arose in the context of [a HIV charity] information session delivered by a doctor at which [the appellant] was present (discussed further elsewhere in this decision record); been able to maintain a profitable side business running events such as community dances and sporting events which rely on sponsorships and ticket sales amongst the local community. His continued ability to make a meaningful profit from this side-business together with the other cumulative factors identified above, do not suggest that [the appellant] or his business or family have been ostracized either financially or socially by their community in Nepal. Further, despite the existence of long-running rumors of [the appellant]'s HIV status, his wife managed to secure employment as the carer of young children at a local school and has maintained that employment for some four years in Nepal. Her work in the trusted capacity as the carer for young children in the community does not suggest that she is viewed with concern or that she has experienced any form of ostracism in relation to [the appellant]'s speculated HIV positive status linked to his generally known prior injecting drug use.
Regarding the submission made that the discrimination and stigma [the appellant], his wife and/or children may face in Nepal, together with the impact of [the appellant]'s likely declining health in the future, may cause [the appellant] significant psychological harm which constitutes persecution and may also cause [the appellant] to resume his drug habit, the Tribunal makes the following observations and findings. While the Tribunal accepts that ignorance, stigma and ostracism against PLWHA in Nepal continues to exist in some areas of Nepal, as revealed by country information detailed in Annexure 2 and as referenced in later sections of this decision, the Nepali Government has spent significant amounts of money to improve education, information and awareness about HIV/AIDS transmission and treatment in a bid to mitigate against the effects of social stigma. Further, despite [the appellant] being suspected and rumoured amongst his local community to be to be HIV positive in connection with his prior drug use, his own evidence is that he has not so much as directly experienced any negative words, discrimination or harm of any type in Nepal. Nor have his wife or children. Contrary to this his evidence is that he has maintained close and consistent family support including being able to live, together with his wife and two of his children in his parents' home; he has had stable and ongoing employment since 2004, primarily but not exclusively with [the HIV charity]; in addition to this employment he has run a successful side business organizing dance parties and sporting events from which he makes between NPR30,000 to NPR 50,000 per event, holding around six such events each year. Notably, [the appellant] told the Tribunal that he received sponsorship and sells tickets to community members interested in participating in such events, indicating that despite community speculation that he is HIV positive as a result of intravenous drug use in the past, he remains socially integrated and members of the community continue to engage with him on a level where he can maintain a profitable side business. While it is claimed at [the appellant] fears that the social stigma he would experience in the reasonably foreseeable future in Nepal, including in the context of his declining health, would cause him psychological harm rising to the level of serious or significant harm, the Tribunal does not consider this to be supported by what the Tribunal accepts of [the appellant]'s social and familial circumstances and his experiences to date. The Tribunal considers his evidence overall to suggest that he continues to be supported and integrated on a family and community level in Nepal despite it being generally known or suspected that he suffers HIV in connection with his prior drug use. The Tribunal is not satisfied on the evidence before it that, even as [the appellant]'s health declines, he or his wife or children face a real chance of social stigma, ostracism or mistreatment which will give rise to harm, including psychological harm to [the appellant], amounting to serious or significant harm as contemplated by the relevant law, in Nepal, in the reasonably foreseeable future. Nor does the Tribunal accept that such pressures give rise to a real chance that [the appellant] will resume his drug use in Nepal in the reasonably foreseeable future.
(Footnotes omitted.)
22 The Tribunal explored the appellant's past experiences regarding access to HIV/AIDS testing, treatment and medication and to medical care more generally in Nepal. Correctly, it reminded itself at [52] that: "While mindful that past experiences are not determinative of what may await an applicant in the reasonably foreseeable future, they remain of some relevance to that assessment". In particular, the Tribunal canvassed:
(a) country information set out in Annexure 2 to the decision record at [95]-[102], indicating access to viral load testing in his home city and Kathmandu ([53]-[55]);
(b) the appellant's capacity to access healthcare, finding that he had in the past been able to access treatment at government hospitals in Nepal and could again in the future ([56]-[57]);
(c) the appellant's evidence of accessing treatment for non-HIV related medical issues, including appendicitis, in Nepal ([58]);
(d) the appellant's evidence of interactions with HIV treatment centres in Nepal, finding it implausible that clinics dispensing his HIV medication would not be aware of his HIV status ([58]);
(e) confidentiality of medical records, finding breaches of confidentiality unlikely and that the appellant has information about providers to make informed treatment choices: [59];
(f) the appellant's claims that he may not be able to access charitable funding which he previously relied on to access HIV treatment in Nepal, finding those claims to be "highly speculative" ([60]);
(g) whether any downturn in global HIV funding would impact the appellant's ability to source income in Nepal, finding that he had employment prospects outside the HIV charity sector ([61]); and
(h) the availability of appropriate medical treatment, testing and care in Nepal in the reasonably foreseeable future, relying on country information sourced by the Tribunal to find that the appellant would be able to access medication with lower toxicity than in the past, and better care of related co-infections and co-morbidities ([61]-[63]).
23 The Tribunal then made the following findings about the likelihood the appellant would suffer significant harm on return to Nepal for the reasons he had nominated, at [64]-[67]:
Based on all the evidence before it and the cumulative considerations, concerns, reasons and findings above, the Tribunal is not satisfied that [the appellant] faces in Nepal in the reasonably foreseeable future, a real chance of serious or significant harm as contemplated by the relevant law, for any of the reasons claimed or arising on the evidence, including cumulatively. Specifically, the Tribunal does not accept that [the appellant] faces a real chance of mistreatment, including neglect, discrimination, social stigma, harassment, ostracisim [sic], denial of access to employment, denial of access to medication, medical services or testing which singularly of [sic] cumulatively give rise to harm amounting to serious or significant harm as contemplated by the relevant law. The Tribunal does not accept that he faces a real chance of being "deprived of basic human rights" or a real chance that he will not be able to "buy from the shops", as his [2014 submissions] claimed. The Tribunal does not accept that [2014] submission that [the appellant], as a person with HIV, has been or will be rejected by his family or society more generally as an person who is HIV positive in connection with his former drug use. Regarding the [2014 submission] that social stigma around HIV/AIDS in Nepal adversely impacts the management of a sufferers health and results in a reduction or denial of care, breaches of confidentiality, withholding information and mistreating patients, the Tribunal notes [the appellant]'s extensive years' of work experience in the area of HIV/AIDS education, awareness and advocacy in Nepal. The Tribunal considers his familiarity with the services and training of service providers in Nepal to be an advantage he will carry into the future and which will allow him to make informed choices regarding the reliable and best service providers in Nepal through which to source testing and treatment, as he has demonstrated himself to have done in the past.
Regarding his capacity to subsist, the Tribunal does not accept that social stigma or discrimination has adversely impacted [the appellant]'s capacity to source employment and conduct a successful side business organizing events which requires community sponsorship and support, despite his evidence revealing long standing community speculation and assumptions that he is HIV positive as a result of his former drug use. Even acknowledging that [the appellant]'s illness may progress to a point where he is no longer able to work, the Tribunal does not accept that he will be disowned or not supported, including in terms of his needs for shelter, food or other basic needs, by his family, including his parents, his siblings and his wife. The Tribunal does not accept that [the appellant] faces a real chance of mistreatment linked to stigma or otherwise in connection with his HIV status linked to his known prior drug use, which will deny him the capacity to subsist. The Tribunal finds, rather, that his capacity to subsist will be secured by his supportive family throughout his life, even if his illness may ultimately deny him the capacity to earn his own income.
Regarding his fear that his wife and children may face social stigma which may adversely impact their capacity to study and/or work, while the Tribunal accepts that [the appellant] has this subjective fear, on the evidence he has advanced his wife and children continue to work and study in Nepal without any adverse interference from anyone despite [the appellant]'s evidence revealing that [the appellant] is generally known or suspected to be HIV positive as a result of his prior drug use.
Further, as reasoned in preceding paragraphs, the Tribunal is not satisfied that [the appellant] faces a real chance of being denied access to effective, appropriate medical treatment, testing and services in Nepal as and when he needs them, whether he has access to charitable funding or not. Nor is the Tribunal satisfied that [the appellant] has in the past, or will in the reasonably foreseeable future, not access treatment he needs out of fear of his HIV status being disclosed to his community more generally.
24 The Tribunal then expressed its conclusions as to its lack of satisfaction under both the refugee and complementary protection criteria at [68]-[78].