Statement of Principles concerning human immunodeficiency virus infection (Balance of Probabilities) (No. 6 of 2019)

Principal concepts are set out in the operative provisions and the Schedule 1 dictionary. Key concepts are: the medical condition covered, the set of causal or associative factors, the temporal and service‑related constraints on when those factors can operate, and the definitional boundaries for exposure and relevant service.

Human immunodeficiency virus infection: The SOP defines the condition as infection caused by HIV‑1 or HIV‑2 (s 7(2)). The instrument clarifies that while certain ICD‑10‑AM codes are associated with HIV infection (B20-B24, Z21), for application of the SOP the statutory meaning is the definition in s 7(2) (ss 7(2)-(4)).

Death from HIV infection: Death is included where the person’s HIV infection contributed to a terminal event or condition. The Schedule defines "terminal event" to include proximate or ultimate causes such as pneumonia, respiratory failure, cardiac arrest, circulatory failure, and cessation of brain function (s 7(5); Schedule 1).

Factors that must exist: Section 9 provides a closed list of factors. At least one of these must exist before it can be said, on the balance of probabilities, that HIV infection or death from HIV is connected with the circumstances of relevant service. The factors are:

1. Being exposed to HIV‑1 or HIV‑2 before the clinical onset of HIV infection (s 9(1)/(1) and Schedule 1 definition of being exposed).
2. Having, within 30 days before clinical onset of HIV infection: a. a genital ulcerative disease; or b. a non‑ulcerative anogenital sexually transmitted infection with clinical symptoms or signs, excluding genital warts; or c. herpes simplex virus type 2 anogenital infection (s 9(2)).
3. Using depot medroxyprogesterone acetate contraception at the time of clinical onset (s 9(3)).
4. Having tuberculosis at the time of clinical worsening of HIV infection (s 9(4)).
5. Inability to obtain appropriate clinical management for HIV infection (s 9(5)).

Definitions and limits: The Schedule supplies definitions that materially affect application. "Being exposed" means percutaneous exposure or permucosal exposure to a specified body substance from an infected person, or receiving a tissue or organ transplant from an infected donor (Schedule 1). "Specified body substance" is limited to blood, blood products, body fluids containing blood, semen or vaginal secretions (Schedule 1). "Relevant service" is statutorily confined to certain service categories: eligible war service (other than operational) under the VEA; defence service (other than hazardous service and British nuclear test defence service) under the VEA; or peacetime service under the MRCA (Schedule 1). The SOP therefore attaches its causal rules to those defined categories.

Relationship to service and timing constraints: Section 10 requires that any s 9 factor relied on be related to the person’s relevant service. Section 10(2) imposes a further constraint for the tuberculosis factor and the inability‑to‑obtain‑management factor: they apply only to material contribution to, or aggravation of, HIV infection where the infection was suffered or contracted before or during, but did not arise out of, the person’s relevant service.

Cross‑SOP interaction: Section 11 provides that if a factor in s 9 refers to an injury or disease covered by another SOP, then the factors in that other SOP apply in accordance with its terms as in force. This establishes a mechanism for incorporating or deferring to other RMA SOPs where those factors intersect.

Evidentiary standard: The SOP's title and s 8 make explicit that connection is assessed on the balance of probabilities and that the RMA’s selection of factors is based on the medical‑scientific evidence available to it (s 8). The SOP therefore sets the medical presumptions that decision‑makers will apply when deciding claim causation matters under the referenced sections of the VEA and MRCA.

Primary affected persons: The SOP applies to persons making claims under the two statutory gateways identified in s 5: claims to which s 120B of the VEA or s 339 of the MRCA apply. The instrument does not itself expand or contract those statutory claim categories; rather, it provides the causal framework decision‑makers must employ when assessing whether HIV infection or death from HIV is connected to the claimant’s relevant service (s 5). The Schedule defines "relevant service" to include specific non‑operational and non‑hazardous service categories (Schedule 1). Therefore the SOP directly affects:

• Veterans or members whose claims fall within those statutory provisions and who assert HIV infection or death from HIV as service‑connected.
• Decision‑makers and medical assessors who will apply the SOP when determining causation for such claims.

Individuals not covered or affected: The Schedule’s definition of relevant service excludes certain categories explicitly. "Eligible war service" is confined to non‑operational war service, defence service excludes hazardous service and British nuclear test defence service, and MRCA coverage is limited to peacetime service (Schedule 1). Consequently, a person whose service consisted primarily of operational service, hazardous service, or British nuclear test defence service, as those terms are excluded in the Schedule’s phrasing, will not have that service treated as "relevant service" for the purposes of this SOP, and the SOP will not apply to claims that rest exclusively on those excluded service types (Schedule 1).

Medical and clinical stakeholders: Hospitals, treating clinicians and diagnostic facilities will be indirectly affected because the SOP fixes the types of clinical facts that will be determinative in causation assessments. RMA’s framing of factors , for example the 30‑day window for certain STIs (s 9(2)) and the particular contraceptive (depot medroxyprogesterone acetate) noted at clinical onset (s 9(3)) , directs what clinical evidence claimants and treating practitioners must supply. The Schedule defines "specified body substance" in a way that narrows the sorts of exposures legally recognised (Schedule 1).

Administrative actors: The RMA is the rule‑maker (s 3). Administrative decision‑makers under the VEA and the MRCA will apply this SOP when considering the specified statutory claim types. The instrument does not itself state which agency or official will adjudicate individual claims, but it binds the medical causation framework that those adjudicators must follow because it is made under the RMA’s statutory power (s 3) and applies to the specified claim provisions (s 5).

Indirect effects: While the SOP does not create new entitlements or payments in itself, its determinations will affect who is found to have a service connection for HIV infection or death from HIV under the VEA and MRCA frameworks. That in turn can have downstream effects for those claimants in terms of whatever entitlements attach under the underlying statutes. The instrument does not set those entitlements; it only sets the medical causation criteria to be used when deciding whether those underlying statutory tests are met (s 5).

Rights established by the instrument: The SOP establishes the medical criteria that a claimant may rely on in asserting that HIV infection, or death from HIV infection, is connected with relevant service for the purposes of claims under s 120B of the VEA or s 339 of the MRCA (s 5, s 9). A claimant who can establish, on the balance of probabilities, that at least one of the enumerated factors in s 9 existed and was related to their relevant service may satisfy the causation threshold set by the RMA for this condition (s 9, s 10(1)). Death is expressly included where HIV infection contributed to a terminal event, with terminal event defined in Schedule 1 (s 7(5); Schedule 1).

Duties and obligations implied by the instrument: The SOP does not impose direct duties on persons, service providers or bureaucracy in the form of express procedural obligations, reporting duties or penalties. However, it imposes an evidentiary regime for decision‑makers: they must apply the RMA’s medical factors when determining whether HIV infection or death from HIV is connected to relevant service in the statutory claim contexts (s 5). Decision‑makers therefore have the operational duty of assessing whether any s 9 factor is present and whether it is related to the claimant’s relevant service (s 9, s 10(1)).

Temporal and causal constraints that act as obligations on proof: Claimants must adduce evidence to show that an enumerated factor existed within the temporal confines specified by the SOP. For example, the STI factors require occurrence within 30 days before clinical onset of HIV infection (s 9(2)). The "being exposed" factor requires exposure before clinical onset (s 9(1) and Schedule 1). The Schedule’s definition of specified body substance limits what counts as exposure (Schedule 1). Those temporal and definitional constraints operate as obligations on claimants to produce evidence consistent with those parameters.

Interplay with other SOPs: Where a s 9 factor refers to an injury or disease covered by another SOP, section 11 directs that the factors in that other SOP apply "in accordance with the terms of that Statement of Principles as in force from time to time" (s 11). Practically, this means decision‑makers may be required to apply the rules from multiple SOPs where a factor crosses into another condition. That places a procedural requirement on decision‑makers to check for and apply relevant SOPs.

Limits on factors as causes versus aggravation: Section 10(2) constrains two factors so that they are capable only of showing material contribution to, or aggravation of, an HIV infection that was contracted before or during relevant service but did not arise out of relevant service (s 10(2)). In other words, those factors cannot themselves be used to establish that the infection arose out of service where the infection was contracted during or before service; they are limited to aggravation or material contribution in those circumstances.

Evidentiary standard: The SOP sets the causation standard as balance of probabilities (title and s 8). This is the legal test decision‑makers must apply when using the RMA’s medical findings. The RMA asserts that its selection of factors is based on the sound medical‑scientific evidence available (s 8). That claim frames the RMA’s role as producing a medically informed presumptive list for administrative application.

What the SOP does not do: It does not itself adjudicate individual claims, prescribe entitlement amounts, create offences, set administrative penalties or detail procedural steps for claim submission or review. It is a medical‑causation instrument to be applied within the statutory claim processes defined elsewhere (s 5).

No penalties in the instrument: The Statement of Principles is a medical‑causation instrument. It contains no criminal or civil penalty provisions, no administrative fines and no enforcement mechanisms within its text. The instrument does not create offences, nor does it specify sanctions for non‑compliance by claimants, clinicians, or administrators. The SOP’s legal effect is to set the medical gatekeeping criteria decision‑makers must apply when deciding claims to which the specified statutory provisions apply (s 5).

Administrative enforcement is indirect: Although the instrument contains no enforcement provisions, it will be enforced in practice through administrative decision‑making under the VEA and the MRCA. Decision‑makers considering claims under s 120B VEA or s 339 MRCA will use the RMA’s SOP to determine whether the requisite causal connection to relevant service exists. The SOP therefore functions as a legally binding evidentiary tool for those administrative determinations because it is made under the RMA’s statutory power (s 3) and made applicable to the specified claims (s 5).

Burden of proof and standards: The SOP sets the causation standard to be applied on the balance of probabilities (title and s 8). This is not a penalty mechanism, but it is the standard that claimants must meet to succeed in a causation finding. The instrument does not separately allocate onus beyond the statutory allocation in the underlying claims framework; rather, it supplies the medical factors decision‑makers must test against the evidence.

Discretion and interpretive enforcement risk: The SOP contains some terms that are not defined in the instrument, for example “clinical onset”, “clinical worsening”, and “appropriate clinical management” (these phrases appear in ss 9(1), 9(2), 9(4)-(5) and s 10). Because the SOP does not define these terms, administrative decision‑makers and medical assessors will necessarily interpret them in the course of applying the SOP. That interpretive process is the mechanism by which application is enforced in individual cases. The instrument creates no internal appeal, review or enforcement procedure; those procedures, if any, are those established by the VEA and MRCA frameworks, which are outside the text of this SOP (s 5 indicates the SOP’s application to claims under those Acts).

Interaction with other SOPs relevant to enforcement: Section 11 requires that where a s 9 factor refers to an injury or disease covered by another SOP, the factors in that other SOP apply according to that SOP’s terms as in force. Practically, enforcement of a causal finding may require cross‑application of multiple SOPs, which will be enforced by the administrative decision‑maker deciding the claim.

Commencement and repeal as enforcement milestones: The SOP commenced on 28 January 2019 (s 2) and repealed the earlier 2010 SOP on the same topic (s 4). For claims determined after commencement, decision‑makers will apply the 2019 SOP; the instrument itself establishes the operative time at which its factors and definitions become the binding medical framework for applicable claims.

Linkage to the VEA and MRCA claim framework: The SOP is expressly made under s 196B(3) of the VEA (s 3) and applies to claims to which s 120B of the VEA or s 339 of the MRCA apply (s 5). The SOP does not alter the substantive provisions of those statutes; rather, it supplies the medical causation criteria that decision‑makers must apply when determining whether HIV infection or death from HIV is connected with relevant service for the purposes of those statutory claims. The instrument therefore functions as a statutory medical gloss for those claim provisions.

Cross‑reference to other Statements of Principles: Section 11 provides a vehicle for interaction where a s 9 factor refers to an injury or disease covered by another SOP. In that event the factors in the other SOP apply in accordance with its terms "as in force from time to time" (s 11). This creates a networked legal relationship between SOPs, where the treatment of overlapping medical issues is resolved by applying the terms of the relevant SOPs together.

ICD coding is informational, not definitional: Section 7(3) notes that HIV infection attracts certain ICD‑10‑AM codes, and s 7(4) identifies the edition of ICD‑10‑AM referenced. However, s 7(2) specifies the legal meaning of HIV infection for this SOP. The instrument therefore interacts with diagnostic coding systems only as a cross‑reference; it does not adopt the ICD codes as the statutory definition. Decision‑makers should therefore be attentive to the statutory definition in s 7(2) rather than relying solely on ICD codes.

Definitions that narrow interaction with other statutory areas: The Schedule’s definition of "specified body substance" limits exposure to a defined set of fluids or products (blood, blood products, body fluid containing blood, semen, vaginal secretions) (Schedule 1). That definition will determine how exposure is treated in relation to other legal frameworks addressing biological exposure or occupational health. The SOP does not purport to displace occupational health or other statutory schemes; it provides a causation framework within the VEA and MRCA claim contexts.

Temporal limits affect overlap with other claims: Section 10(2) limits the operation of two factors, tuberculosis and inability to obtain appropriate clinical management, to cases where the person’s HIV infection was contracted before or during, but did not arise out of, relevant service. This limitation will affect how the SOP interacts with claims where infection allegedly arose during service. For infections contracted during service, the limited factors cannot be used to establish causation arising out of service; they are constrained to showing material contribution or aggravation only in narrowly described circumstances (s 10(2)).

No express interaction with criminal law, public health law or workplace compensation law: The SOP contains no provisions that address criminal law, public health reporting obligations, workplace compensation regimes or civil tort claims. It is silent on those areas. Where overlap exists in practice, the SOP will interact functionally through evidentiary materials (medical records, laboratory results) but the instrument does not purport to harmonise or displace other statutory obligations or entitlements beyond its role in the VEA/MRCA claim context (s 5).

Repeal of earlier SOP: The instrument expressly repeals the earlier Statement of Principles concerning HIV infection No. 6 of 2010 (s 4). The repeal means that, for the purposes of the VEA/MRCA claim provisions to which the SOP applies, the 2019 SOP replaced the RMA’s earlier approach starting from the commencement date (s 2). Decision‑makers must therefore be alert to which SOP was in force at the relevant time for a given claim.

Creation and commencement: The instrument is dated 21 December 2018 and was made under the statutory power in s 196B(3) of the VEA (s 3). It commences on 28 January 2019 (s 2). The instrument is identified as the Statement of Principles concerning human immunodeficiency virus infection (Balance of Probabilities) (No. 6 of 2019) at the head of the text.

Repeal of prior instrument: Section 4 repeals the earlier Statement of Principles concerning human immunodeficiency virus No. 6 of 2010, Federal Register of Legislation No. F2010L00013. The 2019 SOP therefore supplanted the 2010 instrument for the purposes specified in s 5 upon commencement.

No other amendments recorded in the instrument: The text supplied contains no subsequent amendments, no schedules of amendment beyond the Schedule 1 dictionary, and no transitional provisions other than the repeal of the 2010 SOP. The instrument itself does not list any amendments to other statutes, nor does it record any amendment history beyond the replacement of the earlier SOP.

Ongoing operation and interaction with in‑force SOPs: Section 11 contemplates that other SOPs may operate "as in force from time to time" where factors overlap, meaning future amendments to other SOPs will automatically be reflected in their application pursuant to s 11. The instrument therefore establishes a dynamic interplay where changes to other SOPs can affect how this SOP’s factors are applied where they refer to diseases or injuries covered elsewhere (s 11).

What the instrument does not record: The instrument does not include a schedule of prior amendments, dates of ministerial approval beyond the signature page, or any record of consultation or external reports relied upon. Section 8 asserts that the RMA’s view is "on the sound medical‑scientific evidence available" but the instrument does not incorporate or reproduce that evidence, nor does it give a legislative history of prior drafts or consultations.

Implication for future change: Because the instrument is made under a delegated power and references the current force of other SOPs (s 11), it is amendable by further instruments made under the same statutory power. The text includes no procedural limits or freeze on amendment; amendments would follow the statutory process for such instruments under the VEA.

No litigation history in the instrument: The Statement of Principles text supplied contains no record of judicial or tribunal decisions concerning this SOP. It does not cite any cases, nor does it record any litigation or challenges to its validity, scope, or application.

Relevance for litigators: Because the SOP is a medical causation instrument intended for administrative decision‑making under the VEA and MRCA, any litigation or tribunal review would likely arise in the course of appeals against decisions on claims made under those Acts. This instrument does not itself provide information about how tribunals or courts have interpreted its factors, timing constraints or undefined terms, because no litigation history is included in the instrument text.

What is in the instrument that litigation might later test: The instrument contains several points of legal and factual ambiguity that could be the subject of future litigation or merits review proceedings. Examples include:

• Interpretation of undefined terms such as "clinical onset", "clinical worsening" and "appropriate clinical management" (ss 9(1), 9(2), 9(4)-(5)). These are not defined in the SOP and will require clinical and legal interpretation in application.
• Application of the Schedule’s definition of "being exposed to HIV‑1 or HIV‑2" and "specified body substance" to particular factual matrices, for example distinguishing between exposure to a body substance that qualifies under the Schedule and other potential exposures (Schedule 1).
• The limits in s 10(2) on how s 9(4) and s 9(5) can be used to show contribution or aggravation only where infection was contracted before or during but did not arise out of relevant service. The boundaries of "arise out of" may be litigated in the underlying VEA/MRCA claim environments.
• Cross‑application of other SOPs under s 11 where factors overlap. Disputes may arise about which SOPs apply and how to reconcile differing factor lists or definitions.

Absence of any reported litigation in the instrument: The SOP does not indicate any contemporaneous judicial or tribunal interpretation or confirmation of its provisions. Any practitioner assessing likely litigation risk must therefore rely on the instrument’s text and the statutory frameworks of the VEA and MRCA and monitor administrative decisions and tribunal or court outcomes arising from application of this SOP in individual claims.

Terms used but not defined: The SOP uses clinically significant phrases that it does not define. Examples include "clinical onset of human immunodeficiency virus infection", "clinical worsening", and "appropriate clinical management" (ss 9(1)-(5), 10(2)). Because these terms are undefined, assessing whether a factor exists will require clinical evidence and potentially contested expert interpretation. That creates room for disagreement between treating clinicians, medical assessors and claimants about timing and clinical thresholds.

Narrow definition of exposure: "Being exposed to HIV‑1 or HIV‑2" is given a specific meaning in the Schedule: it is percutaneous exposure or permucosal exposure to a "specified body substance" from an infected person, or receipt of a tissue or organ transplant from an infected donor (Schedule 1). "Specified body substance" is itself limited to blood, blood products or any body fluid containing blood, semen or vaginal secretions (Schedule 1). Exposures outside these matrices, by reason of the SOP’s language, are not captured by the being‑exposed factor. Practitioners should not assume the SOP covers every conceivable route of exposure; it adopts a finite, listed understanding.

Temporal windows are tight: The STI factors in s 9(2) require the infection to have occurred within 30 days before the clinical onset of HIV infection. That is a narrow temporal window and may be difficult to prove retrospectively without contemporaneous clinical records. The requirement to show the STI occurred in this precise window is a strict evidentiary hurdle.

Specific contraceptive named: Section 9(3) identifies depot medroxyprogesterone acetate contraception as a factor when present "at the time of the clinical onset of human immunodeficiency virus infection". The SOP names a specific contraceptive product rather than a broader class. Where a claimant was using a different contraceptive, the named factor will not assist. The instrument gives no guidance on why that contraceptive is singled out; practitioners must rely on clinical evidence and the SOP’s text.

Exclusions within definitions of relevant service: The Schedule defines "relevant service" by positive inclusion and by explicit exclusions: eligible war service other than operational service; defence service other than hazardous service and British nuclear test defence service; and peacetime service under the MRCA (Schedule 1). Claims based solely on operational service, hazardous service, or British nuclear test defence service are not within the Schedule’s definition of relevant service for the purposes of this SOP. Practitioners should check the underlying statutory schemes to see how those categories are dealt with in respect of other SOPs or claim contexts.

Two factors limited to aggravation or contribution only: Section 10(2) narrows the operation of s 9(4) and s 9(5) so they only apply to material contribution to, or aggravation of, an HIV infection that was contracted before or during but did not arise out of relevant service. This means that tuberculosis at time of clinical worsening and inability to obtain appropriate clinical management cannot be used to establish that HIV infection arose out of relevant service where the infection was contracted during or before service. Practitioners must therefore be careful in pleading cause versus aggravation.

Cross‑SOP dependency: Section 11 makes the application of factors contingent on the terms of other SOPs "as in force from time to time" where a s 9 factor refers to another injury or disease. That may introduce uncertainty if the other SOP is later amended, or where the relationship between the conditions is contested. Users must check the current versions of other SOPs when a s 9 factor refers to another condition.

Death inclusion requires contribution to a terminal event: Section 7(5) includes death resulting from a terminal event contributed to by HIV infection. The Schedule lists examples of terminal events. Claimants asserting death‑related claims must show that the HIV infection contributed to the terminal event listed. The instrument does not treat all deaths of those with HIV as automatically connected; contribution to a terminal event is required.

No procedural guidance or evidentiary checklist included: The SOP specifies the medical factors but does not provide a procedural list of the types of documentary or laboratory evidence that will suffice to establish each factor. Practitioners must infer the evidentiary routes from the factors and from clinical practice, but the SOP’s silence on procedural matters means that administrative decision‑makers and tribunals will be the sites where evidentiary sufficiency is determined.

ICD cross‑reference is non‑determinative: While the SOP records ICD‑10‑AM codes that correspond to HIV disease, it expressly states that, for the purposes of the SOP, the statutory meaning is the definition in s 7(2) (ss 7(2)-(4)). Practitioners should not rely solely on ICD coding as establishing legal coverage; the statutory definition governs.

For claimants

• Establish that your claim falls under the statutory provisions to which this SOP applies. The SOP is applicable only to claims "to which section 120B of the VEA or section 339 of the MRCA applies" (s 5). Confirm that the claim pathway being used is one of those statutory provisions before relying on this SOP.
• Prove relevant service. The Schedule defines what counts as "relevant service" for this SOP: eligible war service other than operational service under the VEA; defence service other than hazardous service and British nuclear test defence service under the VEA; or peacetime service under the MRCA (Schedule 1). Documentary service records that demonstrate which category of service was rendered will therefore be a necessary starting point.
• Demonstrate at least one s 9 factor and its temporal relationship to infection. The SOP requires at least one enumerated factor to exist and to be related to relevant service (s 9, s 10(1)). Identify which factor or factors are relevant in the case:
  • For "being exposed" (s 9(1)), gather clinical notes, incident reports, laboratory evidence, or contemporaneous records that document percutaneous or permucosal exposure to a specified body substance, or a record of a transplant from an infected donor. The Schedule limits specified body substances to blood, blood products, body fluids containing blood, semen or vaginal secretions (Schedule 1).
  • For the STI factors (s 9(2)), obtain clinical records demonstrating diagnosis and timing of the genital ulcerative disease, non‑ulcerative anogenital STI with clinical symptoms or signs (excluding genital warts), or HSV‑2 anogenital infection, and show these occurred within the 30‑day window before clinical onset of HIV infection.
  • For depot medroxyprogesterone acetate use (s 9(3)), secure medical or pharmacy records confirming use of that specific contraceptive at the time of clinical onset.
  • For tuberculosis contributing to clinical worsening (s 9(4)), obtain tuberculosis diagnosis and timing relative to the clinical worsening of HIV infection.
  • For inability to obtain appropriate clinical management (s 9(5)), provide contemporaneous evidence documenting unsuccessful attempts to obtain care, delays, or denial of treatment, noting that s 10(2) limits how this factor can be used (see below).
• Address the s 10 timing/causation constraint where relevant. If relying on s 9(4) or s 9(5), be aware that s 10(2) restricts these factors to showing material contribution to, or aggravation of, infection where the infection was contracted before or during but did not arise out of relevant service. A claimant should be prepared to show both timing of infection and how the factor materially contributed or aggravated the condition.
• Cross‑check other SOPs where factors overlap. If a s 9 factor refers to another injury or disease that is the subject of a different SOP, section 11 requires application of that other SOP’s factors as in force. Identify any cross‑referenced SOPs and gather the evidence those SOPs contemplate.
• Use clinical expertise to define clinical timing thresholds. Because the SOP does not define "clinical onset" or "clinical worsening", obtain expert clinical evidence to establish when those moments occurred in a particular medical history. Expert affidavits or medical reports can assist in tying clinical events to the SOP’s temporal requirements.

For medical and administrative professionals

• Be precise about timing in records. The SOP’s temporal windows are strict. Document dates and clinical indicators of "onset" and "worsening" to assist adjudicators in applying s 9’s requirements.
• When recording exposure incidents, clearly link the exposure to a specified body substance as defined in the Schedule, and record whether the potential source was known or reasonably suspected to be infected with HIV‑1 or HIV‑2, because "being exposed" requires a substance "derived from a person infected with HIV‑1 or HIV‑2" (Schedule 1).
• Where a claimant alleges inability to obtain appropriate management, contemporaneous records of requests for care, referrals, appointments and denials, or evidence of service gaps, will be critical. However, note the limit in s 10(2) on how this factor can be applied for infections contracted before or during service.
• Coordinate with other RMA SOPs when conditions overlap. Section 11 creates an obligation on assessors to apply the terms of other SOPs where a s 9 factor refers to an injury or disease covered by another SOP. Maintain awareness of the current in‑force versions of other SOPs.

For decision‑makers and reviewers

• Apply the balance of probabilities standard. Section 8 and the instrument’s title make clear that the causal connection must be established "on the balance of probabilities" and that the RMA reached its view "on the sound medical‑scientific evidence available" (s 8).
• Interpret undefined clinical terms with medical evidence. Because terms such as "clinical onset" and "appropriate clinical management" are not defined in the SOP, decisions must rely on clinical interpretation supported by documentary or expert evidence.
• Check the operative SOP in force at the relevant time. The 2010 SOP was repealed by s 4. For claims spanning the repeal and commencement dates, ensure the correct SOP is applied according to the temporal rules governing the underlying statutory processes.
• Reconcile cross‑SOP application carefully. Where s 11 triggers the application of another SOP, ensure that the other SOP’s factors and definitions are applied "as in force from time to time" and that any inconsistencies between SOPs are resolved in accordance with the legal framework and medical evidence.

Practical documentation checklist derived from the SOP

• Service records demonstrating the category of relevant service per Schedule 1.
• Clinical notes, laboratory results and diagnostic reports establishing dates of HIV diagnosis, indicators of clinical onset and worsening.
• Records evidencing exposure incidents (needlestick reports, incident reports, transplant records), with specificity as to the body substance involved and source where possible.
• STI diagnosis and timing records showing occurrence within 30 days before clinical onset, excluding genital warts.
• Pharmacy or prescribing records confirming depot medroxyprogesterone acetate use at the time of clinical onset where relevant.
• Tuberculosis diagnosis timing and clinical notes documenting worsening of HIV coincident with TB where that factor is relied upon.
• Documentary evidence of attempts to obtain clinical management, denials, delays or service unavailability where inability to obtain appropriate management is invoked.
• Any expert medical reports that define the timing of clinical onset and worsening and that link the clinical picture to the enumerated factors.

Note on limitations: This SOP supplies the medical causation criteria for use in specified statutory claim contexts. It does not itself determine entitlement, award levels, or administrative procedures. Compliance in the sense of securing a favourable causation finding will depend on assembling the medical and service evidence the SOP requires and ensuring decision‑makers can apply the RMA’s factors to the documented facts.