Antiretroviral (ARV) treatment is available now along with legislation prohibiting discrimination, helping HIV/AIDS to become just one of many chronic diseases. However HIV-positive status may still provide an obstacle for buying insurance or getting a loan.
Most southern Africa life insurance companies require an HIV test from applicants and will deny coverage for those who do test positive. Financial institutions, without having any life insurance to provide security, are very reluctant to provide loans for starting a business or buying a house.
Amon Ngavetene, AIDS Unit coordinator for Legal Assistance Centre- an organization in Namibia that provides legal advice- said, denying life cover also impacts other rights.
The Legal Assistance Centre is calling on the government of Namibia to pass legislation that will prohibit insurance companies from discriminating on individuals that live with HIV. So far there has been no effect.
Ngavetene added that individuals that were HIV-positive were also discriminated against after they had died as well. Individuals contracting HIV after they have taken out life cover who fail to inform their insurance company risk having their life insurance invalidated when a death certificate indicates the person died of an illness that was AIDS related.
Ngavetene said, an individual might pay for 15 years, but when they die the family doesn’t get a penny. It’s unconstitutional, however it’s hard to challenge due to the fact that it becomes a terms of contract issue.
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Botswana insurance companies also require HIV tests for applicants. However Linny Keorapetse, Botswana Network of Ethics, Law and HIV/AIDS legal officer said, there was at least one insurance company, Metropolitan Life, willing to cover individuals that were HIV-positive, although the cost was much higher.
Those who do test negative still are required to be re-tested every five years. A positive result that comes later basically means that the insurance policy gets converted automatically from life insurance to pure savings.
According to Keorapetse, the constitution of Botswana doesn’t provide for any socio-economic rights to act as a basis to form a court case with. All we can do right now is make noise. We say that it’s discriminatory due to the fact that insurance companies only ask for that one medical test. However, riskier conditions do exist.
Botswana’s HIV prevalence rate is second highest in the world. Almost one in every four adults lives with the virus. However its ARV program is one of the region’s most extensive as well. Free treatment reaches about 90 percent of individuals who need it. Keorapetse pointed out that people nowadays who live with HIV can live an additional 20 years when they take treatment.
Ross Beerman, co-founder and managing director of AllLife, a life insurance company in South Africa, decided that instead of discriminating on individuals that live with HIV, decided to capitalize on the market gap and specialize in offering individuals that are HIV-positive with life cover.
Beerman said, our operating model is very different. With a standard model, price policies are formed on the basis of historical behavior. What we do instead is use forward looking behavior for setting our prices. If you are HIV-positive, how you might have behaved in your past isn’t something we care about. What we do care about is that you stay healthy into the future.
AllLife policyholders are required to get blood tests done regularly and to start ARV treatment whenever their CD4 count, which measures the strength of an individual’s immune system, goes below 200. When a person starts on ARV treatment, AllLife monitors closely the client’s adherence via health care providers as well as text messages sent via cellphone to remind about appointments and send warnings when if they are missed.
Insurance premium costs are two to five times more expensive than a normal life insurance policy. The average monthly payment is around $40 US and buys about $40,000 of coverage. It can be used for starting a business or securing a home loan.
It does appear that being a policyholder does have positive health effects. Beerman said, just from being clients of ours they go for regular monitoring. After six months they get healthier by approximately 15 percent. They realize they can impact their longevity by starting to behave in healthier ways.
HIV-positive individuals living in Bostwana, in contrast, are advised they should join burial societies or steered in the direction of funeral policies. There aren’t any companies currently offering life insurance for people that are HIV-positive, Keorapetse said.
In order to function efficiently, AllLife does rely on IT and administrative systems that are fairly sophisticated. In countries that are less developed in the region they would be harder to be replicated. As an example, there are places where blood tests results aren’t captured electronically.
Beerman said, people who live with HIV should have a right for participating in the mainstream economy normally.
