Most life insurance companies in southern Africa still require applicants to take an HIV test and deny cover to those who test positive. Without life insurance as security, financial institutions are reluctant to lend money to buy a house or start a business.

"The denial of life cover inflicts on other rights," said Amon Ngavetene, coordinator of the AIDS Unit at the Legal Assistance Centre (LAC), a non-profit legal advice organization in Namibia.

The LAC has called on the Namibian government to pass legislation prohibiting insurers from discriminating against people living with HIV, but so far to no effect.

Ngavetene noted that HIV-positive individuals were discriminated against even after their deaths. Those who contract HIV after taking out life cover and fail to notify the insurance company run the risk of having their policies invalidated if their death certificate shows they died of an AIDS-related illness.

"A person could be paying for 15 years, and then when they die their family can't get a penny," Ngavetene told IRIN/PlusNews. "It's unconstitutional but very difficult to challenge because it becomes an issue of the terms of the contract."

Insurance companies in Botswana also require applicants to take HIV tests, but Linny Keorapetse, an assistant legal officer at the Botswana Network on Ethics, Law and HIV/AIDS (BONELA), said at least one company, Metropolitan Life, would cover HIV-positive people, although at a much higher cost.

Those who test negative are required to re-test every five years, but a positive result at a later stage means the policy is automatically converted from life insurance into pure savings.

Botswana's constitution does not provide for socio-economic rights that could form the basis for a court case, said Keorapetse. "The only thing we can do is to make noise about it; we can say it's discriminatory because it's the only medical test [insurance companies] ask for, yet there are riskier conditions."

Botswana has the second highest HIV prevalence rate in the world, with nearly one in four adults living with the virus, but it also has one of the most extensive ARV programmes in the region, with free treatment reaching about 90 percent of people who need it. "Nowadays, people living with HIV who take treatment can live another 20 years," Keorapetse pointed out.

A different approach

Instead of discriminating against people living with HIV, Ross Beerman, managing director and co-founder of AllLife, a South African company, decided to take advantage of this gap in the market to specialize in providing HIV-positive people with life cover.

"We have a very different operating model," he told IRIN/PlusNews. "In a standard model, you price policies based on historical behaviour ... we price on forward-looking behaviour: if you're HIV positive, we don't really care how you behaved in the past, we care about you staying healthy in the future."

Policyholders must commit to going for regular blood tests and starting ARV treatment when their CD4 count [a measure of immune system strength] drops below 200. Once on ARVs, AllLife closely monitors a client's adherence via links with healthcare providers, and regular cellphone text message reminders and warnings if appointments are missed.

Premiums are between two and five times higher than normal life insurance policies (an average monthly payment of about US$40 buys $40,000 worth of life cover), but can be used to secure home loans and start businesses.

In addition, being a policyholder appears to have a positive health effect. "Just by virtue of being our clients they're going for regular monitoring," said Beerman. "They actually get approximately 15 percent healthier after six months; the realization they can have an impact on their longevity means they start behaving in more healthy ways."

In contrast, HIV-positive people in Botswana are steered towards funeral policies or advised to join burial societies. "Currently, there's no company that offers life insurance specifically for people living with HIV," said Keorapetse.

AllLife relies on fairly sophisticated administrative and IT systems to function efficiently, which would be difficult to replicate in less developed countries in the region where, for example, blood test results are not captured electronically.

Nevertheless, Beerman said, people living with HIV have the right to participate in the mainstream economy "in a normal way".

See also: SOUTH AFRICA: Life insurers still snubbing HIV-positive clients

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