JOHANNESBURG, 22 October 2009 (PlusNews) - The availability of
antiretroviral (ARV) treatment and legislation prohibiting
discrimination have helped turn HIV/AIDS into just another
chronic disease, but an HIV-positive status can still be an
obstacle to getting a loan or buying insurance.
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
"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
"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