While society's views on people living with HIV and civil partnerships have largely progressed, the insurance industry still has some way to go. Johanna Gornitzki reports
Human immunodeficiency virus (HIV) and insurance has always been a very sensitive subject. In the early 80s, when HIV was first discovered, the virus was branded as a disease only plaguing the gay community. Originally dubbed Gay-Related Immune Deficiency, people living with the virus were shunned by friends, relatives, employers as well as wider society.
And while things have moved on from those dark days, where many were afraid of even being in the same room as someone suffering from HIV, there is still a major stigma surrounding the virus, and its ultimate form, acquired immunodeficiency syndrome (Aids) - a condition in which the immune system begins to fail, leading to life-threatening opportunistic infections.
And although work carried out by leading HIV/Aids charities and high-profile celebrities has helped to break down misconceptions, much more is needed before the social prejudices surrounding HIV are dispersed.
The insurance industry has not managed to escape this dilemma. There are two main concerns in this area; discrimination against gay men and other people considered to be high risk, and the availability of insurance for people living with HIV.
In response to these issues, the Association of British Insurers (ABI) set up an expert working group specially designated to look at the issues surrounding HIV and insurance and, in 1994, the group published the ABI's inaugural Statement of Best Practice on Underwriting Life Insurance for HIV/Aids, quickly followed by a revised version in 1997.
These two versions, however, caused an uproar among the gay community as they allowed companies to base their criteria on someone's sexual orientation by asking about sexuality - in what has now become known as "the gay question" - instead of basing it on an individual's behaviour towards risk.
The ABI responded to the criticism and, in October 2005, the industry implemented a new Statement of Best Practice on HIV and Insurance, putting an end to this practice by ruling that asking if a person is gay would no longer be acceptable.
To further dispel many of the myths surrounding the treatment of gay men applying for life and protection insurance, the ABI launched a new consumer guide for gay men on HIV and life insurance in December last year, explaining the changes that were put into place by the latest Statement of Best Practice.
Instead of asking about sexuality, insurers are now only allowed to ask the following question: "Within the last five years have you been exposed to the risk of HIV infection?" This question can be followed by an optional: "This can be caught through unsafe sex, intravenous drug abuse, blood transfusions or surgery undertaken outside the EU."
Gay lobbyists, IFAs and providers all applauded the ABI's move, arguing it has solved most, if not all, of the discriminatory problems surrounding HIV and insurance. Some, however, begged to differ.
David Sheppard, sales director at gay specialist IFA Principia Mortgages, believes there are still many unresolved issues. "Behind the scenes, I don't think the industry has changed at all when it comes to HIV-related issues and there is still a degree of homophobia in the industry. For example, a lesbian friend of mine was refused life cover five years ago because her doctor told the insurer he was worried about her mental state of health due to her sexuality - implying she must be suicidal simply because she was homosexual. As long as this perception prevails, it is hard to make any major changes."
Clarification
Sheppard also thinks the revised question has given rise to a new problem. "The big issue I have with this is how do you define unsafe sex? Will that include married couples trying for children? The new question has probably made the problem worse instead of better as there is no clarification of what unsafe sex means," he says.
Responding to the criticism, Jonathan French, spokesperson for the ABI, says the organisation looked at three different options before opting for the final one. "During our consultation exercises, we looked at three different options, including attempting to define safe and unsafe sex and giving full details on application forms. This was rejected because companies were not comfortable with including such graphic information in their literature; plus, what is safe or unsafe sex will vary from person to person."
Another issue that the latest statement failed to address is civil partnership. According to the latest figures from the Office of National Statistics, more than 15,500 gay partnerships have taken place since the Civil Partnership Act came into place on 5 December 2005.
Despite this, some insurers are still treating gay couples as single people when assessing their risk, while others treat them in the same way as heterosexual married couples. Legal & General is one of the companies that admits it does not currently acknowledge civil partnerships.
"The bulk of applications to Legal & General are made through our online protection application where we do not ask a customer whether they are in a civil partnership. We would expect to follow the ABI's Statement of Best Practice when it is announced," says Russ Whitworth, claims and underwriting director of Legal & General.
IFA Chris Morgan of London-based Compass, which has been one of the lead campaigners for urging insurers to take a less bigoted view, admits this is still an outstanding issue. "It is fair to say that this is an issue that hasn't been resolved yet. Single males are likely to pay more in proportion than a married couple. Still, only some insurers offer terms based on civil partnerships," he says.
The ABI Expert Working Group is currently undertaking further research in this area and Morgan says he hopes a new revised Statement of Best Practice with the inclusion of civil partnership will be published before the end of this year.
However, leaving aside the problems gay people are facing, the real issue is the lack of protection provided to people living with HIV. At present, none of the mainstream UK providers provide any life or critical illness cover to people with HIV. And for income protection, HIV cover is only provided to policyholders who took out a policy before contracting the virus and, typically, only if the virus is caught through certain types of profession (as long as the individual has taken reasonable cautions), through blood transfusion or through physical assault.
There are, however, a couple of firms that specialise in life cover for people with HIV. Pulse is one such company. It offers life cover for individuals with HIV, underwritten by Lloyd's.
"HIV is just like any other medical condition. Some people respond better to treatment than others, and for individuals for whom treatment is effective, life cover can be available," says Paul Sandilands, director at Pulse.
Last year, the firm launched a policy called Harbour in conjunction with Totally Insured Group, offering a basic level of life cover that can be enhanced by a layer of accidental death cover. The policy only offers £10,000 sum assured over a 10-year period, however. Ron Moonesinghe, managing director of Totally Insured Group, admits it is far from perfect. "It's not brilliant but it's a start. Surely some cover is better than none."
Morgan is dubious though. "They are charging an extraordinary rate, which is around 30 times higher than an average policy, which is absolutely outrageous," he says.
So why are people with HIV turned down by the insurance industry? Is it still a life-threatening disease?
Recent studies show this may not be the case.
A 2003 study from Switzerland, published in The Lancet, found that people with HIV should be able to obtain life insurance in the same way as successfully treated cancer patients. The authors concluded that successfully treated patients who are HIV-positive or hepatitis C-negative have a short-term mortality as low as, or lower than that of, patients with cancer who have been successfully treated and who are able to obtain life insurance. They argued that "this study provides preliminary actuarial evidence that life coverage could be considered under specific conditions".
A separate study from France, published in 2005, suggested that people with HIV who maintained good immune function on anti-HIV treatment (a CD4 cell count of over 500 cells/mm3) had a death rate that was not significantly greater than the general HIV-negative population.
Edwin J Bernard, editor of Aids Treatment Update at HIV/Aids charity NAM, supports the view aired by the researchers.
"The introduction of potent anti-HIV drug combinations more than a decade ago has led to very substantial reductions in the numbers of people dying of HIV, or becoming ill because of HIV. Many experts now believe that, provided a person with HIV receives effective anti-HIV treatment before their immune system has been severely damaged by the virus, and if they take their drugs regularly and on time, they could live a more or less normal life span.
"Two studies have recently been published supporting this opinion. Researchers from the US recently calculated that, on average, someone who started anti-HIV treatment according to 2004 guidelines would live between 29 and 33 years after being infected with HIV. And a 2007 study from Denmark concluded that a 25-year-old diagnosed with HIV and treated with anti-HIV treatment could expect to live well into their sixties," he says.
"However, estimates and averages are just that. Some people, including myself, who were diagnosed with HIV or Aids in the early 1980s are still alive and well today, despite experts estimating that they would not live more than a few years," Bernard adds.
However, the challenge does not seem to incorporate current research, but rather how to estimate what long-term impact HIV/Aids would have on premiums. As Gerry Warner, protection development manager at Zurich, suggests: "One of the biggest challenges we face as an industry is trying to predict the future for those living with HIV and the impact on their insurance premiums and terms of contract."
"While we can see that there is a similarity in mortality rates for HIV and cancer over the shorter term, there is a lack of historical evidence to enable us to compare rates in the longer term. There is also currently a lack of data available on the long-term impact of HIV treatment," says Warner.
Problems
The problem is that HIV is a relatively new disease in comparison to other critical illnesses and accurate statistics is hard to find as the risk pool is also very small. Professor Donald Jeffries, chairman of the ABI Expert Working Group on HIV, explains: "At this relatively early stage in our studies of HIV - effective treatment and monitoring of individuals only took off in 1996 - all statements about life expectancy, long-term morbidity and so on can only be projections based on modelling. The insurance industry is, of course, used to carrying out such actuarial projections, but in a potentially changing situation we must be sure we understand the behaviour of the virus in the long term."
However, HIV charities blame the industry for sitting on the fence. Lisa Power, head of policy at the Terrence Higgins Trust, says that, among HIV awareness groups, the condition is already viewed as a chronic, manageable condition, adding that the insurance industry's stance, like many other sectors', is out of date.
She says: "Those living with HIV are often refused life cover because people's ideas of what having HIV means is outdated. It's important that insurance companies keep up to date with current findings on the life expectancy of people living with HIV.
"Certainly, a lot of people living with HIV feel they have been discriminated against. It may not be direct discrimination but insurance companies may still be judging people living with the condition on outdated information.
"I think it will take a long time for the rest of the world, outside of the HIV sector, to catch up and realise that people with HIV are living long and fulfilled lives," she adds.
Going forward, the ABI Expert Group on HIV has been looking at what is available in other countries, such as South Africa and the Netherlands, to see whether it would be possible for the UK market to make insurance available to people who are infected with HIV. Such a product is offered in the Netherlands but, so far, there has been a low uptake in sales.
Warren Copp, chief underwriter at Scottish Re, believes cover for people with HIV could be a possibility in the future. "The publication of further mortality studies on this group carried out on large samples and over significant time periods may enable a greater range of cover to be offered in future," he says.
But for now, there is a bleak reality facing people with HIV hoping to buy insurance. As Edwin describes: "I haven't attempted to get life insurance, since I was diagnosed in 1988, and knew that it would be futile to apply in those days and ever since. However, I've managed to get mortgages no problem, and always went with companies that did not require life insurance.
"Now that the Disability Discrimination Act (DDA) 2005 includes all HIV-positive people from being discriminated against in the provision of goods and services, it is time for the ABI to wake up to the fact that HIV is not unlike many other life-threatening illnesses in terms of risk. HIV's main difference is that it is remains a highly stigmatised condition, primarily due to ignorance.
"However, since it has only been as recently as 2004 that HIV-negative men were not discriminated against in applying for life insurance (ABI Statement of Best Practice 2004), I doubt they will react until they are sued under the DDA," he gloomily adds.
Perhaps it is time the industry went back to the medical experts and looked at the HIV issue with a fresh pair of eyes. Because, while the sector has shown that it has taken the concerns of the gay community seriously, people living with HIV - arguably the most vulnerable group in society and most in need of insurance - have been left out in the cold.
And, while no long-term statistics or a huge risk pool are available to predict the exact impact HIV will have on premiums, does this make it right for the industry to continue to contribute to making people with HIV remain socially excluded?
