HIV - Insuring AIDS

In an ideal world, the people who need help the most would receive the assistance they rightly deserve. However, a recent study commissioned by the Malaysian AIDS Foundation (MAF) has found that is not the case when it comes to people living with HIV (PLHIV) seeking health insurance.

A lack of awareness of affordable and effective HIV treatment means companies either exclude HIV from their coverage plans entirely and for those that do cover the condition, the applicant has to fit within a narrow set of criteria for their claims to be approved.

Researchers Dr Sharuna Verghis and Dr Kana Kulasingam found that out of 11 insurance companies surveyed in Malaysia, only three cover HIV with certain conditions, which are in policies without medical underwriting, group life and group medical insurance, and critical illness plans (which covers full-blown AIDS, HIV infections due to blood transfusions, and occupationally acquired HIV).

And it’s not just PLHIV who are often left in the dust by this practice, because insurance companies unaware of improvements in the long-term outlook for PLHIV are losing out on a huge chunk of income by discriminating against them.

A respondent with HIV said the sooner insurance companies realise that PLHIV can live longer and healthier lives, the more money they can make.

“If somebody was smart enough to sell me an insurance policy when I was diagnosed positive, I would be paying my premiums for 26 years and (the insurance company) would have got 26 years of premiums without paying out anything. There’s a huge loss of income for insurance companies because people are surviving longer now and if you multiply that by 3,334 people getting diagnosed per year, that’s a lot of money potential,” the person was quoted as saying.

In their study, Dr Sharuna and Dr Kana cited literature stating that PLHIV on antiretroviral therapy (ART) in their first year since testing positive have a 99.4 per cent of survival compared to a 63.4 per cent chance of survival in PLHIV who are not on ART.

Within a 10-year period, PLHIV on ART have a 78.8 per cent chance of survival while those not on ART only have a 7.4 per cent chance of staying alive.

The study also found that conditions that facilitated private health insurance for PLHIV in other countries are present in Malaysia.

These include the availability of treatment on par with international guidelines, free and/or highly subsidised ART provided by the government and accessible at the primary to tertiary care levels, and integrated care addressing comorbidities such as tuberculosis.

Armed with this evidence, MAF hopes to spark a dialogue between stakeholders to improve access to private healthcare insurance for PLHIV.

It also aims to tackle the pervasive stigma and discrimination against PLHIV in Malaysia that may deter some from even applying for a financial product or filing a claim in the first place for fear of being rejected or having their status exposed to their employers.

During a panel discussion at Hilton Kuala Lumpur, Malaysian AIDS Council president and MAF honorary treasurer Bakhtiar Talhah said that Malaysia can take a leaf out of other countries’ books when it comes to providing health insurance to those with HIV.

“What struck me from the study is the level of HIV knowledge amongst insurance companies in Malaysia relative to other countries around the world, especially within the region. We see places like the Philippines, Thailand, and Sri Lanka being much more advanced in their insurance policies for PLHIV,” said Bakhtiar.

A legal framework that makes it mandatory for private insurance companies to cover HIV in their healthcare insurance plans remains absent in Malaysia, said lawyer and panel speaker GM Tan.

However, the government and other stakeholders can’t afford to rest on their laurels when it comes to protecting PLHIV.

The latest data from the Health Ministry shows that a majority of the 3,293 new HIV infections in 2018 are in those aged 20 to 29 (45 per cent), with those in their 30s making up 31.7 per cent of new cases.

Dr Kana said many of the newly-diagnosed are in their productive years with much to contribute, adding that Malaysia’s economy and workforce is at risk should these individuals fail to receive the necessary care.