health insurance for people with HIV

What insurance company will not insure people with HIV? One that does not understand the virus and the people living with it.

A month back I was called by my line manager to his office, we discussed about health insurance project that my organization implemented last year and their intention to continue and expand the project. The previous project was in collaboration with two non-profit organizations, donor agency and a private insurance company. An insurance product was developed specifically for people with HIV with CD4 count not lower than 300. As we know it, insurance is never free. The project allowed people living with HIV (PLHIV) to pay half of the Rs1,500 annual premium ($34), the other half was shouldered by one of the partners. Through this more than 1000 PLHIVs were able to avail of a health insurance.

There are about 2.3 million cases of HIV in India. PLHIVs need this insurance because although Anti-retroviral treatment (ART) is covered by the Indian government, it is not the only health-related expense they have. Eighty per cent of health expenses in India are out of pocket and only 20% is covered by the government; a household with one PLHIV spends 3 to 6 times higher than the general population because of opportunistic infections as a result of their weakened immune system.

I need to help the project manager extract from our MIS relevant data to determine mortality and morbidity rate of the people with HIV. A meeting with the one of the partners weeks later made the data requirements clear and for what. We need to produce numerical evidences that will convince insurance companies that designing health insurance product for PLHIV is feasible. The partner wanted us to determine the life expectancy of a person living with HIV.

No insurance company with all its business sense intact will offer any product to individuals with already one foot in the grave. This is the challenge we have, to prove that people with HIV are not dead people walking and are still viable clients. But none of us in the organization has the expertise to calculate life expectancy and will require resources to get people to do that for us. The partner was rational enough to accept our proposition that the organization will produce substantial information to establish evidence that people with HIV don’t just drop dead the minute they contract the virus, and in fact can survive many more years with adequate health services.

I don’t blame the insurance companies for their ignorance of the virus. For almost three decades now there is still the stigma that accompanies HIV and the mistaken belief that it is the same thing as AIDS. I, myself, was guilty of that. It was only after meeting people with HIV in the Philippines and hearing their testimonies that my perception changed.

As the project is yet to begin I don’t have the figures to show that there are so and so number of people who have been living with HIV for the past 5, 10, 15 or 20 years. But I do know of Indians, real people who were infected with the virus and yet looking haler than I am.

There’s Senthil, the person I mentioned in my previous post. When he tested positive for HIV some 8 or 9 years ago his CD4 count was 14. He was ready to die. But upon detection of the virus his doctor immediately put him on anti-retroviral therapy, started having proper nutrition; his CD4 steadily rose, now at 800. He is now one of the most active and most committed members of the PLHIV network. He is featured in educational poster wearing a suit and looking suave.


Nandhini was a staff of the organization, a chubby woman who ambled in the office everyday dressed in her smile and colourful sari. One day I saw her with great effort and almost distorted face, taking milk curd. I could emphatise with her because I don’t like curd. “What’s that?” I asked. “Curd, curd, increase CD4”. Had she not divulged to me her HIV status I wouldn’t have guessed at all. She contracted the virus over 5 years ago. She said she maintains her CD4 count above 1000, lower than that and she could get cancer. Consistent with my role in monitoring and evaluation, every week I would ask, “CD4 count?” And she would proudly update me with her progress, last I heard before she resigned from her job to attend to her store her CD4 was 1300.

There’s also N, another staff. He is not as open about his HIV status like the others but he religiously nibbles on amla, a yellowish round fruit with an acrid taste, rich in vitamins and helps increase CD4. (I know because they made me taste it. Oh, they will make me taste everything.)

Of course, there’s the indefatigable KK. Abraham who founded the network with Ashok Pillai and 10 others, back in 1997; he remains an active advocate for the rights of “positive people” (this is not the politically correct term, I must admit). And oh, the first man in India, who was identified to have HIV back in 1986, just passed by as I wrote this! He’s gained weight since the last time I saw him.

There are so many others I’ve met whose names are too difficult for me to remember or pronounce. One thing common to all of them is they are all on ART, getting proper nutrition, living healthy lifestyles. They succumb to illness more often than sometimes. But many of us do, even sans the virus.

It’s premature to say whether private companies would agree to the creation of special health insurance product for these people. If any one does, it is not to say that it will become fashionable to be HIV positive, and it is not even an assurance that all of the estimated 2.3 million PLHIVs in India will be able to buy the product because majority of them are from low-income groups. But if something like this becomes available it is a step forward to changing the view towards HIV and the people living with it. I believe it will, aside from ease the burden of accessing medical services, significantly reduce the stigma that accompanies the virus considering that insurance companies are very prudent in choosing their clients. It should also boost the morale of people with HIV who have not only suffered from discrimination from others but also from self-stigma. And as insurance becomes available, more people may have the courage to get themselves tested, and if positive can come out, disclose their status, get counseling and advices, help prevent possible transmission.

I may be dreaming now, but that’s where many realities start anyway.

photo posted with permission from senthil