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To date, it is true that 'sex between men' has represented the group at the highest risk to HIV infection based upon historical data. However, as Life Assurance Companies specifically ask if a person has already tested positive for HIV/AIDS on their applications, figures relating to past infection are irrelevant when assessing the risk HIV represents within underwriting Life Assurance protecting the future. The Life Assurance Industry justifies their discriminatory stance towards gay men on the basis that they represent a higher risk to HIV infection in proportion to population (Compared to the heterosexual community). This is indeed true if you were to take the heterosexual figures as a whole, but not true if you spend time looking at statistics broken into population sub-groups. As the Life Assurance Companies are underwriting policies that protect people against Death and Illness in the future, then they should be looking at the current and projected infection rates to establish exposure to HIV risk. A comparison between the gay community, and other population sub groups would indicate grossly unfair treatment of homosexuals by the Life Assurance Industry. Comparisons The new diagnosis figures would at first appear to support the Life Assurance Industry's stance towards homosexuals.
(Source: Terence Higgins Trust, numbers of people in the UK with HIV - Appendix I)
(Source: National Aids Trust, UK Statistics - Appendix II) However, within the Terence Higgins Trust document it clearly states that 71%* of heterosexually acquired infections were people from Africa, or exposed to risk from that area. The National Aids Trust estimates this figure to be 80% of new diagnosis rates. (*Source Health protection Agency New Diagnosis of HIV and AIDS - Appendix III.) Population Figures
(Source: The Census 2001 - National Statistics - Appendix IV, V, VI, VII) These figures, when analysed alongside the HIV diagnosis figures, would indicate that 1 in every 206, of the Black African population, will be diagnosed HIV positive in the coming year. Insurance Industry concerns relate to gay men and HIV underwriting risk as a male issue. Therefore it is safe to use the Male population figures for purposes of calculating the risk of sex between men. 28,581,233, times 6% (equals 1,714,873 gay men in the UK), meaning that 1 in every 1,014 gay men are likely to become HIV positive in the coming year. The 6% same sex figure is likely to be less than the reality, as not all people will be willing to admit a same sex sexual encounter, so the precise figure is likely to lie between 6% and 10%, giving a figure of 1 in every 1,690. As a direct comparison, this means that a Black African resident in the UK is at least five times more likely to contract HIV than a gay man in the coming year. United Kingdom New Diagnosis Rates 1995 - 2002
Source:
Underwriting Surveys We've taken a look at the underwriting practices that both gay men and the black African community face when applying for Life Assurance and Critical Illness Cover. Survey of Life Assurance/Critical Illness (Gay Men) - 18th December 2003 Gay men are currently subjected to compulsory HIV Testing, highly intrusive personal questions and in a number of cases loaded premiums when making an application.
Underwriters have also used speculative information to establish a persons risk to HIV. Many companies have been asking the applicant's GP to comment on their patient's sexuality, or using occupation, or co-habiting status as an indicator of risk to HIV. Survey of Income Protection Underwriting of Gay Men - 18th December 2003 Even though Income Protection Insurance has an exclusion relating to HIV/AIDS, a number of Life Assurance Companies ask for a HIV test, and answers to personal lifestyle questions. Life Assurance Companies attempt to justify this stance by hiding behind miss selling of policies to HIV positive people. It is highly discriminatory to ask gay men about their personal circumstances, and for HIV testing on policies that exclude HIV/AIDS.
Survey of Migration Underwriting, Life Assurance/Critical Illness - 17th December 2003 Applicants that have migrated here from Africa would only be required to take an HIV test within the following periods of time. No GP's Report is required in most cases, and no loaded premiums are applied to the policy. Once outside the time periods within the table, no HIV Testing would be required.
Comparison of Underwriting Procedures These underwriting procedures would indicate that the Life Assurance Industry is aware of the migration issue. However, the procedures in existence do not take account of the fact that up to 16,650 people are estimated to be living in the UK undiagnosed with HIV.
It is clear that the Heterosexual diagnosis figures are going to increase at a rate above the ones of sex between men. The balance of underwriting between Homosexual and Heterosexual applications therefore is highly discriminatory towards gay men. The underwriting procedures in place only safeguard the Industry's risk for a set time period of say 2-5 years. In a number of cases, it is clear that after the period of 2-5 years, applications are accepted without an HIV test, personal questions or loaded premiums. Background to the New Diagnosis Rates Gay Community The gay community has had a decade of dealing with the HIV issue, and has built a large number of resources that provide education and support. HIV prevention is constantly promoted in the gay media and safe sex messages, including free condoms, are available in nearly all bars, clubs and saunas. As a result the HIV new diagnosis rates in the gay community have remained reasonably stable since 1995. Over the last 10 years, CD 4 counts at diagnosis have been steadily rising within gay men, indicating that they are testing for HIV earlier and taking responsibility for their health. Recent gay sex surveys have reported that 56%* of gay men surveyed had undertaken an HIV test, with this figure rising to 70%* in Central London. Earlier diagnosis has been proven to be a key factor in controlling onward transmission. (*Source: Gay Men's Sex Survey 2002 - Appendix XI) 'Diagnosis at an earlier stage of infection extends the opportunities for treatment to postpone further illness, combination therapy to reduce viral load and for earlier behaviour change to reduce onward HIV transmission. Overall in 2002, 35% of newly diagnosed HIV-infected individuals had CD4 counts below 200 mm3 (the recommended threshold at which therapy should have commenced). Over recent years, however, the data shows a trend for homo/bisexual men to be tested at earlier stages of their infection. Heterosexuals were more likely to be diagnosed later compared to homo/bisexual man, although a high proportion of heterosexuals may have been infected abroad and lacked the opportunity to have had an earlier UK diagnosis.' (Taken from Health Protection Agency - Renewing The Focus - HIV and Other Sexually Transmitted Infections in the United Kingdom in 2002). Prevalence of New Diagnosis Gay Renewing the focus, highlights that undiagnosed HIV prevalence amongst homosexuals is 5.4%* within London, and 2.4%* outside London. This would appear to be high, in comparison to the overall heterosexual figure 0.8%*, however it is important to take account of sub-population groups before making a judgement. African Renewing the focus does not offer a breakdown of sub-population groups as a percentage, but instead an estimate in pure numbers that 4,800* Black Africans are undiagnosed within the UK. When placed against a community numbering 485,277, the percentage figure within this sub-population group would appear to be close to 10%. (All Taken from Health Protection Agency - Renewing the focus - HIV and other sexually transmitted infections in the United Kingdom in 2002). African Community There are many cultural issues that face the African Community relating to HIV infection. Sexual Attitudes and Lifestyles Since most Africans have only recently migrated to the UK, many traditional practices and beliefs remain prevalent among local communities. Gender, ethnic origin (ie. Tribal Groups), religion, acculturation and other factors influence these. Most data on the sexual attitudes, beliefs and lifestyles of African communities has come from the United States and has limited relevance to this country. There are, however, a few studies in England on African communities that measure specific HIV-related risk attitudes and behaviours. Some themes emerging from research to date include: -
Epidemiology - Characteristics HIV infected Africans tend to be diagnosed later than other population subgroups. There is also some evidence to suggest that Africans have a lower uptake of anti-retroviral treatments. These factors can have a major impact on subsequent health and on transmission.
(All of the African community paragraphs were taken from the document HIV prevention and African communities living in England - a framework for action - National Aids Trust)
(Taken from Health Protection Agency - Renewing The Focus - HIV and Other sexually transmitted infections in the United Kingdom in 2002). Risk to the Industry It is clear that the underwriting procedures for Life Assurance and Critical Illness Cover for gay men are out of proportion to the risk that they represent. When considered against other sub-population groups, gay men are being discriminated against and treated unfairly. The Life Assurance Industry's exposure to HIV risk is only going to increase if the present system of underwriting is to remain. The large number of undiagnosed people carrying HIV, combined with testing at a later stage of infection, within sub-population groups should be a major consideration within the underwriting of Life Assurance and Critical Illness products. The present system only protects the insurance industries risk from migrating people, during the first say 2-5 years, with no attention paid to people settling for periods of time longer than this. Once the initial period has passed there are no requirements for HIV testing, medicals or loaded premiums. If the Life Assurance Industry does not pay attention to the risk that HIV represents across all population groups they are likely to incur a large liability in the future. This could affect future premium rates, company reserves and quality of insurance offered to the general public. It is time that the Life Assurance Industry looked closely at ways of underwriting insurance products without discriminating against any particular risk group. It is clear that HIV is no longer a 'pink' issue and is one that affects society in general. The following responses to the ABI review of the HIV guidelines represent the first steps in 'equalising' the underwriting process the Life Assurance Industry applies to applicants. We have also offered recommendations that are intended to protect the industry from the threat that HIV represents. By adopting 'equalisation', the insurance industry will be avoiding accusations of discrimination, conflict with the Racial Equality Commission and a potential case at the European Court of Human Rights, over their treatment of gay men. |
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