HIV should be treated as a chronic condition in underwriting, Swiss Re says | Reinsurance Business
HIV should be treated as a chronic condition in underwriting, Swiss Re says
Local practice in South Africa lags behind the science on HIV, the reinsurer’s SSA underwriting head argues
Reinsurance News
HIV should be treated as a chronic condition in insurance underwriting rather than an exceptional risk, Swiss Re has argued, saying local practice in South Africa lags behind the medical evidence.
The argument was set out by Lerato Magano, head of underwriting and claims for Sub-Saharan Africa at Swiss Re, who published the article on Swiss Re’s website to mark Zero HIV Stigma Day.
South Africa has approximately 8.15 million people living with HIV, according to Statistics South Africa’s 2025 mid-year population estimates – around 20% of global HIV cases. Of those, 6.3 million were on antiretroviral therapy in 2024, based on UNAIDS figures.
Medical advances in HIV treatment
Medical treatment for HIV has advanced considerably since ART became widely available, and underwriting models globally have begun to follow evidence that individuals on effective ART can achieve stable health outcomes and normal life expectancy, Swiss Re said. South Africa began rolling out Lenacapavir, a twice-yearly long-acting preventative injection, in October 2025; UNAIDS reported that the first South African patient received it in June 2026, describing the drug as almost 100% effective in preventing HIV.
Despite those advances, Swiss Re argued, local underwriting practice continues to treat HIV as an exceptional condition. The effect, Magano said, is to limit insurance access and reinforce internalised stigma – the self-directed shame and fear of disclosure that can deter people from seeking financial protection. “When stigma lives within, it delays action, erodes confidence and isolates people from care,” she said.
Underwriting and market access
Swiss Re contended that aligning underwriting practice with current medical evidence would expand the insurable population, and called on insurers and policymakers to remove barriers to coverage for people living with HIV. It did not specify which products or markets it considers most affected, nor did it publish data on HIV declination rates among South African insurers.
South Africa is among the few African markets with insurance penetration above the global average, but faces structural access challenges: non-life penetration stands at 2.3% of GDP against a 4% global average, according to the African Insurance Organisation. Set against that backdrop, and with the country representing around 20% of global HIV cases, Magano said South Africa’s insurance market was positioned to lead progress on HIV insurability – making the gap between medical evidence and underwriting practice a particularly consequential one to close.
