HIV has changed, but insurance practices have not

He is sitting across from me in the consultation room. I have known him for years as a cheerful man, but today is different. ‘Doctor, I am not able to get credit life insurance. Without that insurance, we won’t be get a mortgage for our house.’

He is married, has two young children, and has been living with HIV for several years. He takes his medication as prescribed, his immune system has recovered and his viral load has been undetectable for years. This means he is in good health and cannot transmit HIV through sex. As long as he continues to take his medication as prescribed, his life expectancy will be similar to that of someone without HIV.

From a medical perspective, that is reassuring. Yet he keeps getting the same answer from several insurers: a premium surcharge of up to 100 per cent, purely because he is living with HIV.

‘But didn’t you say that HIV is now a chronic condition?’ he asks. His surprise is understandable. While HIV still requires treatment and medical monitoring, the perception of it as an inevitably fatal condition is long outdated. Today, more than 19,000 people in Belgium are living with HIV. In nearly nine out of them, the viral load has been suppressed to an undetectable level. For most people living with HIV, it is therefore a well-managed chronic condition. According to Sciensano’s most recent 2025 HIV report, there is no significant difference in mortality rates between people living with HIV and the general population.

However, this medical progress is barely reflected in the insurance sector. People living with HIV still face excessive premium surcharges, and the exclusion of HIV-related care from hospitalisation insurance, as well as the outright refusal of income protection insurance. Such decisions are often made without transparent justification and on the basis of criteria that vary significantly from one insurer to another.

A credit life insurance is often a prerequisite for a mortgage. For my patient, this requirement put the purchase of his home at risk. Those who have to pay consistently higher premiums have less access to housing and financial security.

Insurers are entitled to assess medical risks. However, they must demonstrate that any surcharge is based on up-to-date data and is proportionate to the applicant’s state of health. For people living with HIV who are receiving effective treatment, a surcharge is becoming increasingly difficult to justify.

Since 2020, Belgium has had a ‘right to be forgotten’. For people who have had cancer, insurers are no longer permitted to consider their oncological history after a specified period. A similar framework exists for people living with HIV, but the associated conditions are exceptionally strict. These conditions do not adequately reflect current medical realities and are therefore unworkable.

Sensoa asked the Belgian Health Care Knowledge Centre (KCE) as early as 2021 to review the existing conditions. This matter is still under assessment, with no concrete policy follow-up. In the meantime, thousands of people continue to face uncertainty, administrative complexity and significant financial barriers.

Responsibility lies not only with insurers, but also with policymakers. Transparent, consistent and scientifically sound criteria are not a favour; but a minimum requirement for equal treatment.

Back to my patient. Following persistent objections and medical justification, the premium surcharge was eventually reduced to 25 per cent. He agreed and was able to buy his house. But the question remains: why should someone with a well-managed chronic condition first have to fight for recognition that he has long since earned medically?

Dr Jelle Visser
Physician, Head of the HIV Reference Centre at the Institute of Tropical Medicine (ITm) Antwerp