Occup. Med. 1992; 42: 119
VIEWPOINT '92
HIV testing and life insurance J. Tamin Ashworth Hospital, Parkbourn Maghull, Liverpool L31 1HW, UK
AIDS specialists estimate that 'on average the implications for life insurance play an important role in the decision as to whether to be tested (for HIV) for four or five out of every ten people they counsel'. This is quoted in a recent report, commissioned by the Department of Health and the Association of British Insurers (ABI)1. What are the implications for life insurance? Life insurance questionnaires now invariably ask whether the applicant has had HIV testing. Some believe that someone who has been HIV tested is 'unlikely to be able to obtain cover even if the result of the test is negative'2. The ABI deny this, stating that 'having a negative HIV test will not, of itself, prevent someone from obtaining life insurance or even affect the cost, providing there are no adverse risk factors present'3. However the DOH report states that 'it is clear that this is not fully apreciated, or believed to be practice by all (AIDS) Specialists'4. Workers who may be at risk of acquiring HIV from occupational exposure include emergency workers such as police officers, firemen and ambulance personnel. However, all of the documented cases of occupationally acquired HIV infection are in health care workers5. The majority of these are from sharps injuries. The emphasis should be on the prevention of such injuries6. However, when such an injury does occur, and there is a risk of HIV transmission, then the post-exposure procedure could involve HIV testing of the health care worker after counselling7. If Occupational Physicians are carrying out such counselling, it is likely that, like the AIDS experts, they will seriously consider the effect of such testing on the worker's future ability to obtain Life Insurance. On the other hand, the management of health care workers after exposure to HIV infected blood may include the administration of Zidovudine within an hour of exposure. Such is the recommendation of Professor Jeffries8. If his recommendation is followed, then the health care worker will need to have HIV testing to determine whether seroconversion occurs or not. At the SOM Research Panel Symposium on AIDS, Dr Mary Reynolds of Canada Life Insurance stated that Life Insurance is not a welfare right, and a too liberal approach would escalate costs beyond the reach of the majority9. Though this is true, insurance companies, when asking about HIV testing, are trying to determine 'high risk behaviour' as well as identifying the HIV positive individuals. Can health care workers
Correspondence and reprint requests to: Dr J. Tamin, Ashworth Hospital, Parkbourn Maghull, Liverpool L31 1HW, UK.
© 1992 Butterworth-Heinemann for SOM 0962-7480/92/030119-01
who sustain sharps injuries be considered to be in the 'high risk groups'? Given that the risk of infection after substantial occupational exposure has been estimated at 0.31 per cent10,1 would contend that they should not. Ms Hilary King, executive director of the BMA's foundation for AIDS, would like the question on application forms to be: 'Have you had a positive HIV test?' rather than inquiring about previous negative tests and categorising people into particular groups11. If the ABI decides not to accept the BMA's recommendation, I would like to see them at least agree that if a worker has had an HIV test because of occupational exposure, then this should be disregarded for Life Insurance purposes. As Occupational Physicians, it would then allow us to manage post-exposure incidents without the fear that the worker would lose their ability to obtain life insurance. I feel it is the duty of Occupational Physicians, through their Faculty and the SOM, to obtain an undertaking from the ABI that HIV testing in workers following occupational exposure will not influence the latter's ability to obtain life insurance cover at normal rates.
REFERENCES 1. British Market Research Bureau Ltd. AIDS and Life Insurance, for the Department of Health and the Association of British Insurers. London: HMSO, 1991; 35. 2. Taylor D. Legal aspects of HIV and AIDS in Insurance Law. Legal Action May 1989; 14-6. 3. Dillner L. Asking about HIV. Br Med J 1991; 303: 327-8. 4. British Market Research Bureau Ltd. AIDS and Life Insurance, for the Department of Health and the Association of British Insurers. London: HMSO, 1991; 25-6. 5. Advisory Committee on Dangerous Pathogens. HIV the causative agent of AIDS and related conditions, Second revision of Guidelines. January 1990; 3 7 - 8 . 6. British Medical Association. A code of practice for the safe use and disposal of sharps. June 1990. 7. Expert Advisory Group on AIDS. Guidance for clinical health care workers: protection against HIV and hepatitis viruses, recommendations. London: H M S O , January
1990; 25-31. 8. Jeffries DJ. Zidovudine after occupational exposure to HIV. BrJ Med 1991; 302: 1349-50. 9. Deacon SP. Personal communication. SOM Research Panel Symposium on AIDS 1988. 10. Marcus R. CDC Co-operative Needlestick Surveillance Group. Surveillance of health care workers exposed to blood from patients infected with the human immunodeficiency virus. N EnglJ Med 1988; 319: 1118-23. 11. BMAfighton against insurers. Medical Monitor 2 August 1991; 4.
VIEWPOINT '92
HIV testing and life insurance J. Tamin Ashworth Hospital, Parkbourn Maghull, Liverpool L31 1HW, UK
AIDS specialists estimate that 'on average the implications for life insurance play an important role in the decision as to whether to be tested (for HIV) for four or five out of every ten people they counsel'. This is quoted in a recent report, commissioned by the Department of Health and the Association of British Insurers (ABI)1. What are the implications for life insurance? Life insurance questionnaires now invariably ask whether the applicant has had HIV testing. Some believe that someone who has been HIV tested is 'unlikely to be able to obtain cover even if the result of the test is negative'2. The ABI deny this, stating that 'having a negative HIV test will not, of itself, prevent someone from obtaining life insurance or even affect the cost, providing there are no adverse risk factors present'3. However the DOH report states that 'it is clear that this is not fully apreciated, or believed to be practice by all (AIDS) Specialists'4. Workers who may be at risk of acquiring HIV from occupational exposure include emergency workers such as police officers, firemen and ambulance personnel. However, all of the documented cases of occupationally acquired HIV infection are in health care workers5. The majority of these are from sharps injuries. The emphasis should be on the prevention of such injuries6. However, when such an injury does occur, and there is a risk of HIV transmission, then the post-exposure procedure could involve HIV testing of the health care worker after counselling7. If Occupational Physicians are carrying out such counselling, it is likely that, like the AIDS experts, they will seriously consider the effect of such testing on the worker's future ability to obtain Life Insurance. On the other hand, the management of health care workers after exposure to HIV infected blood may include the administration of Zidovudine within an hour of exposure. Such is the recommendation of Professor Jeffries8. If his recommendation is followed, then the health care worker will need to have HIV testing to determine whether seroconversion occurs or not. At the SOM Research Panel Symposium on AIDS, Dr Mary Reynolds of Canada Life Insurance stated that Life Insurance is not a welfare right, and a too liberal approach would escalate costs beyond the reach of the majority9. Though this is true, insurance companies, when asking about HIV testing, are trying to determine 'high risk behaviour' as well as identifying the HIV positive individuals. Can health care workers
Correspondence and reprint requests to: Dr J. Tamin, Ashworth Hospital, Parkbourn Maghull, Liverpool L31 1HW, UK.
© 1992 Butterworth-Heinemann for SOM 0962-7480/92/030119-01
who sustain sharps injuries be considered to be in the 'high risk groups'? Given that the risk of infection after substantial occupational exposure has been estimated at 0.31 per cent10,1 would contend that they should not. Ms Hilary King, executive director of the BMA's foundation for AIDS, would like the question on application forms to be: 'Have you had a positive HIV test?' rather than inquiring about previous negative tests and categorising people into particular groups11. If the ABI decides not to accept the BMA's recommendation, I would like to see them at least agree that if a worker has had an HIV test because of occupational exposure, then this should be disregarded for Life Insurance purposes. As Occupational Physicians, it would then allow us to manage post-exposure incidents without the fear that the worker would lose their ability to obtain life insurance. I feel it is the duty of Occupational Physicians, through their Faculty and the SOM, to obtain an undertaking from the ABI that HIV testing in workers following occupational exposure will not influence the latter's ability to obtain life insurance cover at normal rates.
REFERENCES 1. British Market Research Bureau Ltd. AIDS and Life Insurance, for the Department of Health and the Association of British Insurers. London: HMSO, 1991; 35. 2. Taylor D. Legal aspects of HIV and AIDS in Insurance Law. Legal Action May 1989; 14-6. 3. Dillner L. Asking about HIV. Br Med J 1991; 303: 327-8. 4. British Market Research Bureau Ltd. AIDS and Life Insurance, for the Department of Health and the Association of British Insurers. London: HMSO, 1991; 25-6. 5. Advisory Committee on Dangerous Pathogens. HIV the causative agent of AIDS and related conditions, Second revision of Guidelines. January 1990; 3 7 - 8 . 6. British Medical Association. A code of practice for the safe use and disposal of sharps. June 1990. 7. Expert Advisory Group on AIDS. Guidance for clinical health care workers: protection against HIV and hepatitis viruses, recommendations. London: H M S O , January
1990; 25-31. 8. Jeffries DJ. Zidovudine after occupational exposure to HIV. BrJ Med 1991; 302: 1349-50. 9. Deacon SP. Personal communication. SOM Research Panel Symposium on AIDS 1988. 10. Marcus R. CDC Co-operative Needlestick Surveillance Group. Surveillance of health care workers exposed to blood from patients infected with the human immunodeficiency virus. N EnglJ Med 1988; 319: 1118-23. 11. BMAfighton against insurers. Medical Monitor 2 August 1991; 4.
