Can you get medical aid if you have HIV?

Considering that 7.1 million South Africans were living with HIV in 2016, it’s not surprising that government spends up to R23 billion on programmes to improve the awareness and treatment of this disease. Moneybags journalist, Isabelle Coetzee, has a look at how South Africans are affected and how medical schemes are involved.

According to Avert, an HIV/AIDS non-profit organisation, 270 000 new infections were recorded in 2016 and 110 000 South Africans died of AIDS-related illnesses in the same year.

HIV prevalence currently stands at 18.9% but it varies across provinces, with KwaZulu-Natal being the highest, at 40%, and the Western Cape being the lowest, at 18%.

The population groups that are most affected by this include men who have sex with men, sex workers, people who inject drugs, children and orphans, and women and adolescent girls.

Even though South Africa has the largest HIV rate in the world, many people are still hesitant when it comes to being tested, and many more aren’t receiving the correct treatment.

Since its discovery in 1983, a cure has not yet been found. However, with the correct treatment, those with HIV can live long and full lives.

The most important treatment today is antiretroviral therapy (ART). This involves taking daily drugs to keep the viral levels, or viral loads, at a manageable level.

Last year nearly 4 million South Africans received ART – but this was only 56% of people who were living with HIV at the time.

In light of this, what role does medical aid play in supporting their members who live with HIV/AIDS?

According to Dr Noluthando Nematswerani, head of Centre for Clinical Excellence at Discovery Health, medical aid schemes are required by law to offer care to members who have HIV/AIDS because it’s considered a Prescribed Minimum Benefits (PMB).

PMB’s include a list of conditions and treatments that medical aid schemes are required to cover in full for all of their members.

In other words, people living with HIV/AIDS are entitled to diagnosis, treatment, and management of this disease, regardless of the type of medical scheme they are part of because it’s required by law to offer them this treatment.

Discovery Health Medical Scheme, for example, offers a programme called HIV Care that ensures members are treated for all HIV related illnesses – at no extra cost.

“All HIV positive members within the Scheme will need to apply for registration into the HIV Care programme,” said Dr Nematswerani.

“Registration to the programme allows members access to doctor visits, monitoring blood tests, medication for treatment and prevention of opportunistic infections, antiretroviral medications (including medications for Prevention of Mother to Child Transmission), and flu and hepatitis vaccinations,” he explained.

According to Dr Nematswerani, Discovery Health Medical Scheme currently has 46 000 members registered on the HIV Care Programme.

He points out that if someone is currently on a medical aid scheme and they find out that they have HIV/AIDS, it will, by law, not have an impact on their medical aid scheme.

With 80% of HIV funds being domestically raised, medical aid schemes have a large role to play in supporting their members with this illness.