When D T Thyagaraj (50) of Padmanabhanagar, suffered a heart attack 10 years ago, he was wheeled into one of the prestigious hospitals in Bengaluru. Once he survived the attack and was out of the ICU, Thyagaraj sensed that the world around him had changed so completely in so short a time. First he was isolated from the general ward and then supplied food in plastic plates. The doctors and nurses armed themselves with double gloves each time they came to check on him. Their hush-hush talk, suspicious glances, and curt answers left him and his family shocked.

Launch of the first ever health insurance policy for people living with HIV held in Bangalore on August 13, 2008. (From Left). Sanjay Chaganti, C P Uday Chandran, K Sujata Rao, B Sriramulu, Asha Ramaiah, George Deikun, K K Abraham, and P Saroja Kanchan. Pic courtesy: PSI.

Almost a week into this ordeal, Thyagaraj was at his wits’ end. He refused to remain silent and protested against the ill-treatment. Only then did the hospital staff reveal his HIV-positive status. Suddenly, Thyagaraj realised that ‘being positive’ meant something else and that the same was being felt by a community of 2.5 million people (NACO, 2006) all over India.

After years of positive life and discrimination in all spheres of life, Thyagaraj now has a renewed sense of hope and confidence when he says “things are changing”. He has been the State Insurance Co-ordinator, Karnataka Network of Positive People (KNP+), Wilson Garden, Bangalore, for a year. Also, he is the policy-holder of the first-ever insurance package launched by Star Health & Alliance Insurance Company Ltd, and Population Services International, with support from USAID in August 2008.

Insurance - a positive change

This change couldn’t have come at a better time. Although the first serological evidence of HIV infection surfaced in 1986 in Chennai, the focus of government-led efforts and those involved in AIDS battle was largely confined to creating awareness about HIV/AIDS, preventing new infections, drawing up nutrition charts, offering care and support, and organising rallies to drum up public support. One crucial issue has remained unaddressed: a secure life for those already infected as they are under constant threat of losing jobs and family support.

This is where treatment and more importantly, its access and costs come in.  Anti-Retroviral Therapy (ART), consisting of at least three anti-retroviral drugs to suppress the HIV virus, has been the most effective form of treatment so far. Although these drugs are being distributed freely, targeted government initiatives are leaving many out of coverage. The government also offers treatment for tuberculosis (TB) - one of the deadly opportunistic infections suffered by people living with HIV (PLHIV) - free of cost.

However, free ART and TB medicine do not alone complete HIV treatment. With immunity levels dipping constantly, the infected people need life-long medical attention at a very high cost. Moreover, certain recurring infections or RIs like herpes and diarrhea call for hospitalisation. Then comes the question of quality healthcare in an atmosphere free from stigma and discrimination - which has been a major issue as far as the public health sector is concerned. While the rich prefer private treatment, a majority of the PLHIV from poor and middle-class population can ill-afford the same unless covered. This means, it’s not only the infected individual whose finances are at risk, but also the caretakers of his family, infected or not.

As this alarming situation was emerging, the possibility of a health insurance package targeting the HIV-positive population wasn’t considered a viable venture by the government or the private insurance sector. On its part, the central government covers only those PLHIV working for the Railways and the Armed forces; whereas some PSUs offered coverage through Central Government Health Scheme and Employees’ State Insurance Corporation. But this covered segment is extremely small and the possibility of the poor falling under this category is even smaller.

Insurance policy took shape in NGO’s laboratory

“This is where we stepped in,” says Atul Kapoor, Director, PSI, an NGO that addresses the health problems of the low-income and vulnerable population with help from the private sector. Headquartered in Washington DC with its India head office in New Delhi, PSI also has programs focusing on malaria, child survival and reproductive health.  In Bangalore, PSI is based in Kumarapark West.

To boost public-private partnership, PSI started talking to various insurance companies and finally found that Star Health already had a policy designed but had no takers for months. “We were aware that many positive people could not put up with the mounting hospital expenditure and had to sell their assets or dig into savings. This severely affected their mental health and even cut short their lives. Those who could have otherwise lived for at least 15-20 years after infection, died much sooner as they didn’t have emotional and financial support.”

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