The Impact of HIV/AIDS on Life Insurance Underwriting and Mortality Assumptions in Nigeria

This study examines the impact of HIV and AIDS prevalence on life insurance underwriting practices and mortality assumptions in Nigeria, with a focus on ensuring actuarial adequacy while avoiding discriminatory exclusion of affected populations. Nigeria has the second-largest HIV-positive population in the world, and while antiretroviral therapy has significantly extended life expectancy for people living with HIV, mortality differentials relative to uninfected cohorts remain relevant for insurance pricing. Current underwriting practices among Nigerian life insurers vary widely, from blanket exclusion of HIV-positive applicants to limited risk acceptance with premium loading. This study uses HIV prevalence data from the National Agency for the Control of AIDS, ARV treatment outcomes from Federal Ministry of Health program reports, and underwriting practice surveys administered to 60 life insurance underwriters and actuaries across Lagos, Abuja, and Kano. Mortality rate differentials between treated and untreated HIV populations are quantified using available clinical follow-up data. Findings reveal that modern ARV treatment significantly narrows the mortality differential between HIV-positive individuals on treatment and uninfected peers, making blanket exclusion actuarially unjustified for treated applicants with suppressed viral loads. Most sampled insurers continue to apply blanket exclusions despite this evidence. The study concludes that HIV underwriting practices in Nigerian life insurance are outdated relative to clinical evidence. It recommends that NAICOM issue updated HIV underwriting guidelines aligned with current treatment outcomes and prohibit blanket exclusions for ARV-treated applicants.

Keywords: HIV/AIDS, life insurance underwriting, mortality assumptions, ARV treatment, NAICOM.