Leading Article: HIV testing: when policy and practice diverge

IT IS worrying that so many people are still reluctant to be tested for HIV. A recent study has shown that half the adults with Aids in England and Wales learnt that they were HIV positive less than a year before succumbing to Aids. Had they known earlier, their lives could have been prolonged and the risk of transmitting the disease reduced. Not surprisingly, the greatest unawareness was among heterosexuals, who feel at less risk than homosexuals, although the proportion of cases is shifting.

There are many reasons why people at risk avoid tests. They include fear, ignorance and indifference. But a significant number worry about being unable to obtain a mortgage or life insurance. This is because insurance companies are suspicious of applicants who admit to having been tested, even if the result of the test is negative. They tend to assume that a person who voluntarily takes a test must have a lifestyle that increases risk. If further questioning reveals that the applicant is a homosexual, that in itself may push up the premium.

The Government has pressed the insurers on this point, as has the Terrence Higgins Trust. The trust argues that applicants for insurance should be treated as individuals, taking into account facts about their physical condition and lifestyle, not thrown into categories based on general assumptions. It points out that homosexuals who lead steady lives and/or take precautions against Aids are likely to live longer than heterosexuals who smoke, drink heavily and sleep around. Indeed, someone who volunteers for a test is demonstrating a responsible attitude and will receive counselling to lower the risk from then on.

Insurers naturally try to seek as much information as possible to help them to calculate a risk they are being asked to cover. They point out that risk assessment is made particularly difficult by the existence of a lethal disease about which not much is known. According to the guidelines of the Association of British Insurers, 'having had 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'. Practice in fact varies. A positive test naturally rules out cover altogether, though it does not affect existing policies.

The market should eventually come to the rescue because, if homosexuals are paying higher premiums than are justified by mortality statistics, someone will eventually offer them better rates.

But the whole problem will pale into insignificance when genetic testing becomes common, presenting a picture of each individual's vulnerability to disease and their life expectancy. As attempts to withhold such information will almost certainly fail, the result will be pressure for much wider differentiation of premiums, with some lucky people being offered cheaper rates than are now available and others finding it difficult to get insurance at all. A tough decision will then have to be made. Should the state take over the burden of high- risk categories, and if so at what level of risk, or should insurers be compelled to do so, thereby forcing low-risk customers to finance the less fortunate?