More Than a Virus: The Cost of HIV Stigma in South Africa

Today, 21 July is not just another day on the calendar. It is Zero HIV Stigma Day which marks a day to reflect, challenge perceptions and recommit to dignity and equity for people living with HIV. Importantly, it is also a day which commemorates and celebrates the life of the late Prudence Nobantu Mabele, who in 1992 became the first woman in South Africa to publicly disclose her HIV‑positive status. Her courage transformed the national conversation around HIV and laid the foundation for decades of activism, awareness and progress.

Prudence's example should serve as inspiration for the insurance industry to improve how HIV is treated in our products and underwriting. HIV is an insurable medical condition.

As of 2025, more than eight million people in South Africa are living with HIV, representing around 20% of HIV cases worldwide ¹. Medical progress has been extraordinary from the widespread availability of antiretroviral therapy to recent innovations such as the roll-out of long-acting‑ preventative injections like Lenacapavir. Yet while the science has advanced, stigma remains one of the most enduring challenges.

Figure 1: Percentage of People Living with HIV in South Africa who have responded “Yes” to the following statements

Although external stigma has shifted, one of the most persistent and damaging forms that remains is internalised stigma. This form of stigma lies in the fear of disclosure, the shame that lingers long after diagnosis and the belief that a person’s professional, social or financial opportunities are limited. This internalised stigma is shaped not only by personal experiences but also by the systems and structures that continue to treat HIV as exceptional, rather than as another chronic condition.

This stigma has a knock-on effect on the insurance industry, where HIV often remains on the boundaries of insurability.

There remains an opportunity to align science, public perception, and underwriting capacity with these developments. Doing so would support a more consistent approach to HIV alongside other chronic conditions.

Globally, underwriting models are evolving in line with science, recognising that individuals on effective treatment can achieve normal life expectancy and stable health outcomes. However, in some instances local practice continues to view and single out HIV as exceptional.

Treating HIV differently from other chronic illnesses does more than limit insurance access; it reinforces internalised stigma and risks eroding decades of progress. If HIV is recognised as a chronic condition, then policies, products and practices will evolve in ways that reflect that reality.

The local insurance industry can contribute towards putting an end to structural stigma.  As policymakers and leaders, it is important to interrogate outdated underwriting models and align decisions with evidence by removing barriers. With our market representing around 20% of global HIV cases, we have a significant opportunity to lead meaningful progress.

The call to action for our industry is clear: continue to challenge outdated assumptions about HIV-positive lives and ensure underwriting and risk assessment practices reflect today's evidence. By doing so, we can expand access, reduce stigma and help build a more inclusive insurance landscape.