Academic journal article Health Sociology Review

The Socioeconomic Impact of Antiretroviral Treatment on Individuals in Soweto, South Africa

Academic journal article Health Sociology Review

The Socioeconomic Impact of Antiretroviral Treatment on Individuals in Soweto, South Africa

Article excerpt

Introduction

In South Africa, HIV prevalence among pregnant women attending antenatal clinics has peaked at 30.2% (Department of Health 2005). UNAIDS and WHO (2005) reported that an estimated one million people in South Africa require antiretroviral treatment. The benefits of antiretroviral therapy for the management of HIV have been well established in the clinical literature with improvements in HIV related morbidity and mortality (Wood et al 2003:2419). Antiretroviral drugs have a dramatic effect on HIV positive patients by creating the conditions for substantially prolonging life and enabling life to be fully active and therefore economically productive (Love 2004:642).

This paper describes the findings of research undertaken to assess the short-term socioeconomic impact of antiretroviral treatment (ART) in HIV positive patients. This impact was primarily examined through two sub-problems: what socioeconomic changes are seen on commencement of antiretroviral treatment in an eighteen-month period; and how changes in health affect the ability of individuals to participate in economic activity. Patient data collected at the Perinatal HIV Research Unit (PHRU) in South Africa (Soweto1) in two programmes, namely the PHRU Treatment Access Programme (PTAP) and the Comprehensive Care and Support Programme (CCS), were utilised for descriptive analysis in phase one and followed by in-depth case study analysis in phase two.2

Literature review

Numerous studies have been conducted to assess the socioeconomic impact of HIV/AIDS. Desmond et al (2000) argue that because HFV/AIDS causes significant increases in illness and death in prime age adults, the effect is seen in both households and communities. The documented economic impact at the household level is decreased income, increased costs, decreased productive capacity and changing expenditure patterns. The decrease in income, together with the increase in health care expenditure, leads to a fall in expenditure on other basic needs. This shrinkage and reallocation of the household budget reduces food security thereby increasing the chances of malnutrition and sickness in other members in the home.

Adult illness or death reduces household income. Less labour is available because the affected individual may not be able to work and also because the time of others may be diverted to care for the sick. Illness also increases household expenditure on medical care, food and washing materials (Barnett and Whiteside 2002:189). In rural Limpopo, South Africa, Oni et al (2002) reported that the average annual income was approximately 35% lower in households affected by HIV/AIDS than in nonaffected households, and Morris et al (2000) found the impact of HIV on individual households to be as much as a 67% decrease in average income with one HIV infected household member. In addition, two thirds of the 700 households surveyed by Abt Associates (2002) reported a loss of income as a consequence of HIV/AIDS and almost half reported not having enough food.

In a longitudinal, controlled study of households affected by HIV in the Free State, South Africa, Booysen et al (2002) found HIV affected households were poorer and more dependent on non-employment sources of income and spent less money on food. The total cost of morbidity to households was relatively low where unemployment levels were very high. Ill household members were primarily cared for by family members with no direct loss of income reported. A larger number of children in affected households were not attending school and orphans were found to be sheltered in both affected and non-affected households. Similarly, Bachmann and Booysen (2003) found that HIV/AIDS affects the health and wealth of households aggravating pre-existing poverty. Thirty-five percent of affected households needed someone to accompany an ill member to a health service and the median number of hours that home carers spent with ill members was five per day. …

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