Effects of AIDS-related disability on workforce participation and earned income in Botswana: A quasi-experimental evaluation

Abstract

Background: Botswana is regarded as a leader of progressive HIV/AIDS policy, as the first country in sub-Saharan Africa to establish a free, national antiretroviral therapy program. In light of such programmatic successes, it is important to evaluate the potentially changing relationship of HIV/AIDS to the wellbeing of individuals, households, and institutions in the country. Methods: We evaluate the effects of HIV-related illness on absenteeism and earnings several years after the start of the national treatment program among a random sample of adults in Botswana using survey data from 3999 individuals aged 15 to 49, using quasi-experimental methods. We compare absenteeism between individuals with and without HIV-related illness, using a propensity score matching approach. We then estimate the effect of HIV-related illness on earnings using a Heckman selection model to account for selection into the workforce. We stratify our analyses by sex. Results: Men and women with HIV-related illness were absent by about 5.2 and 3.3 additional days, respectively, in the month prior to the survey compared to matched controls, and earned approximately 38% and 43% less, respectively, in the month prior to the survey compared to those without HIV-related illness. Conclusions: HIV-related illness appears to increase absenteeism in this sample and dramatically reduce earnings. The findings suggest a need for policies that confer greater financial security to individuals with HIV/AIDS in Botswana.

Identifying “What Matters Most” to Men in Botswana to Promote Resistance to HIV-Related Stigma

“…Since the epidemic started, national policies have been developed to protect PLWH from employment discrimination (Botswana, 2010(Botswana, , 2012. However, prior qualitative studies in Botswana have found that having HIV has been linked to loss of income (Farahani et al, 2013;Rajaraman et al, 2006) and that fears of HIV-related job loss persist (Castro & Farmer, 2005;Weiser et al, 2003), which is particularly relevant, given high unemployment rates (18%; Statistics Botswana, 2020a).…”

“…In particular, experiencing HIVrelated discrimination can threaten employment and economic status by undercutting multiple masculine ideals, including providing for one's family, having status in society, and being seen as strong, healthy, and independent (Rakgoasi & Odimegwu, 2013). Although Botswana has legal protections against HIV-related discrimination (Botswana, 2010(Botswana, , 2012, many PLWH remain concerned that their employability is threatened with fewer opportunities and greater insecurity (Farahani et al, 2013;Rakgoasi & Odimegwu, 2013).…”

Foundations for Living: Evaluation of an Integrated Employment and Housing Program for People Living With HIV

“…According to the International Labour Organization (2018), PLWH lost earnings due to removal from the labor force or reduced work productivity. International researchers who examined earning losses found that the average productivity loss due to HIV/AIDS ranges from 20% to 55% (Farahani et al, 2013; Habyarimana et al, 2010; Thirumurthy et al, 2011). In France, the unemployment rate among PLWH was 1.62 times higher than the general population (Annequin et al, 2016).…”