Socio-economic inequality and HIV in South Africa

BackgroundA gap in knowledge exists regarding the economic burden on households of subsidized anti-retroviral treatment (ART) programs in Nigeria. This is because patients also incur non-ART drug costs, which may constrain the delivery and utilisation of subsidized services.MethodsAn exit survey of adults (18+years) attending health facilities for HIV/AIDS treatment was conducted in three states in Nigeria (Adamawa, Akwa Ibom and Anambra). In the states, ART was fully subsidized but there were different payment modalities for other costs of treatment. Data was collected and analysed for direct and indirect costs of treatment of HIV/AIDS and co-morbidities’ during out-and in-patient visits. The levels of catastrophic health expenditure (CHE) were computed and disaggregated by state, socio-economic status (SES) and urban-rural location of the respondents. Catastrophic Health Expenditure (CHE) in this study measures the number of respondents whose monthly ART-related household expenditure (for in-patient and out-patient visits) as a proportion of monthly non-food expenditure was greater than 40% and 10% respectively.ResultsThe average out-patient and in-patient direct costs were $5.49 and $122.10 respectively. Transportation cost was the highest non-medical cost and it was higher than most medical costs. The presence of co-morbidities contributed to household costs. All the costs were catastrophic to households at 10% and 40% thresholds in the three states, to varying degrees. The poorest SES quintile had the highest incidence of CHE for out-patient costs (p<0.0001). Rural dwellers incurred more CHE for all categories of costs compared to urban dwellers, but the costs were statistically significant for only outpatient costs.ConclusionART subsidization is not enough to eliminate economic burden of treatment on HIV patients. Service decentralization to reduce travel costs, and subsidy on other components of HIV treatment services should be introduced to eliminate the persisting inequitable and high cost burden of ART services. Full inclusion of ART services within the benefit package of the National Health Insurance Scheme should be considered.

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“…A similar socio-economic inequality has also been found in South Africa, Spain and some high income countries. [13–16]…”

Section: Discussionmentioning

confidence: 99%

What Is the Economic Burden of Subsidized HIV/AIDS Treatment Services on Patients in Nigeria and Is This Burden Catastrophic to Households?

Etiaba

Onwujekwe

Torpey³

et al. 2016

PLoS ONE

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“…We also considered previous analyses on the role of these indicators in health inequities (Asada, Whipp, Kindig, Billard, & Rudolph, 2014). Similarly, previous research addressing sexual health and HIV were also considered (Ruiz-Muñoz et al, 2013; Varas-Díaz, Neilands, Malavé-Rivera, & Betancourt, 2010; Varas-Díaz et al, 2014; Wabiri & Taffa, 2013). …”

Section: Methodsmentioning

confidence: 99%

Sexual Health and Socioeconomic-Related Factors Among HIV-Positive Men Who Have Sex with Men in Puerto Rico

et al. 2015

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Most of the research among HIV-positive populations has been approached from behavioral risk models. This is particularly true for those otherwise socially vulnerable groups like men who have sex with men (MSM). As a response to this pattern, we examined data from an ongoing health promotion research being conducted in Puerto Rico (PR). The study is limited to HIV-positive MSM and consists of the participation in a survey interview that includes domains used to assess indicators of socio-economic-related factors (age, educational level, employment, religion, and partnership status) and sexual health (sexual satisfaction, condom use, and sexual health knowledge (SHK)). Participants reported a relatively high level(75 %) of sexual satisfaction and inconsistent condom use (50.9 % reported always using a condom). A deficient (61 %) SHK was also reported. In multivariate analyses, a higher educational level was associated with higher sexual satisfaction (aβ = 3.223; 95 % CI 0.291–6.156) and higher levels of SHK (aβ=1.328; 95 % CI 0.358–2.297), while unemployment was associated with less condom use (aOR 0.314; 95 % CI 0.122–0.810). Not having a primary sexual partner was associated with less sexual satisfaction (aβ= −3.871; 95 % CI −7.534–0.208) and more condom use (aOR 4.292; 95 % CI 1.310–14.068). Findings support the notion that men of a disadvantaged socioeconomic position may have a poorer sexual health status; with a lower level of education and unemployment leading this disparity. Findings also evidence that partnership status may have a role in the sexual health of HIV-positive MSM. To our knowledge, this is the first comprehensive analysis of sexual health and socio-economic indicators among Hispanic/Latino HIV-positive MSM in PR and in the Caribbean. Findings provide valuable information to address the sexual health needs of an underserved population.

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“…We recruited 202 HIV-infected children (median age 11 years [IQR [8][9][10][11][12][13]; 48.8% female) and 285 uninfected children (median age 10 years [IQR [8][9][10][11][12][13]; 48.8% female). There was no significant difference in age or sex…”

Section: Baseline Characteristics Of Participantsmentioning

confidence: 99%

Disability, social functioning and school inclusion among older children and adolescents living with HIV in Zimbabwe

Rukuni

McHugh

Majonga

et al. 2017

Tropical Med Int Health

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ObjectiveIncreasing numbers of children with HIV are surviving to adolescence and encountering multiple clinical and social consequences of long‐standing HIV infection. We aimed to investigate the association between HIV and disability, social functioning and school inclusion among 6‐ to 16‐year‐olds in Zimbabwe.MethodsHIV‐infected children receiving antiretroviral therapy from a public‐sector HIV clinic and HIV‐uninfected children attending primary care clinics in the same catchment area were recruited. Standardised questionnaires were used to collect socio‐demographic, social functioning and disability data. Multivariable logistic regression was used to assess the relationship between HIV status and disability and functioning.ResultsWe recruited 202 HIV‐infected and 285 HIV‐uninfected children. There was no difference in age and gender between the two groups, but a higher proportion of HIV‐infected children were orphaned. The prevalence of any disability was higher in HIV‐infected than uninfected children (37.6% vs. 18.5%, P < 0.001). HIV‐infected children were more likely to report anxiety (adjusted odds ratio (aOR) 4.4; 95% CI 2.4, 8.1), low mood (aOR 4.2; 2.1, 8.4) and difficulty forming friendships (aOR 14.8; 1.9, 116.6) than uninfected children. Children with HIV also reported more missed school days, repeating a school year and social exclusion in class. These associations remained apparent when comparing children with HIV and disability to those with HIV but no disabilities.ConclusionsChildren with HIV commonly experience disabilities, and this is associated with social and educational exclusion. Rehabilitation and support services are needed to facilitate educational attainment and social participation in this group.

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Socio-economic inequality and HIV in South Africa

Cited by 78 publications

References 18 publications

What Is the Economic Burden of Subsidized HIV/AIDS Treatment Services on Patients in Nigeria and Is This Burden Catastrophic to Households?

What Is the Economic Burden of Subsidized HIV/AIDS Treatment Services on Patients in Nigeria and Is This Burden Catastrophic to Households?

Sexual Health and Socioeconomic-Related Factors Among HIV-Positive Men Who Have Sex with Men in Puerto Rico

Disability, social functioning and school inclusion among older children and adolescents living with HIV in Zimbabwe

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