26 March 2012
By Neha Madaan
The medical expenses incurred by families who have at least one HIV positive member are a serious strain on their finances, pushing many of them into a “poverty trap”.
This was revealed in a field survey of 401 such families in the city, undertaken by the Gokhale Institute of Politics and Economics (GIPE) to gauge the economic profile of People Living with HIV (PLHIV) and the socio–economic impact of HIV at the household level.
The families surveyed are registered with a city NGO, which works towards providing socio–psycho, legal support and counselling to PLHIV. Though the study included households from all strata of society, and from varied economic backgrounds, nearly 50% of the sample group was from the lower economic categories. The study was completed under the guidance of Sanjeevanee Mulay, former associate professor at GIPE.
Varun Sharma, who undertook the study, is a former senior research fellow at GIPE and currently assistant professor at the Institute of Health Management Research (IHMR) in Bangalore. He said the study was an attempt to estimate the relationship between HIV prevalence and poverty. “We cannot overlook the fact that PLHIV from the lower socio–economic background, especially from the slum areas in cities like Pune, are most vulnerable. This should be considered while drafting policies and programmes concerning HIV,” he said.
Sharma said the study used economic methods such as Principal Component Analysis (PCA) and Standard of Living Index (SLI).
Based on these two indices, the study found that families with HIV+ persons are more destitute compared to other families.
“This is especially true of households run by HIV+ women. The study revealed that 70% of the sample households managed by women have a middle socio–economic status whereas about 50% of them can be categorised as the ‘poorest of the poor’. In comparison, only 30% of households run by men fit in the category. The reason for this may be that, in general, a woman’s income is less than that of a man,” he said. The study revealed that though antiretroviral therapy (ART) for treating HIV is free at the public health centres, HIV+ people have to spend from their own pockets on other illnesses and ailments which come with the HIV infection, Sharma said. “The economic burden is more on those who are already poor, and it leads to medical poverty trap. In the analysis, we found that there is a sharp increase of 20% BPL headcounts, when adjusted for out–of–pocket health spending,” he said.
HIV+ people from the upper and middle socio–economic backgrounds usually opt for private health facilities, which are better, and also because it offers them a privacy.
Sharma said a comparison between the families surveyed and the city’s non–HIV urban households (surveyed under the national reproductive and child health programme) confirmed that a majority of PLHIV households either came from the lower economic strata of society or had gradually become impoverished over a period of time. According to the study, 36.9% households with HIV+ members had a low standard of living.
Sanjeevani Kulkarni, coordinator, Prayas Health Group, which treats more than 3,500 HIV/AIDS patients from the city and other parts of the country at its clinic, said special focus on widowed women diagnosed with HIV is needed. “Around 33% of the total population of HIV infected women belongs to this category. Implementation of policies that address the needs of such sections of society is imperative,” she said.The Study
- 63% families surveyed are headed by men; 70% of these households are nuclear families
- 22% families with PLHIV are illiterate; 45% have education till secondary level
- 43% PLHIVs are married, 43% are widowed
- 71% PLHIVs are employed. 40% of these are marginal workers. 24% are regularly employed, 40% are casually employed and 6% are self–employed
- 73% PLHIVs depend on private doctors for non–hospitalised illnesses. For hospitalization, 49% depend on private hospitals.
- To meet expenses, 23% families resorted to liquidation of assets, 17% borrowed from friends and 19% dug into their savings.