Impact mitigation steps targeted at households of people living with HIV should be integrated into national and provincial AIDS strategies and social protection schemes should be responsive to the needs of AIDS-affected families, according to two large-scale studies from Asia presented at the XVIII International AIDS Conference (IAC) underway here.

Households of people living with HIV are under extreme socio-economic stress on several fronts such as income and employment; consumption; borrowings, liquidation of assets; health; stigma, food security; education; and gender; and the coping mechanisms often lead them into irreversible impoverishment that will qualitatively affect the gains on MDGs at a disaggregated level, the studies from Indonesia and China, supported by UNDP said.

In Indonesia, the study that covered seven provinces and 2038 sample households (1019 PLHIV-households and an equal number of non-PLHIV households as the control group), found that unemployment is higher among PLHIV households and they also lost about 55 per cent of their income in caring for the sick compared to non-PLHIV households. The quality and tenure of employment also is substantially compromised. Similarly, the health expenses of PLHIV households were five times higher than that of the non-PLHIV households, which severely constrained other expenses such as on education. PLHIV households spent 36 per cent less on education. The dropout rate of children in the PLHIV households was higher, particularly in the higher classes.

Girls were the hardest hit. Girl children dropped out twice as many times as boys. Even among the children who attended schools, there was considerable absenteeism. The disproportionate impact on women was a major cause for concern, the study said. The impact on them was worse than on men in terms of stigma and discrimination; access to treatment; opportunistic infections, household burden, decision making roles and inheritance.

The study was carried out by the Central Bureau of Statistics, Jakarta in collaboration with UNDP, National AIDS Commission, ILO, UN Volunteers, UNAIDS and JOTHI, the national network of people living with HIV. Trained JOTHI members were part of the research team.

A redeeming feature of the results, however, was the relief offered by social support – assistance by government, NGOs and so on. The huge income-expenditure disparity is offset to a considerable level by social support, without which the depletion of resources of PLHIV-households would have been faster. This needs to be further strengthened. Coverage of ARV was improving and has a commensurate impact in terms of the burden of opportunistic infections.

An advance summary of the report may be downloaded here:

A detailed final report will be published later this year.

China impact

The study in China, carried out in five provinces, also found severe socio-economic impact on households of people living with HIV. It covered 931 PLHIV-households and 995 non-PLHIV households. There was considerable loss of income because of HIV and that has led to drastic reduction in consumption expenses, mainly education, food and household materials. Only 50 per cent of people living with HIV have disclosed their status and about 35 per cent of them experienced discrimination. Discrimination was the highest in schools.

Dropping out of school was considerably higher in PLHIV-households (88.9 per cent Vs 97.2 per cent). Twice as many girls dropped out as boys. Borrowing and liquidation of assets were among the key coping mechanisms and social support played a considerable impact mitigation role. HIV also impacted agriculture in terms of reduced farming activity. In terms of the impact on women, as in the case of Indonesia, they had substantially higher care and household burden and reduced access to healthcare in urban areas. HIV also affected household structures, marriage and relationships.

An advance summary of the report can be downloaded here:

The study was carried out by the Beijing Institute of Information Control (BIIC) in partnership with UNDP, the Chinese Center for Disease Control and Prevention and National Center for AIDS/STD Control and Prevention (NCAIDS).

The key findings from a third study from Cambodia, also supported by UNDP and UNAIDS, covering more than 17,000 individuals across the country, will be presented at the IAC on 23 July.

A press release from UNDP said the main objective of the multi-country studies is to assess the socio-economic impact of HIV on households of people living with HIV in low prevalence/concentrated epidemic settings and to inform impact mitigation policies and programmes. The studies also seek to guide social protection schemes to be sensitive to the needs of people living with HIV and their households.

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