Relationships between HIV/AIDS, income and expenditure over time in deprived South African households

• Published in: AIDS care Vol. 16; no. 7; pp. 817 - 826
• Main Authors: Bachmann, M.O., Booysen, F. L. R.
• Format: Journal Article
• Language: English
• Published: Abingdon Taylor & Francis 01.10.2004; Taylor & Francis Ltd
• Subjects: Acquired Immune Deficiency Syndrome; Acquired Immunodeficiency Syndrome - economics; Acquired Immunodeficiency Syndrome - epidemiology; AIDS; AIDS/HIV; Biological and medical sciences; Cohort Studies; Deprived areas; Expenditure; Family Characteristics; General populations; Health; Health care expenditures; Health Expenditures - statistics & numerical data; HIV; HIV Infections - economics; HIV Infections - epidemiology; Households; Human immunodeficiency virus; Humans; Income; Logistic Models; Medical sciences; Morbidity; Mortality; Odds Ratio; Poverty; Poverty - trends; Prevention and actions; Public health. Hygiene; Public health. Hygiene-occupational medicine; Rural Health; Socioeconomic Factors; South Africa; South Africa - epidemiology; Surveys and Questionnaires; Urban Health; South Africa; Africa; Social environment; Human; Immunopathology; Socioeconomic status; Mortality; Household; Prediction; AIDS; Health service; Immune deficiency; Infection; Financing cost; Follow up study; Viral disease; Family environment; Public health
• ISSN: 0954-0121; 1360-0451
• DOI: 10.1080/09540120412331290220

We compared 202 households with an HIV-infected member, and 202 unaffected neighbouring households, in one rural and one urban area in Free State province, South Africa. Interviews were conducted with a key informant in each household, at baseline and 6, 12 and 18 months later, with 87% follow-up. Results of the baseline and 6 months study were published previously; this paper reports on trends over the full 18 months of follow-up. We analysed changes in income and expenditure and their relationships with morbidity and mortality using multiple regression. Over 2 years, a third of affected households reported at least one death, mainly due to infectious disease. Affected households' real expenditures decreased over time, while real incomes did not, absolutely and relative to unaffected households. Mortality and morbidity independently predicted lower expenditure (adjusted relative expenditure 0.86 and 0.84, respectively), mortality predicted lower income (adjusted relative income 0.80) and higher expenditure predicted less morbidity and mortality (adjusted odds ratios for a US$100 monthly difference 0.78 and 0.65). Households' economies and HIV/AIDS were thus dynamically related, and occurred against a background of progressive poverty. Expenditure was a more sensitive indicator of the economic impact of HIV/AIDS than was income.