The financial cost of living with HIV in Asia
Households affected by HIV face higher healthcare costs but lower income, evidence review suggests.
Households affected by HIV in Asia are more likely than others to struggle financially, with an HIV diagnosis linked to a fall in income but a rise in healthcare spending.
Households affected by HIV also face higher unemployment and higher food insecurity and are more likely to borrow money or sell off assets.
The evidence review, published in The Lancet, set out to investigate the socioeconomic impacts not only of living with HIV but of living with HIV and a non-communicable disease (NCD). NCDs are chronic illnesses, such as heart disease, that become more common as people age. Better antiretroviral treatment (ART) means people living with HIV are now living longer so are more likely to develop an NCD. Yet little is known about the impact of living with both conditions.
Reviewing evidence from Asia and the Pacific over the last 30 years, researchers found 29 studies that investigated the socioeconomic impact of HIV (from Cambodia, China, India, Indonesia, Malaysia, Myanmar, Nepal, Thailand and Vietnam). But only one study examined the combined impact of HIV and NCDs on household finances.
Most households affected by HIV were low-income families. More lived below the poverty line than other households.
In Cambodia, China, India and Myanmar, the average monthly income was lower in households affected by HIV than others. In China, households affected by HIV were US$250 worse off each month than other households.
Being diagnosed with HIV led incomes to drop by 55% in India and 23% in Cambodia.
Households affected by HIV spent less on goods and services but more on health services. In Indonesia, out-of-pocket health spending was six times higher compared to other households. In Cambodia, it was two times higher, and HIV costs alone accounted for 33% of household income. In China, HIV costs were more than double household income, suggesting families were facing mounting debts.
The study that examined the joint impact of NCDs and HIV, which was conducted in Myanmar, found that households affected by both conditions spent 50% of their income on healthcare. Households not affected by HIV or NCDs spent 10%.
People living with HIV with an NCD faced healthcare costs more than eight times higher than the costs faced by people who were only living with HIV. ‘Catastrophic’ health expenditure, defined as using 40% or more of non-food spending to cover healthcare, was reported by 14% of households affected by HIV and NCDs, and 10% of households affected by HIV only.
In Cambodia, 77% of households affected by HIV were unemployed, compared to 54% of other households. People in households affected by HIV were absent from work for an average of 2.65 days/month, compared to 0.67 days/month in other households.
One Indian study found that being diagnosed with HIV lowered the chances of getting work, not only for that person but for other family members. Access to ART increased employability by 47% and income by 25%.
Another Indian study found that nearly half of households affected by HIV were food insecure, and this was more likely to happen if the household head was a woman or had more advanced HIV.
The findings highlight the need for more research on the joint financial impact of HIV and NCDs. Integrating HIV and NCD care could be one way to ease the healthcare costs facing affected households, leading to a better quality of life for people living with HIV and their families.