AIDS Care Psychological and Socio-medical Aspects of AIDS/HIV
ISSN: 0954-0121 (Print) 1360-0451 (Online) Journal homepage: http://www.tandfonline.com/loi/caic20
Consumption patterns and levels among households with HIV positive members and economic impoverishment due to medical spending in Pune city, India Varun Sharma, Divya Krishnaswamy & Sanjeevanee Mulay To cite this article: Varun Sharma, Divya Krishnaswamy & Sanjeevanee Mulay (2015) Consumption patterns and levels among households with HIV positive members and economic impoverishment due to medical spending in Pune city, India, AIDS Care, 27:7, 916-920, DOI: 10.1080/09540121.2015.1015482 To link to this article: http://dx.doi.org/10.1080/09540121.2015.1015482
Published online: 04 Mar 2015.
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Date: 03 December 2015, At: 00:17
AIDS Care, 2015 Vol. 27, No. 7, 916–920, http://dx.doi.org/10.1080/09540121.2015.1015482
Consumption patterns and levels among households with HIV positive members and economic impoverishment due to medical spending in Pune city, India Varun Sharmaa*, Divya Krishnaswamyb and Sanjeevanee Mulayc a
School of Health Systems Studies, Tata Institute of Social Sciences, Mumbai, India; bCentre for Budget and Policy Studies, Bangalore, India; cPopulation Research Centre, Gokhale Institute of Politics and Economics, Pune, India
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(Received 26 August 2014; accepted 27 January 2015) HIV infection poses a serious threat to the economy of a household. Out of pocket (OOP) health spending can be prohibitive and can drag households below poverty level. Based on the data collected from a cross-sectional survey of 401 households with HIV+ members in Pune city, India, this paper examines the consumption levels and patterns among households, and comments on the economic impoverishment resulting from OOP medical spending. Analysis reveals that households with HIV members spend a major portion of their monthly consumption expenditure on food items. Medical expenditure constitutes a large portion of their total consumption spending. Expenditure on children’s education constitutes a minor proportion of total monthly spending. A high proportion of medical expenditure has a bearing on the economic condition of households with HIV members. Poverty increases by 20% among the studied HIV households when OOP health spending is adjusted. It increases 18% among male-headed households and 26% among femaleheaded households. The results reiterate the need of greater support from the government in terms of accessibility and affordability of health care to save households with HIV members from economic catastrophe. Keywords: coping strategies; economic impoverishment; HIV; out of pocket health spending; India
Introduction HIV-related illnesses result in increased medical expenditure and households mostly meet this by out of pocket (hereafter referred to as OOP) spending (Riyarto et al., 2010). Frequent illness associated with HIV infection can undermine livelihoods on one hand and increase medical expenditure on the other, contributing to impoverishment (Barnett, Whiteside, & Desmond, 2001; Lopera, Einarson, & Ivan Bula, 2011; Whiteside, 2001). HIV/AIDS has the greatest effect on families with only one employed person (Kebede & Retta, 2004). Studies reveal that households with HIV+ members usually have limited financial resources compared to households without HIV+ members (Oni, Obi, Okorie, Thabede, & Ordan, 2002). These financial resources are disproportionately distributed amongst food, non-food and medical expenditure. Various studies indicate a change in consumption patterns of households with HIV+ members and show how resources are diverted towards health care (Bachmann & Booysen, 2003; Bechu, 1998; Duraisamy et al., 2006; Oni et al., 2002; Tibaijuka, 1997). The OOP health spending accentuates financial burden and leads to impoverishment (Duraisamy et al., 2006). Studies also showcase the visible difference in how HIV/AIDS impact poor and non-poor households (Mather et al., 2004; Yamano & Jayne, 2004). *Corresponding author. Email:
[email protected] © 2015 Taylor & Francis
This paper broadly examines consumption levels and patterns among households with HIV+ members and analyses the poverty inducing effect of OOP medical spending.
Methods Study sites Cross-sectional data were collected through interviews1 (conducted between January 2008 and September 2008) with households with HIV+ members in Pune city of India. Selection criteria Adult (over 18 years) people living with HIV (PLHIV) were selected based on average household monthly income (indicator of economic condition; less than/equal to Rs 2000; Rs 2001–4000; Rs 4001–6000; more than/ equal to Rs 6000) and CD4 cell/µL count (indicator of disease progression; less than 200 cell/µL; 200–499 cell/ µL; more than/equal to 500 cell/µL) followed by the Centre for Disease Control. Sampling procedure and sample size The list of 1400 individuals registered under the Adherence, Counseling and Treatment project (till December
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Table 1. Background characteristics of households with HIV+ members. Headship of household with HIV+ members
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Characteristics Household headship Composition of household Less than or equal to two members Three to four members More than or equal to five members Mean household size (SD) Household structure Joint/extended Nuclear Religion Hindu Muslim Christian Buddhist/Neo-Buddhist Any other Caste SC ST OBC Others Monthly income (INR) 6000 HIV status of head of the household Positive Negative Do not know
Male
Female
253 (63.1)
148 (36.9)
24 135 94 4.23
32 81 35 3.63
p valuea 0.001
(9.5) (53.4) (37.2) (±1.41)
(21.6) (54.7) (23.6) (±1.37) 0.311
82 (32.4) 171 (67.6)
40 (27.0) 108 (73.0)
218 11 3 19 2
(86.2) (4.3) (1.2) (7.5) (0.8)
134 4 1 9 0
(90.5) (2.7) (0.7) (6.1) (0.0)
83 35 27 108
(32.8) (13.8) (10.7) (42.7)
46 20 23 59
(31.1) (13.5) (15.5) (39.9)
122 78 28 25
(48.2) (30.8) (11.1) (9.9)
100 36 9 3
(67.6) (24.3) (6.1) (2.0)
0.633
0.563
