Stronger social safety net for HIV-positive households needed in Asia
Vienna - Job insecurity, inadequate food intake and poor education are a few of the pressures on households of people living with HIV that should be tackled more strongly by national and provincial AIDS strategies, according to two new studies from Asia supported by UNDP.
HIV and AIDS-affected families in Asia need robust social safety nets as protection from extreme stresses on their income, assets and health, in addition to helping them deal with the persistent stigma attached to their HIV-positive status, say the reports presented this week at the XVIII International AIDS Conference.
Women and girls in the countries studied during the research, Indonesia and China, are disproportionately affected by these socio-economic stresses which can lead to a steep decline into poverty, rolling back hard-won gains on the globally agreed Millennium Development Goals.
Protections such as cash transfers, insurance coverage, food support and employment programmes should be made responsive to the needs of AIDS-affected families, the reports found.
The Indonesia study (1) that covered seven provinces and a sample of 2,038 households, including a control group of 1,019, found that unemployment is higher among HIV-positive households, compared to the control group, and they also lost about 55 percent of their income in caring for the sick.
The quality and tenure of employment for HIV-affected households is substantially compromised and their health expenses were five times higher than that of the control group, causing severe constraints on other expenses such as education.
HIV-affected households spent 36 percent less on education, and dropout rates of their children were higher, compared to the control group. Twice as many girls as boys dropped out of school, and even among the children who attended schools, there was considerable absenteeism.
The disproportionate impact on women was a major cause for concern, the study found. 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.
"One heartening feature of the findings was the relief offered by social support in the form of assistance by government and non-governmental organizations," the report said, citing the improved availability of drug combinations, anti retroviral treatments, that slow down HIV growth.
The study in China (2), carried out in five provinces and covering 931 HIV-affected households and a control group of 995, also found a severe socio-economic impact on households of people living with HIV, including a considerable loss of income that led to drastic reduction in expenses, mainly for education, food and household materials.
Only 50 percent of people living with HIV had disclosed their status and about 35 percent of them experienced discrimination. Discrimination was the highest in schools, where the dropout rate was much higher for those from HIV-affected households compared to those unaffected (88.9 percent vs 97.2 percent). Twice as many girls as boys dropped out.
As in the case of Indonesia, women had a substantially higher care and household burden and reduced access to healthcare in urban areas.
HIV also affected household relationships, pressuring many to borrow money or sell assets and, where it was available, social support played a considerable role in softening the impact.
The main objectives of the Asia studies were to assess socio-economic impacts of HIV on affected households in settings where the spread of the virus is low or concentrated, and to use the results to inform policies and programmes to reduce household exposure to these impacts.
In contrast to the spread of HIV in Africa, no country in Asia has a generalized HIV epidemic, making it necessary to target the entire sexually active population with prevention efforts. Nearly five million people in Asia are living with HIV and more than 400,000 die from an AIDS-related illness each year.
This week’s International AIDS Conference, where the studies were launched, is a gathering for HIV workers, as well as policy makers, persons living with HIV and others committed to ending the pandemic. Participants assess the current state of HIV/AIDS worldwide, evaluate recent scientific developments, lessons learnt and collectively chart a course forward.
(1) The study was conducted 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.
(2) The study was conducted by the Beijing Institute of Information Control in partnership with UNDP, the Chinese Center for Disease Control and Prevention and National Center for AIDS/STD Control and Prevention.
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