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The sampling frame, based in one service organisation, meant that the results cannot be automatically generalised to other populations. Because of limited HIV testing, and confidentiality requirements for HIV screening, a comprehensive sampling frame was not available. Instead we aimed to maximise internal validity by comparing affected households with their neighbours.
The substantial disease burden and economic changes among unaffected households highlight the need for comparison populations in HIV impact studies. They were thus more likely already to have symptoms than were all HIV infected individuals, as reflected in the frequency of illness and death. Thus this study probably largely reflects the experience of households affected by symptomatic HIV infection, which would be more severe than that of households in which someone was infected but still asymptomatic.
Unfortunately, the number and characteristics of all potential index cases who were invited to take part in the study were not recorded, so the extent of response bias could not be determined. Misclassification of affected households as unaffected would have reduced the strength of association between affected status and health or economic variables. Conversely, by excluding potentially unaffected households experiencing tuberculosis or pneumonia at baseline, we may have exaggerated the morbidity difference between affected and unaffected households.
Aids Africa Essay | Bartleby
Secondary analysis provided reassurance that such bias, if present, would have been slight. Finally, the short duration of follow up precluded identification of longer-term trends which future survey rounds are intended to detect. Longitudinal studies can potentially distinguish causes from effects by examining their sequence, but we did not clearly show a dominant temporal direction of effect between poverty and illness.
By continuing the study with six-monthly follow up for a total of three years we aim to elucidate these puzzles. We suggest that future similar studies should sample a higher proportion of middle income households, in order to detect possible changes in employment and income that were undetectable in this very poor population.
The study has several implications for health and social policies. It quantifies poverty among affected households, and the compounding effects of illness. This raises questions about how social welfare policies can target the most vulnerable households — the study suggests that health services may be an appropriate starting point for many.
The study shows the importance of free government clinics and hospitals in providing care, and in avoiding poverty or barriers to access caused by user fees. These services should be protected. It shows that households already provide a substantial amount of home-based care for ill members. The high unemployment rate meant that caring for ill members rarely led to lost income among carers. The government policy of supporting home-based care by training and employing lay carers from low income communities, currently being implemented in South Africa, could simultaneously introduce government money into poor communities, and provide an appropriate level of palliative care.
Economic impact of HIV/AIDS
In one poor rural and one poor urban area of the Free State, South Africa, households affected by HIV had a higher burden of illness and were substantially poorer then their neighbours. Affected households' income and expenditure declined more rapidly during 6 months of follow up.
Government hospitals and clinics, and members of affected households, are all important providers of essential care and so their support should be a priority. Cape Town, Medical Research Council. Kironde S: Tuberculosis. South African Health Review Bloemfontein, Free State Department of Health. Soc Sci Med. Econ Jl. Stata Corporation: Stata Reference Manuals. Release 6. College Station, Texas, Stata Press.
Washington, Futures Group International. Download references. The authors are responsible for this report. Correspondence to Max O Bachmann. Both authors have read and approved the final manuscript. Reprints and Permissions. Search all BMC articles Search. Methods We compared households with an HIV-infected member, and unaffected neighbouring households, in one rural and one urban area in Free State province, South Africa.
Results Members of affected households, compared to members of unaffected households, were independently more likely to be continuously ill adjusted odds ratio OR 2. Open Peer Review reports. Methods The study had a controlled cohort design, with individual- and household-level data from households affected and unaffected by HIV, gathered at baseline and six months later.
Results We obtained baseline information from affected households with members, and from unaffected households with members Table 1. Table 1 Demographic and economic characteristics of households at baseline Full size table. Table 2 Period prevalence of illness and death among households and individuals, at baseline and after 6 months Full size table.
Table 3 Increased odds of illness and death in affected and unaffected households: logistic regression models Full size table. Table 4 Ratios between affected and unaffected households' income and expenditure: linear regression models Full size table. Discussion The study quantifies the higher morbidity and mortality among selected South African households affected by HIV, and their impact on household economies.
However, each of these symptoms can be related to other illnesses so the only way to be sure of HIV infection is to get tested.
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Aids Foundation, South Africa [online], available at: www. Bazilli, S. Van Wyk, B.
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The New Drug War. This is a good resource. Statistics: On 21 November , a new UN report said more than three-quarters of Aids-related deaths occurred in sub-Saharan Africa and South Africa was officially the country with the highest prevalence of HIV in the world. Further Reading. Global Aids Update. By reducing incentives to invest in education and training, and by lowering school attendance, it may radically undercut the skill and knowledge base of the economy. While the government reacted with hostility to such studies, they may have increasingly influenced its appraisal of the potential benefits of ARV intervention.
Analysis of the climate for investment in South Africa, however, may have had the opposite effect. The past two decades have seen ongoing business uncertainty about the long-term stability of the society. Foreign direct investors and financial markets might otherwise be only too willing to treat AIDS as an overarching threat to policy certainty and political stability. It would be too cynical to attribute the slow move towards ARV treatments from to , and the announcement of a scaling-up in , to an electoral calculation.
We can presume that the government has considered the possible implications of the pandemic for political and social stability. While an accelerated ARV programme has struck many analysts as self-evidently rational, the government may have registered potentially explosive negative consequences. The more successfully ARVs reduce deaths, the faster the overall cost of providing treatment escalates. The problem of sustainability is not primarily financial, however, but rather infrastructural.
The World Health Organization has launched an initiative to place three million people on antiretroviral treatment by the end of , 68 with even Swaziland and Malawi proposing immediate seven-fold and twenty-fold increases in ARV treatment respectively. Pretoria in planned a fifty-fold increase in two years — from less than 3, people on ARVs in the public sector in to , by April — and a further scaling-up to 1,, people by April The cabinet has acknowledged the need to recruit and train health professionals on a large scale, and to increase the availability of necessary non-health resources such as clean water.
Unprecedented clinical, social, psycho-social and nutritional expertise, however, must be created at a time of declining human resources and growing HIV prevalence among health workers. The tuberculosis control programme is failing, as are the simplest public health measures like childhood immunizations in poor provinces. De facto rationing of treatment will be inequitable, and will bring political risks that the government must be concerned to minimize.
Substantial population movement to the cities, moreover, might follow failure to deliver on the ARV promise in rural areas, overwhelming urban health facilities and overloading other public service providers. It has legislated a new role for the traditional healers who will provide rural palliative care, and has prioritized nutrition programmes and social grants that create incentives to die in rural areas.
Its failure to address stigmatization can also be explained in this way, as an attempt to control open defiance and the search for treatment in urban areas. Stigmatization is closely related to personal responsibility.
Each one of our citizens has a responsibility to take all necessary measures to protect his or her health. Any complex policy cannot be just the creation of leaders, but must be understood in the context of the institutions and intellectual discourses that allow it political and administrative viability. The intellectual discourses of the liberation movement created an inhospitable environment for a biomedical science that lacked an appealing social epidemiology of the virus.