The HIV/AIDS epidemic in South Africa has been spreading over the past ten years. The epidemic has now reached a stage where death and disease are increasing rapidly. 43 percent of South African homes are so poor they do not have enough food to eat.  How do poor families cope when a family member becomes ill with HIV/AIDS?

Most families living with HIV/AIDS use government-run health services. Health clinics are run by nurses who refer patients to district and regional hospitals where they are cared for by non-specialist doctors. These services are free of charge for patients without health insurance. 

The University of East Anglia, UK, together with the University of the Free State, South Africa, looked at the affect of HIV/AIDS on South African families’ incomes over a period of 18 months.  The income and spending of 200 families living with HIV/AIDS in Free State Province were compared with those of 200 families who have so far escaped the virus.  The heads of the households were asked questions about employment, savings, debt, assets and borrowing.

Families living with HIV/AIDS tended to be larger, with lower incomes and outgoings, and fewer people in employment.  The study also found that in these families:

• illness is more likely to be caused by infection: tuberculosis, HIV/AIDS, bronchitis, sexually transmitted disease and pneumonia
• deaths are also more likely to be caused by infectious disease: HIV/AIDS, tuberculosis, pneumonia and meningitis
• illnesses are more serious and place a greater burden on the family.  The sick are less able to perform their usual tasks, and are more likely to need to be admitted to hospital, cared for at home, and accompanied to a health facility.
• the medical costs – for medical consultation, medicine and transport - are on average US$ 6.10 (five percent of their monthly income).  For families without HIV/AIDS medical costs are lower: US$ 3.30 or two percent of their monthly income.

In families living with HIV/AIDS, income does not decrease over time as it does with unaffected families. While it seems there is a general increase in poverty in the population as a whole, the families with HIV/AIDS have already learnt to live with less money and low employment. Death in unaffected families impacts upon the family income more than in families with HIV/AIDS, perhaps again because the latter have adapted to a lower income.

The researchers suggest that:

• To discover the effect of HIV/AIDS on a family’s income it is important to compare them with unaffected families in the community.
• Measuring family spending rather than family income gives a more accurate picture of how much wealth a family has.

The situation in South Africa is a vicious circle:  poverty can lead to HIV/AIDS, while HIV/AIDS can bring with it greater poverty.  The free government-run health care in South Africa, a middle-income country, makes an enormous difference to people with HIV/AIDS.  In poorer African countries the cost of treatment can plunge poor families even deeper into debt.  Nevertheless, the economic and health problems caused by HIV/AIDS are enormous.  Wide ranging support is needed for people with HIV/AIDS as well as their families and neighbours.

Source(s):
‘Relationships between HIV/AIDS, income and expenditure over time in deprived South African households’, Aids Care 16(7): 817-826, by M.O.Bachmann and F.L.R.Booysen, 2004

Funded by: US Agency for International Development

id21 Research Highlight: 17 June 2005

Further Information:
Max Oscar Bachmann
School of Medicine
Health Policy and Practice
University of East Anglia
Norwich
NR4 7TJ

Tel: +44 (0) 1603 593752
Contact the contributor: m.bachmann@uea.ac.uk

University of East Anglia, UK

University of the Free State, South Africa

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'The impact of HIV/AIDS on rural livelihoods'

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