Costs and financial burden of care and support services to PLHA and households in South India

Abstract

The objective of this study is to estimate the medical and non-medical out-of-pocket expenditure on care and support services to PLHA, the financial burden on households, the indirect costs and coping strategies to meet the financial burden. A structured pre-tested questionnaire was used to collect data from a cohort of 153 clients of YRG CARE, a leading Chennai based NGO, who had completed the first and third waves of interview during 2000/01 and 2001/02 respectively.

The results show that the median out-of-pocket medical and non-medical expenditures (direct cost) for treatment and services are Rs. 6,000 (US $ 122) in a reference period of six months. Clients on antiretroviral (ARV) drugs spend five times more than those not on ARV. The median direct cost significantly increases with stage of disease, household income, and poverty level. The financial burden of treatment, measured as the ratio of direct cost to household income, is greater on lower income (82%) than on higher income (28%) households. 31% and 45% of the clients reported loss of income and workdays respectively.

In conclusion, the direct costs and financial burden of care and support services increase with the stage of disease. The financial burden is disproportionately more on low-income households. HIV/AIDS leads to depletion of savings and increases the indebtedness of households.

Acknowledgments

The authors wish to thank the anonymous referees of this journal for their valuable comments and suggestions. This is part of a larger collaborative research on ‘Scaling up affordable and appropriate care and support services for PLHA in South India’ sponsored by the Population Council /HORIZONS programme and carried out at the YRG CARE. The research grant from the sponsoring organizations, and the excellent research facilities and assistance from the YRG CARE are gratefully acknowledged. The opinions expressed herein are those of the authors and do not necessarily reflect the views of the sponsoring agencies or the organizations to which the authors are affiliated.