The economic impact of HIV/AIDS morbidity and mortality on households in Addis Ababa, Ethiopia

Abstract

The present study investigates whether the household-level economic impact of an adult AIDS death is different from that of death from another cause. The data come from cross-sectional post-mortem interviews (verbal autopsies) with relatives or primary caregivers of deceased adults randomly selected from deaths recorded in an ongoing burial surveillance in Addis Ababa. Our analyses consist of three parts. First, we assess the sociodemographic risk factors for AIDS mortality. Subsequently, we reverse the causal order of this relationship and carry out an analysis of the effect of AIDS mortality on the subjective experience of change in the household's financial situation following the death of a household member. Finally, we quantify the direct and indirect costs of illness and death on the household. Results indicate that households experiencing an HIV/AIDS death are poorer than those experiencing a non-HIV/AIDS death. In addition, poorer households experience a greater decline in socioeconomic status following death of a household member. AIDS mortality has more detrimental effects on the household economic status than deaths due to other causes. While the difference between AIDS and non-AIDS mortality in terms of direct costs is minimal, the indirect cost of an AIDS death per household exceeds that of non-AIDS death by 58%. In conclusion, poor households are more likely to experience an AIDS death and in turn are more vulnerable to the socioeconomic impact of death. Therefore, it is justifiable to target HIV-impact mitigation programs on poorer households.

Keywords:

• HIV/AIDS
• mortality
• morbidity
• socioeconomic impact
• Ethiopia
• Addis Ababa

Acknowledgements

The Addis Ababa Mortality Project is funded by the AIDS Foundation of Amsterdam (grant no. 7022) and receives support from the Centralized School of Nursing and the Department of Community Health of Addis Ababa University. Funding for the VA interviews came from a Mellon Pilot Project Grant to the Population Studies Center of the University of Pennsylvania. Religious leaders and the Addis Ababa Labor and Social Affairs Bureau facilitated our access to the burial sites. We wish to thank Dr Getachew Tizazu, Dr Sisay Yifru, Dr Ashenafi Bekele, Dr. Desalegn Negatu, Dr. Mikyas Demisse, Dr Yayeh Negash, Dr. Mehila Zebenegus and Dr. Dagne Muluneh for the review of VA interviews. We would also like to thank John Knodel for his suggestions on the VA questionnaire.