Socioeconomic disparities in access to HIV/AIDS treatment programs in resource-limited settings

Abstract

This study employs data from rural South Africa to determine whether there were socioeconomic differences in the profile of HIV-infected persons living in the community and HIV-infected patients presenting for hospital-based outpatient HIV/AIDS care and related services. There were 776 HIV-infected persons aged 18–35 years in Limpopo Province, South Africa who were included in the study, including 534 consecutive patients who presented for care at a hospital-based outpatient HIV clinic, and 242 persons living in the community. Persons seen in clinic had a higher overall socioeconomic profile compared to the community sample. They were more likely to have completed matric or tertiary education (P=0.04), less likely to be unemployed (P<0.001), and more likely to live in households with access to a private tap water supply (P<0.001). These differences persisted after multivariable adjustment. Our findings demonstrate that important socioeconomic differences in uptake of hospital-based HIV/AIDS care were identified among HIV-infected adults living in a rural region of South Africa. This suggests an important limitation in hospital-based HIV/AIDS care and underscores the need to monitor the equity implications of highly active antiretroviral therapy scale-up in resource-limited settings.

This work was presented at the 11th Global Forum for Health Research in Beijing, China on 1 November 2007

This work was presented at the 11th Global Forum for Health Research in Beijing, China on 1 November 2007

Acknowledgements

At the time this research was conducted, Dr Tsai was a medical student and acknowledges funding from the Benjamin H. Kean Traveling Fellowship in Tropical Medicine (American Society for Tropical Medicine and Hygiene), the Frederick C. Robbins Fellowship (Case Western Reserve University School of Medicine), and the Harvey Fellows Program (Mustard Seed Foundation). Dr Pronyk acknowledges funding from the AngloAmerican Chairman's Educational Trust, AngloPlatinum, DFID, the Ford Foundation, the Henry J. Kaiser Family Foundation, Hivos, the South African Department of Health and Welfare, and the Swedish International Development Agency. Patient care was partially funded by the President's Emergency Plan for AIDS Relief, through USAID (Award No. 674-A-00-05-00003-00). The sponsors had no role in study design, data collection, analysis, interpretation, or writing this report. The authors have sole responsibility for the material presented herein.

Notes

This work was presented at the 11th Global Forum for Health Research in Beijing, China on 1 November 2007