Many clinics in Africa have shown that antiretroviral (ARV) treatment radically improves the health of people with Aids. Recent research at a health centre in western Kenya shows that ARV treatment also transforms the socio-economic status of patients and their families. By improving their health, treatment allows Aids patients to return to work. This in turn reduces the work burden placed on other family members.
These results underscore the importance of looking beyond the health benefits of treatment. The economic benefits of treatment are also substantial, and they are realised by treated patients as well as their family members. Knowing more about the magnitude of these economic benefits is useful in light of the current situation in sub-Saharan Africa.
In Kenya, where HIV prevalence is reportedly falling, more than 55,000 HIV-positive adults already receive ARV treatment. But there is a long way to go before universal access to treatment is achieved. Over 1.5 million Kenyan adults are HIV-positive, with 273,000 of them having Aids and in need of treatment.
Treatment costs and inadequate funding are among the major obstacles to increasing access. For example, the annual cost of ARV medicines alone represents a large fraction of per-capita income. To explore the economic benefits, we conducted a survey that gathered socio-economic information from many patients and families in western Kenya. We were fortunate to collaborate with the AMPATH program (Academic Model for Prevention and Treatment of HIV/AIDS) of Moi University and Indiana University in the US. A team of research assistants interviewed more than 200 patients receiving free ARV treatment at a rural health centre. More than 500 other families in villages where these patients lived were also visited.
When the patients were first interviewed in 2004, they were just beginning to receive ARV treatment. After analysing the survey data, we found much evidence in support of the view that HIV/Aids deepens poverty. The patients and their families were initially worse off than other adults and families living in the same villages.
The patients worked much less on the farm and in businesses. Their families owned less land and purchased less fertiliser, which translated into smaller maize harvests. As a result, children under five years in their families had worse nutritional status. The education of children between 8-18 years also suffered, as they were attending fewer hours of school than other children in the same villages.
The key question when the families were revisited six months later was whether ARV treatment improved various aspects of their social and economic well-being. The patients’ medical records showed they were much healthier. This health improvement was also accompanied by a large and rapid economic recovery. Treatment made it possible for patients to return to work on their farms and in small business enterprises.
Perhaps more importantly, as the treated patients became healthier and more productive, the children in their families also benefited.
This is supported by the noteworthy result that school attendance of all children in patients’ families improved significantly. The benefits of treatment even trickled down to very young children, who experienced a dramatic improvement in nutritional status. Thus, treating an adult Aids patient today means that future generations will be better off. This wide array of benefits strengthens the case for donors and governments to provide greater resources to treatment programmes.
Admittedly, the scaling-up of treatment programmes poses significant other challenges. Trained clinicians and outreach workers will be needed to ensure that proper care is given and that patients take their medicines regularly. Some patients may also need nutritional supplements for treatment to be effective. A continued stream of funding and an affordable supply of second-line therapies — when first-line therapies fail — will also be critical.
At the national level, such treatment could help prevent the Kenyan economy from stagnating due to the effects of HIV/Aids.
Joshua Graff Zivin, Mabel Nangami and Harsha Thirumurthy. The writers are health and economic experts.