Abstract
BackgroundThere have been only limited studies assessing the economic burden of HIV/AIDS in terms of direct costs, and there has been no published study related to productivity costs in Nepal. Therefore, this study explores in detail the economic burden of HIV/AIDS, including direct costs and productivity costs. This paper focuses on the direct costs of seeking treatment, productivity costs, and related factors affecting direct costs, and productivity costs.MethodsThis study was a cross-sectional, quantitative study. The primary data were collected through a structured face-to-face survey from 415 people living with HIV/AIDS (PLHIV). The study was conducted in six representative treatment centres of six districts of Nepal. The data analysis regarding the economic burden (direct costs and productivity costs) was performed from the household’s perspective. Descriptive statistics have been used, and regression analyses were applied to examine the extent, nature and determinants of the burden of the disease, and its correlations.ResultsAverage total costs due to HIV/AIDS (the sum of average total direct and average productivity costs before adjustment for coping strategies) were Nepalese Rupees (NRs) 2233 per month (US$ 30.2/month), which was 28.5% of the sample households’ average monthly income. The average total direct costs for seeking HIV/AIDS treatment were NRs 1512 (US$ 20.4), and average productivity costs (before adjustment for coping strategies) were NRs 721 (US$ 9.7). The average monthly productivity losses (before adjustment for coping strategies) were 5.05 days per person. The major determinants for the direct costs were household income, occupation, health status of respondents, respondents accompanied or not, and study district. Health status of respondents, ethnicity, sexual orientation and study district were important determinants for productivity costs.ConclusionsThe study concluded that HIV/AIDS has caused a significant economic burden for PLHIV and their families in Nepal. The study has a number of policy implications for different stakeholders. Provision of social support and income generating programmes to HIV-affected individuals and their families, and decentralising treatment services in each district seem to be viable solutions to reduce the economic burden of HIV-affected individuals and households.
Highlights
There have been only limited studies assessing the economic burden of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) in terms of direct costs, and there has been no published study related to productivity costs in Nepal
Average total direct costs to the HIV-affected household (NRs 1512 or United States Dollar (US$)20.4 per visit) for HIV/AIDS treatment in our study were higher than other studies on HIV/AIDS conducted in Nepal [28, 29]
Conclusions the doctor’s fees and medicine costs in the government hospitals in Nepal are minimal, the HIVaffected households are still paying a considerable amount of money for diagnostic tests, transportation, food and lodging
Summary
There have been only limited studies assessing the economic burden of HIV/AIDS in terms of direct costs, and there has been no published study related to productivity costs in Nepal. Long-term illness due to HIV/AIDS demands a higher level of treatment costs for the HIV-affected households. The household level impact of HIV/AIDS includes direct costs, including medical and non-medical costs, and productivity costs such as loss of labour time, as a result of the morbidity of HIV positive household members, as well as time spent by others caring for them [6]. This evidence suggests that HIV/AIDS places significant economic pressure on households trying to pay for health care costs, and trying to make up for lost income
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