Hope for the dying: HIV/AIDS, antiretroviral treatment packages and intrahousehold resource allocation

2017-02-06T06:16:18Z (GMT) by Abimanyi-Ochom, Julie
The HIV/AIDS epidemic has devastated and impacted millions of lives worldwide especially in Sub-Saharan Africa. Since its discovery in 1981, the challenge at the onset of the epidemic was the unavailability of treatment but this changed in 1987, with the development of antiretroviral therapy (ART) and subsequently the availability of generic drugs which reduced treatment costs considerably and increased the survival of those infected with HIV. However, challenges still remain in terms of risk of HIV infection and low use of services for HIV including Voluntary Counselling and Testing (VCT). Additionally, despite the provision of ART especially to resource constrained countries in Sub-Saharan Africa including Uganda, there are other numerous challenges faced by People Living With HIV and AIDS (PLWHA) that impede maximising benefits from ART despite the enormous global commitment in fighting HIV/AIDS. This thesis generally investigates aspects relating to HIV prevention, care and treatment looking at the case of Uganda and Kenya. Firstly, the thesis explores factors that are important for the use of VCT for women in Kenya and factors that are important to reduce HIV risk for women in Kenya and Uganda. Secondly, the thesis explores how access to treatment of HIV in terms of different ART packages may impact households’ resource allocation outcomes; highlighting the personal and household burden of HIV/AIDS in Sub-Saharan Africa. The literature on HIV/AIDS is vast but challenges still exist in reducing risk and boosting uptake of VCT as a means of HIV prevention. This thesis adds knowledge to the HIV prevention literature by using the Demographic and Health Survey data that incorporate individual HIV status to explain HIV risk and likelihood of using VCT for women as a means of informing HIV prevention policy. The results reveal that individuals from high socio-economic backgrounds are more likely to use VCT but are equally more likely to be at greater risk of HIV infection, unlike past studies that have always emphasised individuals from low socio-economic as those at greater risk. Reduction of risk would require policies that target individuals from all socio-economic backgrounds to achieve better prevention success. The existing literature on HIV/AIDS and care has considered the provision of ART drugs to resource constrained countries including Uganda which, is mainly focused on here. Given the transformed nature of the illness experience of HIV/AIDS as a result of increased survival due to ART availability, the focus has shifted to how individuals and households manage to live with the illness and has considered aspects relating to wellbeing including work, education and quality of work. However, little attention has been focused on the challenges faced by individuals and households affected by HIV in resource constrained communities despite the fact that such challenges might reduce the benefits from HIV treatment. This thesis uses both individual and household level data from the Centre for Health Economics Uganda HIV survey to explore how provision of additional support in addition to ART impacts households’ wellbeing in terms of children’s work, children’s education outcomes and adult labour allocation. The thesis reveals that children from households with a PLWHA are likely to engage more in child work and are hence more likely to be potentially vulnerable. Also, adults from households that received additional support are indicated to have better outcomes in terms of labour hours and cash at hand, hence better survival than PLWHA who do not have such additional support. The thesis also adds to the limited literature relating to the impact of formal assistance to households on children’s schooling outcomes for households with a PLWHA. The results reveal that although formal assistance may have no impact on children’s school enrolment, it is important for schooling quality through better school progression. Finally, the thesis considers the association between labour supply (for individuals, males and females separately and couples) and belonging to a household with a PLWHA, in terms of antiretroviral treatment packages (ARTP) offered by two healthcare agencies (TASO and MOH) and belonging to a household without a known person living with HIV (non-PLWHA). The results suggest that social support by TASO to households with PLWHA may have unintended outcomes in terms of disincentivising work for males; while females from TASO households supply more hours of labour compared to those receiving support from the MOH. It is possible that social support empowers TASO women to greater participation in the labour market. An analysis of a collective labour participation model reveals that bargaining power among couples influences total household labour supply, with males contributing fewer hours while females contribute more hours to total household labour supply, implying rejection of the unitary model. The results imply that policies aimed at improving household labour outcomes need to consider gender dynamics within the households, and the bargaining power of the intended recipient to be effective.