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NATIONAL COUNCIL OF APPLIED ECONOMIC RESEARCH Parisila Bhawan 11 Indraprastha Estate New Delhi 110 002 India T+91 11 2337 0466(D), 2337 9861-63 F+91 11 2337 0164 W www.ncaer.org E infor@ncaer.org Suman K. Bery Director - General E sbery@ncaer.org Message The first AIDS case in India was detected in 1986 and since then the HIV and AIDS epidemic has emerged as a serious public health problem in India. As on December 2005, an estimated 5.21 million persons were living with HIV infection and till 31 July 2005, 111,608 AIDS cases had been reported. HIV and AIDS is more than a health problem and its impact reaches far beyond the health sector. HIV and AIDS affects the individual, the family and the community at the micro-level and the various sectors of the economy at the macro-level. This report focuses on the socio-economic impact of HIV and AIDS on the affected individuals and their households in the six high-prevalence states of India. The economy-wide and sector-wide impact has been dealt with in a supplementary report. The study is based on a sample of 2,068 HIV households (covering 2,385 People Living with HIV and AIDS {PLWHA}) and 6,224 non-HIV households as a control group. To our knowledge no such study has been carried out in India on such a large scale. This study combines quantitative research techniques with qualitative approaches like case studies and focus group discussions. It focuses on the impact of HIV and AIDS on household income and on the pattern of consumption and savings and reflects the devastating effect of the disease on the household economy due to loss of income and increased medical cost. The impact on the education of the children of the affected families is assessed by comparing the enrolment and dropout rates of the children from HIV households with children from non-HIV households. On the employment front, it is not only the affected individuals who face the brunt of the disease, but also other family members who are the caregivers of the affected persons. The individuals and families affected by HIV and AIDS not only bear the heavy financial burden, but also have to face stigma and social isolation attached to the disease. The study looks at this stigma and discrimination faced by the PLWHA and their families in different settings such as family, community, at the workplace and health facilities. As this prejudice arises mainly due to lack of knowledge, awareness and misconceptions about the disease, the study also attempts to note the awareness level and the views and attitudes of the general population. We are grateful to the National AIDS Control Organisation (NACO) for entrusting this important and sensitive study to NCAER and to the UNDP for funding the project. We hope that the findings of this study would be helpful to NACO and other organisations working in this field for designing and implementing various programmes for the welfare of the people living with HIV and AIDS. I would like to thank Dr. Basanta Pradhan and his team for the successful completion of this pioneering, important and sensitive study. Suman Bery Director-General vi
Study Team Core Team Basanta K. Pradhan : Chief Economist and Project Director Ramamani Sundar : Senior Consultant and Project Coordinator Shalabh K. Singh : Research Analyst Other Researchers S. K. Mondal : Associate Fellow Geetha Natesh : Consultant Sampurna Singh : Consultant Abhilasha Sharma : Research Analyst Indranil De : Research Associate Krishnashree Devee : Research Associate Project Review Committee Suman Bery : Director-General Abusaleh Shariff : Chief Economist Field Coordinators S. K. Mondal Geetha Natesh D. Subrahmanyam T. K. Krishnan A. K. Yadav Vijaya Laxmi Computer Programming J. M. Chawla : System Analyst Technical Support Bijay Chouhan : Executive (IT) vii
Page 1: Socio-Economic IMPACT of HIV and AI
Page 4 and 5: © United Nations Development Progr
Page 6 and 7: The macro-model prepared in this st
Page 10 and 11: Acknowledgements viii Socio-Economi
Page 12 and 13: CHAPTER 5 Impact on the level and p
Page 14 and 15: Table 4.5(a) Table 4.5(b) Work forc
Page 16 and 17: Table 7.7 Table 7.8 Table 7.9 Table
Page 18 and 19: Box 6 Case Study 6: ART still a far
Page 20 and 21: MSACS MSAPCS MSM N NACO NCAER NEDHI
Page 22 and 23: While the case studies helped in ca
Page 24 and 25: A notable feature about savings is
Page 26 and 27: The differences between HIV and non
Page 28 and 29: Nearly one-fourth of the sample PLW
Page 30 and 31: Around 5.5 percent of female PLWHA
Page 32 and 33: Chapter 1 Introduction 1.1 Backgrou
Page 34 and 35: generally in the most productive ye
Page 36 and 37: and stipulate conditions for agreei
Page 38 and 39: in Andhra Pradesh. Of the six state
Page 40 and 41: to HIV. While the rate of prevalenc
Page 42 and 43: ut also attempts to assess the know
Page 44 and 45: The selection of the districts depe
Page 46 and 47: For every HIV household surveyed in
Page 48 and 49: 2.1.6 Household questionnaire The h
Page 50 and 51: Chapter 3 Profile of Sample Househo
Page 52 and 53: were illiterate (Table 3.2). Of the
Page 54 and 55: percentage has been much lower for
Page 56 and 57: percentage of women is less than th
Page 58 and 59:
Chapter 4 Impact of HIV Status on I
Page 60 and 61:
HIV and HIV households respectively
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for non-HIV households in urban are
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higher than for HIV households, aga
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and care of the sick. Notably, the
Page 68 and 69:
Table 4.8 Change in sectoral distri
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Table 4.11 Loss of income of HIV an
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cultivation and non-agriculture sel
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Table 4.14 Average number of workda
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clearly from the survey that the im
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Table 5.1 Share of expenditure on s
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When comparing expenditure on educa
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Table 5.3 (Contd....) House rent 23
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Table 5.4 (Contd....) Medical 278 2
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Table 5.4 (Contd....) Other food 3,
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Table 5.5 (Contd....) All Cereals 1
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Table 5.6 Distribution of annual co
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Table 5.6 (Contd....) Education of
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Table 5.7 (Contd....) HIV household
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Table 5.8 Per capita item-wise annu
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Table 5.8 (Contd....) Total 6,363 7
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urban areas allocate only around 63
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Table 5.11 (Contd....) HIV househol
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noted that this is not to be compar
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The head count ratio for HIV househ
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Table 5.16 Consumption poverty in t
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They may be pushed into poverty due
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Both the average household and per
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Chapter 6 Impact of HIV and AIDS on
Page 116 and 117:
Table 6.1 Ever and current enrolmen
Page 118 and 119:
persons in third or fourth stage. A
Page 120 and 121:
substantial gender gap in both ever
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children belonging to HIV household
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medium school to a Kannada medium g
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Box 4 Case Study 4: Grooming grandm
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Chapter 7 Impact of HIV and AIDS on
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clinical stages based on the infect
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By sex Table 7.4 Frequency of illne
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Table 7.7 Illness episodes receivin
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Box 5 Case Study 5: Hoax Cure: The
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Table 7.12 Frequency of hospitalisa
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Table 7.15 Distribution of hospital
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tried to find out how the HIV-affec
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Box 6 Case Study 6: ART still a far
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Chapter 8 Stigma and Discrimination
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men under this is lower (40%). Arou
Page 150 and 151:
family members as seen in the surve
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causes for the spread of the infect
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Table 8.6 Stigma and discrimination
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Box 7 Case Study 7: Stigma at the w
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not have visited health facilities
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Table 8.10 Distribution of PLWHA re
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Table 8.11 Distribution of responde
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Table 8.13 Distribution of responde
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tests and those who test positive a
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The surveillance data indicates tha
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Table 9.2 Details about caregivers
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Table 9.3 Gender differences in pre
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A very high percentage of women had
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Fifty-two percent of the men knew w
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Table 9.4 Profile of HIV-positive w
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for the sick, bringing up children
Page 182 and 183:
The combined impact of lower income
Page 184 and 185:
In addition to the scaling up of na
Page 186 and 187:
References Arndt, C. and J. D. Lewi
Page 188 and 189:
Fredland A. Richard, “AIDS and De
Page 190 and 191:
Saseendran Pallikadavath and Stones
Page 192 and 193:
Appendices
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Socio-economic impact of HIV/AIDS o
Page 196 and 197:
1.16 Did your household change the
Page 198 and 199:
Codes: Marital status Relationship
Page 200 and 201:
Study Number 0 2 5 State Type of Ho
Page 202 and 203:
Fan 207 Bicycle 208 Radio/Transisto
Page 204 and 205:
III Other annual consumption expend
Page 206 and 207:
Reasons for non-enrolment (5.3): Ch
Page 208 and 209:
Study number 0 2 5 State Type of ho
Page 210 and 211:
Study Number 0 2 5 State Type of Ho
Page 212 and 213:
Part II: Details about PLWHA (Inter
Page 214 and 215:
8.13 If unmarried, do you intend to
Page 216 and 217:
Study Number State Type of Househol
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9.18 If yes, specify the form of em
Page 220 and 221:
Study number State Type of househol
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Codes: Reasons for no treatment Ill
Page 224 and 225:
Study Number State Type of Househol
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If the Caregiver is an household me
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12.9 If yes, by whom? a) Husband-1
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21 Breathing problems/breathelessne
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Socio-economic survey of households
Page 234 and 235:
Page 236 and 237:
Section 3: Prevalence of acute and
Page 238 and 239:
4B. Household savings, borrowings a
Page 240 and 241:
Page 242 and 243:
Page 244 and 245:
5.12 Do you think education improve
Page 246 and 247:
Codes: Paid Work outside home-01 Pa
Page 248 and 249:
Page 250 and 251:
8.12 Do you know anyone who had die
Page 252 and 253:
Code list Codes for nature of illne
Page 254 and 255:
250 Socio-Economic Impact of HIV/AI
Page 256:
This study highlights the socio-eco
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