Socio-Economic Impact of HIV and AIDS in India31 Dec 2006
The Socio Economic Impact of HIV and AIDS in Andhra Pradesh, Karnataka, Maharashtra, Manipur, Nagaland, Tamil Nadu.
HIV and AIDS are a serious challenge for the developing as well as the developed world. India, with an estimated 5.206 million people living with HIV in 2005, accounts for nearly 69 percent of the HIV infections in the South and South-East Asian region. This is despite it being a low prevalence country with an overall adult HIV prevalence rate of 0.91 percent.
India has six high prevalence states - Andhra Pradesh, Karnataka, Maharashtra, Tamil Nadu, Manipur and Nagaland. Of these six states, Andhra Pradesh has recorded the highest prevalence of two percent among the antenatal clinic attendees and 22.8 percent among STD clinic attendees in 2005.
Socio-economic impact analysis Globally, the adverse socio-economic impact of HIV and AIDS is visible at the household, sectoral, and at the macro level. Given the low overall HIV prevalence in India, there has not been any significant effort to study the impact comprehensively. Focus so far has been on studying the impact at the level of the individual and the households.
A comprehensive ‘Socio-Economic Impact of HIV and AIDS’ study, was sponsored by UNDP and NACO, and undertaken by NCAER. This study assessed the impact of HIV at the level of households using household survey. It also assessed the impact on select sectors (industry, agriculture, health and tourism) and made projections of likely impact at the macro level using CGE modeling. The findings at the household level, which are reported in this volume, were based on analysis of data from an independent primary survey conducted by NCAER in the six high-prevalence states. The survey was supplemented with information gathered through focus group discussions and case studies.
The unique aspects of the study include the large sample size- almost 8,000 households – and the comprehensive nature of the analysis which ranges from the economic impact in terms of consumption, savings and health costs to the impact on education, health and level of stigma and discrimination. The findings of such can studies contribute to effective and evidence based planning. This study is especially well timed because its findings can enrich the third National AIDS Control Programme, which is currently being finalised.
Executive Summary xx Socio-Economic Impact of HIV and AIDS in India Data and methodology For every HIV household surveyed in a village/urban block, three non-HIV households belonging to similar socioeconomic strata were interviewed. This ratio was chosen to reduce the variance in the non-HIV sample and select a large number of households with matching characteristics to each HIV household. This ratio was also influenced by budgetary considerations.
Overall, the sur vey covered 2,068 HIV households and 6,224 non-HIV households spread over the rural and urban areas of the six HIV highprevalence states .The number of PLWHA interviewed was higher at 2,385, since wherever there were more than one adult PLWHA in a family, an additional person was interviewed. The number of female and male respondents, were 1,043 and 1,342 respectively.
The challenge of conducting a survey of this nature lies in identifying Persons Living with HIV and AIDS (PLWHA) and securing their consent for an interview. The list of PLWHA attending VCTC at government hospitals was not provided to the NCAER team for reasons of confidentiality and to respect the rights of the PLWHA. Keeping in mind the ethical issues and the directions of the Institutional Review Board at NCAER, support was enlisted from the counsellors of the State AIDS Control Societies and representatives of the NGOs working in this field. By virtue of working with the PLWHA directly, the counsellors and NGOs were sensitive to their needs and were also able to gain the trust of the PLWHA. Moreover, they were also well qualified for conducting the interviews.
These counsellors and NGOs approached the HIV households with whom they were in touch and conducted the interviews subsequent to receiving consent from the PLWHA.
For the larger states such as Andhra Pradesh, Karnataka, Tamil Nadu and Maharashtra, 400 HIV households were drawn per state. Since Nagaland and Manipur are smaller states, 450 HIV households were drawn for both states. For the non-HIV households, a listing of households in the locality/village was used to select the sample. A maximum of 150 households were listed in each selected village and in urban areas, around 100 households were listed in each block.
Nine case studies and six Focus Group Discussions (FGDs) were conducted in order to collect information that would supplement the findings of the quantitative survey. The six FGDs (one FGD in each state) were conducted with the members of the Network of Positive People. While the case studies helped in capturing problems like stigma and discrimination, the findings from FGDs were useful in confirming quantitative findings and to further analyse data from the household survey.
Profile of the sample The sample mostly included households that had low income and educational levels. Though the HIV and non-HIV households shared similar socio-economic characteristics, in comparison, the non- HIV household heads were better educated and also had a marginally high average annual income. The average annual household income was Rs. 47,260 for the sample HIV households in comparison to Rs. 48,900 for the non-HIV households. In terms of education, 27.8 percent of heads of the HIV households were illiterate as compared to 19.9 percent of the heads of