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United Nations Development ProgrammeChinese Center for Disease Control and Prevention

National Center for AIDS/STD Control and PreventionAnd

Beijing Institute of Information and ControlJuly 2010

Socio-economic impact of HIV at the household levels in China: the results

from a five-province study

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Team Leaders: Liu Kangmai Yuan Jianhua Edmund Settle

Research Team Members:Xu Xiyang Jiang Siyu Jiang Tao Deng Yuchen, Xia Zhiyong Wang Qiang Lin Dan Mao Tian, Pu Hongbo Gao Yuhua Jiang Xiaopeng

Technical Support:Dr. Basanta K. Pradhan G. Pramod Kumar

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Outline

Background

Introduction

Main findings

Recommendations

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• Reported cases by end of 2009: 326,000, mostly in rural areas

• Estimated PLHIV: 740,000 (by end of 2009)

• Overall prevalence low, but severe concentrated epidemics among MARPs and in certain pockets

• Started to spread from MARPs to the general population

• Need for strategic information for policies and programmes on impact mitigation

Background

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Field survey in five provinces(1)

• Objective: Assess SE impact of HIV at individual and household levels and advise impact mitigation steps

• Study period: Feb. 2008 to Jan. 2010

• Locations: Five high HIV prevalence provinces - Yunnan, Guangxi, Sichuan. Hubei and Shanxi.

• Partners: Office of HIV/AIDS Prevention and Treatment of Yunnan province; Centers for Disease Control of Guangxi, Sichuan, Hubei and Shanxi provinces; Red Ribbon Home (Yunnan); Liuanhuaming Group (Sichuan); Libaqiang Group (Shanxi)

• Methodology : Quantitative and Qualitative - questionnaire surveys, FGDs, in-depth interviews, case studies

Introduction

Sampling & limitationsSampling: multi-stage and systematic

Selection of the control group: households in the neighbourhood of PLHIV-respondents with similar socio-economic background

Sample size: 931 HIV households (1027 PLHIV, 654 males and 373 females) and 995 non-HIV households (472 males and 523 females)

Limitations: MARPs not included, hence impact on them not assessed; study not longitudinal, hence impact over time unable to capture; mitigation by existing Govt/NGO assistance reduces the apparent impact; possible recall errors

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Impact on income and employment

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Impact on income and employment

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Impact on consumption

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Stigma and discrimination

Community Health facilities School

Not disclosed 50.6% 29.7% 89.9%Disclosed 49.4% 70.3% 10.1%

Among disclosed, reporting discrimination 34.5% 13.2% 79.2%

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Impact on education

Household income (Yuan)

Enrollment ratio of children aged 10-14HIV

HHs(%)Non-HIV HHs(%) Chi-square P

0-9,999 82.8 98.9 186.325 0.0000-4,193 71.0 100.0 129.838 0.000

10,000-19,999 97.5 93.3 12.781 0.00020,000-29,999 97.6 100.0 9.442 0.00230,000-39,999 100.0 100.0 --- ---40,000+ 100.0 100.0 --- ---Total 88.9 97.2 144.690 0.000

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Impact on education

Gender Drop-out rate of children aged 10-14(%)HIV HHs Non-HIV HHs

Boy 7.7 4.4Girl 13.8 0.9Total 11.1 2.8

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Impact on women time use pattern

0

5

10

15

20

25

Mal e Femal e Mal e Femal eNon- HI V househol d members PLHI V

Work t i me House work t i me Non- worki ng t i me

hours

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Gender and health-seeking behavior

Level of hospital

PLHIV(%) Non-HIV HHs (%)

Male Female Male Female

Village 29.2 42.9 53.5 53.1Town 27.4 16.0 23.2 19.5County 33.4 32.2 12.6 15.9City 5.3 3.0 3.9 4.1Others 4.7 5.9 6.8 7.5

Male(RMB)

Female(RMB)

Male(RMB)

Female(RMB)

Village 131 225 85 286Town 652 168 423 632County 1,204 493 1,126 589City 1,139 800 4,241 1,144Others 584 564 48 114Total 700 326 460 426

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Coping mechanisms

Coping mechanisms HIV HHs(%) Non-HIV HHs(%)

Borrowings from relatives and friends 60.7 66.7Usury 2.0 4.3Borrowing from small financial institutions 9.0 9.0Savings 25.5 32.7Medical insurance 14.5 14.0Liquidation of assets 10.9 5.2Spouse has to go out to work 9.1 5.9Children have to go out to work 8.0 9.3

Have to do additional work 8.5 9.7

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Social securityPercentage of households who received support

Average amount of support

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The expansion of anti-discrimination education and its integration into all IEC activities should be a high

SE impact mitigation of PLHIV-households should be part of the national AIDS strategy

Combine various efforts to provide day-to-day support to PLHIV- households, especially those with single parents, widows and elderly.

Initiate targeted measures to reduce vulnerability of women to HIV and the impact on women living with HIV.

Recommendations

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The social safety net for PLHIV and their families should be integrated into broader and well funded national safety net programs. It will not only help PLHIV, hut also will allow the government achieve greater impact and equity. Specifically;

Efforts to improve medical care for PLHIV should focus on integrating their needs into new social insurance initiatives ; the RCMS in rural areas; and basic medical insurance and others in urban areas.

Life support for PLHIV should be incorporated into broader existing government support programs by advising the MLSA to cover PLHIV.

Income generation activities for PLHIV should be combined with broader anti-poverty and development programs, in order to advance HIV households’ own abilities to cope with the burdens of the disease themselves.

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Thanks!