AIDS,longevity and long-run income

This article studies the long-run impact of HIV/AIDS on per capita income and education. We focus on the disincentive to human capital accumulation given by shorter life span. We work with a continuous time overlapping generations model with education and saving decisions, calibrated for a cross-section of countries. The simulations predict that the most affected countries in Sub-Saharan Africa will be in future, on average, 20% poorer than they would be without AIDS. Schooling will decline in some cases such as Botswana, South Africa and Zambia by more than 40%. The impact of population decline was found to be irrelevant.     

THE ECONOMIC IMPACT OF HIV/AIDS ON SMALL,MEDIUM AND LARGE ENTERPRISES1

Based on the Bureau of Economic Research (BER's) 2005 HIV/AIDS survey, this paper provides a snapshot view of the nature and the extent of the impact of HIV/AIDS on companies of different sizes in South Africa, as well as their response to the epidemic. Whereas the focus of most of the previous workplace surveys has been on “evaluating workplace responses”, the present study also considers the economic impact of HIV/AIDS. This study provides evidence of the impact of HIV/AIDS on the largest sample of small, medium and large companies in South Africa to date. The survey results suggest that employer responses are strongly linked to company size, with the majority of medium and large companies indicating that they have an HIV/AIDS policy in place and small companies having done little in the way of action against the epidemic.     

Relational Co-ordination and Stigma at Work: How Frontline Employees Compensate for Failures in Public Health Systems

Co-ordinating collective work and communicating a shared understanding of tasks is necessary to accomplishing organizational goals. Stigma could exacerbate co-ordination challenges between public and private organizations by further widening differences in goals and incentives among employees. Using relational co-ordination theory, we explore how stigma can influence employee behaviour in the context of healthcare delivery. We study healthcare professionals and frontline workers involved in the fight against AIDS in India to examine how public health systems fail due to a lack of communication and co-ordination, and that these failures are worsened by stigma. When stigma is present, relationships between employees become strained due to misaligned work routines, lack of information sharing and cooperation failure. Our findings reveal emergent responses from frontline employees that mitigate co-ordination failures through: (1) role adaptation to improve predictability of tasks; (2) social purpose identification to promote a common understanding and engage stigmatized clients; and (3) affective attachment that encourages extra-role behaviours and task ownership. We draw implications for relational co-ordination and stigma, as well as public-private co-ordination in public health systems.     

The South African disability grant: Influence on HIV treatment outcomes and household well-being in KwaZulu-Natal

This paper explores the implications of the disability grant for household members' well-being and adults' success on ART (antiretroviral therapy). It uses case studies based on data from an in-depth qualitative study of 10 households in KwaZulu-Natal. Receipt of the disability grant ensured that the basic needs of the HIV-infected adult could be met by other household members, especially when the grant was received when the person first met the qualifying criteria and in conjunction with ART. Where treatment was effective, HIV-infected adults were able to make substantial contributions to the well-being of other members in addition to the financial support provided by the grant itself. Thus, early access to financial support in conjunction with commencing ART may lead to improved health outcomes and reduce poverty and vulnerability associated with illness in poor households. This synergistic relationship between social welfare and treatment may in turn contribute to greater cost-efficiency.     

Cost-effectiveness of a chronic pain intervention for people living with HIV (PLWH)

Background: Chronic pain is a common, disabling, and costly comorbidity, particularly in people living with HIV (PLWH). This study developed and pilot tested a pain self-management intervention for chronic pain tailored to PLWH called Skills TO Manage Pain (STOMP).

Objectives: Given the additional resources needed to deliver STOMP in HIV clinical settings, an important objective of the pilot study was to assess not only STOMP’s preliminary efficacy, but also its cost-effectiveness.

Research design and subjects: The present study draws from a 44-participant, 2-arm randomized pilot trial of the STOMP intervention vs usual care among PLWH and at least moderate chronic pain (Clinicaltrials.gov: NCT02824562). Cost-effectiveness is presented as the incremental cost-effectiveness ratio (ICER). Costs were considered from the clinic perspective over a 1-year time horizon using real costs from the pilot trial. It was conservatively assumed there would be no costs savings. The Standard Gamble (SG) method was used to directly measure utilities.

Results: Thirty-six participants met inclusion criteria for the present analyses. Mean age was 52 years; 61% were female and 86% were black. The total cost of STOMP was $483.83 per person. Using the SG method, the change in QALYs was 0.15, corresponding to an ICER of $3,225.

Conclusions: STOMP’s cost/QALY is substantially lower than the $50,000 to $100,000/QALY benchmark often used to indicate cost-effectiveness. Although based on a pilot trial and, therefore, preliminary, these findings are promising, and suggest the importance of cost analyses in future STOMP trials.     

HIV病毒检测服务利用中的感知风险问题

对于HIV检测的服务利用,目标人群会主观上感知到许多风险,这些风险是阻碍服务利用的重要因素。本文基于消费行为理论和感知风险理论,对HIV检测中感知风险的产生、发展和内容进行深入分析和理解,从而为改善HIV检测服务、促进服务利用提供参考和建议。     

Targeting interventions to high-risk populations: Benefits and costs

Targeting prevention interventions to high-risk populations may increase intervention benefits, but identifying and/or finding the high-risk populations may increase intervention costs. We explore the costs and benefits of targeting in the context of human immunodeficiency virus (HIV) prevention in high-risk injection drug users (IDUs). Focusing interventions on such a population should maximize the number of HIV infections averted. Recruiting high-risk IDUs for such interventions, however, may be more difficult and costly. We base our analysis on an earlier model that determines the allocation of resources to two interventions, street outreach and methadone maintenance. The model seeks to minimize HIV incidence in a population of heterosexual IDUs and their non-injecting sex partners. We conclude that while targeting an inexpensive intervention like street outreach rarely proves to be cost-effective, even a costly targeting effort can increase cost effectiveness for an expensive, effective, narrowly focused intervention such as methadone maintenance.     

Using the travel cost method to value visits and stigma in connection with ARV adherence in Uganda

This article uses the travel cost method to value both client visits to collect antiretroviral therapy (ARV) and stigma, which prevents ARV adherence. Using a representative sample for Uganda initiated specifically for this study, we found a willingness to pay (WTP) valuation for visits made in the range of US$14–US$17 and a willingness to accept (WTA) valuation of US$25 for visits missed. The valuations for stigma based on a novel measure of stigma using a new estimation method were close to the valuations for visits. These valuations can be used to estimate the benefits to carry out cost–benefit analyses (CBAs) of interventions aimed at increasing ARV coverage and adherence.     

HIV infection and economic growth

This paper presents an endogenous growth model based on a simplified ‘learning by doing’ model. In this model, a negative shock, namely HIV infection, leads to a stationary active population. We show it is possible to neutralize the effects of the HIV shock while at the same time insuring steady economic growth. However, this result vanishes in the absence of a policy to fight against the HIV shock. Further, an increase of the HIV infection rate negatively affects the growth rate of the economy. This last finding implies that a high and sustainable economic growth rate is incompatible with a high incidence of HIV infection of the active population.