The demographic and socioeconomic consequences of HIV/AIDS

We quantify the impact of adult deaths from AIDS, and from other causes on household economic wellbeing, using a large longitudinal dataset spanning more than a decade. Verbal autopsies allow us to distinguish AIDS mortality from that of other causes. We find that households in which members die of AIDS are systematically poorer than other households, measured using members’ educations, household assets, and self-assessed poverty. The timing of the lower SES observed for these households and their AIDS deaths suggests that the socioeconomic gradient in AIDS mortality is being driven primarily by poor households being at higher risk for AIDS, rather than AIDS impoverishing the households. Moreover, we find, using reports on asset holdings and households’ self-reports of poverty, that households that experience a death from any cause are systematically poorer following a death. Funeral expenses born by the deceased’s household can explain some of the impoverishing effects of death in the household. The scale-up of antiretroviral therapy (ART), late in our study period, has begun to change the age profile of mortality in the study area. However, to date, ART has not changed the socioeconomic status gradient observed in AIDS deaths.

Recent studies suggest a rapid change in fertility preferences among young adults across sub-Saharan Africa. In this study, we examine the sensitivity of Malawians’ fertility preferences to a variety of hypothetical (but common) events that may alter fertility preferences and intentions. Using new data from the Tsogolo la Thanzi (TLT) study in southern Malawi, we analyze expected changes in desired number of children (quantum) and the pace of childbearing (tempo) in response to this variety of events. We further employ the Coombs scale, a measure of underlying family size preferences, to predict the direction of both dimensions of fertility preferences. To measure tempo change, the survey questions respondents about their preferred timing to next birth. We find 1) that both the quantum and tempo dimensions of fertility preferences are most responsive to AIDS-related conditions and 2) that young adults’ preferences are relatively impervious to changing economic conditions and family issues. Our results indicate that the generalized AIDS epidemic in Malawi is critically important for understanding young people’s fertility preferences and, ultimately, their behaviors.

The link between HIV infection and poverty has attracted considerable research attention in recent years, but the relationship is rather complex and findings from existing studies remain inconclusive. While some argue that poverty increases vulnerability, existing empirical evidence from sub-Saharan Africa largely support the view that wealthier men and women, especially rural residents, have higher prevalence of HIV. In this paper, we focus on urban/rural differentials in the association between HIV infection and poverty in Kenya. The study is based on secondary analysis of data from the Kenya Demographic and Health Surveys conducted in 2003 and 2008. We apply multilevel logistic regression models, allowing the poverty risk factor to vary across rural and urban communities (i.e. clusters) in Kenya. The results suggest that the urban poor in Kenya have significantly higher odds of HIV infection than their urban non-poor counterparts, despite poverty being associated with a significantly lower risk among rural residents. Interesting urban/rural differentials are observed in poverty risk factor by key demographic and socio-cultural characteristics, including gender disparities and ethnicity. For example, the rich-poor gap among urban residents is wider for women, with poor urban women being particularly vulnerable.

The objective of this study focuses linking available routine and non-routine HIV and AIDS data, examine performance and identify gaps. Lagos state has a population of 17, 297,025 with growth rate of 4.6%. (DPRS, 2010). It is commercial nerve center linking four countries of Benin Republics, Togo, Cameroon and Chad. Currently, the state HIV prevalence is 5.1% compared with national 4.1% and is experiencing generalized epidemics as the infection cut across general and MARPs. The prevalence of LGA includes Badagry 8.3%, Surulere 7.3%, Lagos Island 6.3%, Ikeja 3.3%, Epe 2.7%, Ijede 1.3% and Agbowa 1.3% respectively (ANC, 2010). The prevalence of young age 15-24 years is 2.7%. The antenatal coverage is 420,448 in the state (NNRIMS data 2011). HIV prevalence among most at risk population (MARPS) showed that MSM 15.8%, non brothel female sex workers (13.0%), brothel based female sex workers (12.1%), IDUs (3.0%), Armed forces (2.6%), Police (2.1%) and Transport Workers (0.9%) (IBBSS, 2010). There is need for HIV/AIDS integrated focused interventions in general population and most at risk population in the state.

Background. The main aim of survey in 2010-2011 was to gather information about the problems of people living with HIV (PLHIV) in Russia.
Methods. The sample size was 660 people living with HIV aged 18 and over in 11 major towns in Russia. PLWHIV were involved in conducting of survey at all stages.
Results. 35 % of respondents encountered any form of discrimination or stigmatisation due to HIV status . 21 % encountered some form of discrimination from organisations or. 78 % of PLWHIV experienced negative feelings towards themselves. Human rights of 12 % had been violated, 28 % could not say with certainty whether their rights had been violated or not. Only 18 % of those whose rights had been violated, took some kind of action to protect them. 60 % made the decision to be tested for HIV independently and voluntarily. 43 % did not receive any kind of pre – and post testing counselling. 36% say that public health workers displayed discrimination . 23% had received advice from public health workers not to have children at least once since their diagnosis of HIV was confirmed. 4 % of survey participants mentioned that healthcare workers had forced them to have a sterilisation.
The survey became an instrument for protecting the rights of people living with HIV. The results were presented and discussed at the State Duma hearings

The number of People Living with HIV/AIDS (PLWHA) in Nigeria is among the highest in sub-Saharan Africa. Escalating number of PLWHA in Nigeria demands for more number of caregivers. The information on perception of women on Willingness to Give Care (WGC) to PLWHA is insufficient in Nigeria, hence this study. The study utilized NDHS 2008 dataset with focus on women aged 15-49(n=27,195). Analysis was done using Chi-square and logistic regression models. Mean age of the women was 28.79±9.4years. The prevalence of women who were WGC to PLWHA was 65.4% with urban women (70.8%) WGC to PLWHA than their rural counterparts (61.9%;p<0.05). WGC to PLWHA increases with increasing level of education (p<0.05). The higher the level of wealth index, the higher the percentage of women who were WGC to PLWHA. Women who knew someone who had died of HIV/AIDS (82.8%) were WGC than those who did not (62.8%;p<0.05). Female youths (15-24 years) were more likely (OR=1.1,C.I=1.07-1.23) not Willing to Give Care (NWGC) to PLWHA than older women. Agreeing that PLWHA should be ashamed of themselves (OR=2.8,C.I=2.60-2.90) inhibits NWGC to PLWHA than disagreeing. The odds of NWGC to PLWHA was strikingly lower among women residing in the Northern Nigeria (OR=0.30,C.I=0.28-0.33) than South.

Using primary data, the study analysed the gender-wise impact of HIV/AIDS on socio-economic consequences of households in Puducherry region, union territory of Puducherry, South India. To better understand the impact of the disease, the study compared the changes in household economic conditions both at the time of interview and at the time of detecting HIV, i.e., ‘impact time’. Further, the most visible economic impact of HIV/AIDS related illness being on the household finances, the study also examines both direct and indirect costs of the disease. The results revealed that more male and female respondents are concentrated in high risk occupations at the time of contracting HIV, compared to females, more males are in advanced stage of the disease. Regardless of gender, their standard of living (SLI) and employment had significantly lower when compared to their SLI and employment before HIV detection. Among the currently employed respondents, females reported more number of workdays lost but the income lost by them is half lower than that of their male counterparts. The mean number of illness in the month preceding the survey was significantly higher for symptomatic than for the asymptomatic patients. But, there was no significant difference in direct and indirect costs of morbidity between the groups.

Sullivan,Rachel (Dept Demography, U Califonia, Berkeley 94720-2021 [e-mail:rachsull@demog.berkeley.edu]), Competing Pressures:Predicting Population Policy Adoption in sub - Saharan Africa.

Why did pronatalist African countries adopt grownth limiting population policies? This paper uses a country - level data set i constructed for the period 1985 - 1999 to predict which sub - Saharan African countries adopted national population policies, & when? Using a variety of analytic techniques ( geographic comparison, logistic regression & event - history analysis, 2) politically "weaker" countries were somewhat more likely to adopt policies, & 3) countries experiencing demo graphic pressure were also more likely to adopt policies.
I conclude that policy adoption occurred at the nexus of internal & external pressure.

Consent rates for HIV testing in population surveys are often low, which may cause a bias in prevalence estimates if refusal to test is correlated with HIV status. Interviewer identity represents a plausible variable that affects testing, but not HIV status, and can be used in a Heckman-type selection model that provides consistent prevalence estimates. We innovate by adopting an interviewer random effects estimator which improves on the existing interviewer fixed effect approach in three respects. Firstly, using our model allows the effects of interviewer identity to be estimated even for those whose interviewers conducted a small number of interviews. Secondly, this methodology facilitates the use of bootstrapped standard errors which are necessary to correct for regression parameter uncertainty in the correlation between consent and HIV status. Thirdly, we propose a Bayesian model averaging approach that gives estimates that are consistent and unbiased. We report results for Zambia and Ghana. For Zambia we estimate a prevalence rate of 32% among males who refuse consent compared with 12 % among those who agree to test, substantially increasing the estimated population prevalence rate.

In this paper an attempt has been made to study the socio-economic attributes of the HIV positive cases in Mizoram- a state in India located close to the ‘Golden Triangle’. Vulnerability to HIV/AIDS in the state increases due to state’s geographical proximity to international boundary (Bangladesh in the West and ‘Golden Triangle’ – Myanmar, Thailand and Laos in the East), where there is high incidence of HIV/AIDS and the region which traditionally offers passage to drug and heroin. The study takes into account the demographic background of the infected persons including their age, sex, marital status as well as their family, educational status and religious persuasion etc. Their economic status and the mode of contracting the infection, level of awareness etc constitute the other aspects. The study through personal interviews of some 30 odd infected persons also investigates into the consequences they face in the society in terms of reaction of the family, discrimination faced etc.