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01 December 2011
Large number of HIV-affected households in Asia on the verge of irreversible poverty: UNDP study
Bangkok, Thailand -- The severe social and economic impact of HIV on the households of people living with HIV in Asia forces a large number of households to adopt coping mechanisms that erode their income, savings, assets and human capital, and push them into irreversible poverty, according to a new report released by the UNDP Asia Pacific Regional Centre based in Bangkok.
Urgent impact-mitigation measures, including HIV-sensitive social protection, are required to arrest this rapid socio-economic decline of tens of thousands of households in the region, the report said.
Within households of people living with HIV, the impact on women is considerably higher.
The report, titled 'Socio Economic Impact of HIV at the Household Level in Asia: A Regional Analysis' based on national studies undertaken by UNDP in partnership with national institutions in Cambodia, China, India, Indonesia and Vietnam over the last six years, found that HIV affects almost all aspects of human life across a spectrum of indicators. All the national studies were case- controlled (compared HIV-affected and non-HIV-affected households with similar socio-economic backgrounds), and together covered 17,000 households and 72,000 individuals.
The most striking finding in all the countries surveyed was that HIV-affected households, which already have a relatively lower asset base, extinguish their savings and liquidate assets far more commonly than the non-HIV-affected households. This trend is particularly prominent in Cambodia, China, Indonesia and India. While most households borrow and end up in debt, many also find it difficult to borrow because of their adverse 'credit-worthiness', as was seen in China. This often forces them to borrow from money-lenders at higher interest rates, pushing them into debt traps.
A common problem that aggravates the financial burden on HIV-affected households and leads to their use of irreversible coping mechanisms is HIV-related catastrophic health expenditure and loss of jobs/unemployment. Except in Cambodia, health expenditure as a percentage of overall consumption is substantially higher in the HIV-affected households compared to the non-HIV-affected households. For instance, the HIV-affected households in India, Indonesia and Vietnam spend three times more on health than non-HIV-affected-households. An illuminating exception, however, is Cambodia, where the HIV-affected-households spend less on health; probably because of the near-universal coverage of ARV (94%). Cambodia is also exceptional in that it has impressive coverage of ARV among women and reported reduced discrimination at health facilities. The rising health expenditures of households lead to compromises on quality and quantity of food consumed (e.g. comparatively poorer protein consumption), particularly among the poorest; as well as compromises in expenditures on education of children. In terms of unemployment, HIV-affected household members in China, Indonesia and Vietnam have lower workforce participation. A large number of them have lost their jobs because of HIV.
“The study clearly demonstrates the severity of the impact of HIV on households and the need for sustainable impact mitigation steps, ideally integrated into the social protection schemes targeted at vulnerable and marginalised populations,” said Mr. Nicholas Rosellini, Deputy Assistant Administrator and Deputy Regional Director, UNDP Regional Bureau for Asia and the Pacific. “Without intervention, many of them will slip into irreversible poverty,” he added.
HIV’s destructive toll on human capital accumulation is evident in the reduced school enrollment and higher drop-outs among the children of HIV-affected households. Children in HIV-affected households in China, India, Indonesia and Viet Nam are less likely to attend school than those in non-HIV-affected households. Children from the poorest households, as well as girls, suffer more. Girls fare particularly badly in terms of school drop-outs as well.
“The answer lies in HIV-sensitive social protection,” said Mr. Clifton Cortez, Regional Practice Leader for HIV, Health and Development, at UNDP’s Asia Pacific Regional Centre. “It’s a question of tailoring social protection initiatives so that they address the socio-economic vulnerability of HIV-households,” he added. “Countries such as India provide brilliant examples of HIV-sensitive social protection”.
The report also notes high levels of internal stigma and discrimination in all spheres of life, including relative to community and state institutions, employment, as well as domestic and social spaces. The nature of discrimination varies but the most common are discrimination at workplace and health facilities, as well as social isolation, verbal abuse, and physical harassment.
A gender disaggregated analysis of the data shows that within the affected households, the impact on women is considerably higher – whether it is the economic and household burden, access to services including ARV, discrimination and violence against them, or education. The gender disaggregated analysis is presented as a separate report, released along with the main report today.
The reports may be downloaded here:
For more information:
In Bangkok, G. Pramod Kumar and Kazuyuki Uji Tel. +66 (2) 304-9100 ext 2676
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