South African HIV patients receiving antiretroviral therapy (ART) in the public sector treatment programme experienced nearly complete recovery of employment, a University of KwaZulu-Natal study involving 30 000 people aged between 18 and 59 over a 10-year period has found.
The study, conducted by researchers at UKZN’s Africa Centre for Health and Population Studies, was published this week in Health Affairs, a leading health policy journal.
Four years after initiation of antiretroviral therapy, employment among HIV patients had recovered to about 90 percent of baseline rates observed in those same patients three to five years before they started treatment. Many patients initiated treatment early enough so that they were able to avoid any loss of employment due to HIV.
“This study provides some of the strongest evidence yet of the large economic benefits that South Africa’s treatment programme has had for people with HIV and their households,” said the study’s lead author, Jacob Bor of the Africa Centre and Harvard School of Public Health in the US.
The study took place among a community in the Umkhanyakude District of northern KZN. Ten years of socio-economic data was collected on these people from 2001 through 2010 by the Africa Centre, as part of its ongoing population and health surveillance programme. The community where the study took place is rural, and has a high HIV prevalence (28% of adults) and high unemployment.
Since 2004, more than 2 000 adults in the study initiated antiretroviral therapy in the government HIV treatment programme that serves the community.
“Because of the unique data collected by the Africa Centre, it was possible to measure changes in employment among HIV patients relative to levels of employment in these same patients, years before job-threatening HIV illness and the decision to seek care. This critical baseline had eluded previous clinical studies.”
The researchers were also able to adjust for changes in local economic opportunities over time, and observe employment even for non-resident household members who migrated temporarily for work.
“As this study shows, the economic benefits of ART are very large. In South Africa, where three million people are expected to be on ART by 2020, these benefits will be widely enjoyed,” said Professor Till Bärnighausen, Senior Epidemiologist at the Africa Centre, Associate Professor at Harvard School of Public Health, and the study’s senior author.
Patients in the study who lost work before starting ART experienced long jobless spells, over three years on average. However, the researchers found that these patients fared no worse than other community members in returning to work after job loss.
“We expected that obstacles such as incomplete health recovery, treatment side effects, barriers to labour migration, and discrimination would disadvantage HIV patients on ART in returning to work,” Bor said.
“However, we found that in cases of job loss, 90 percent of time out of work for HIV patients could be explained by factors faced by similar workers in the general population.”
“By and large, HIV patients receiving ART are able to work – if there are jobs available. Much larger economic benefits of HIV treatment will be possible, with greater employment opportunities for all South Africans,” Bor said.
“Our findings indicate that job creation efforts should be sensitive to the needs of people with HIV on ART, but should not prioritise people with HIV over the general population.”