The economic burden of HIV and AIDS on households in Nigeria

The study estimates the economic burden of HIV and AIDS on households in a Nigerian population. The data derive from a cross-sectional survey of households affected by HIV or AIDS in Ife-Ijesa Zone, Osun State, Nigeria. The sample consisted of 117 purposively selected, consenting adult HIV patients attending a general and teaching hospital. Participants were asked to self-report monetary expenses for HIV-related care, loss of savings, and funeral costs. The data show a significantly sharp drop in the participants' household income as a result of care for HIV-related illnesses, from the time of knowing one's HIV status to the time of illness, among three occupational categories (artisans, civil servants and unemployed; p = 0.02). Mean income among those in the unemployed category fell by 84.1%, income among artisans dropped by 72.6%, and income among civil servants decreased by 44.4%. The monetary loss during the course of HIV-related illnesses was heaviest for the artisan group, followed by the unemployed and the civil servants. Those who had lost a substantial part of their savings to HIV-related care were most numerous among the unemployed, followed by artisans and civil servants. Out of 16 households, 11 (42.3%) had received support from relatives during a funeral ceremony. There was a significant association between the occupational group and working for more hours after illness (χ² = 9.28, df = 4; p = 0.05). Nearly all orphaned children were distributed to the extended family following the AIDS death of a parent. Among all the occupational groups, borrowing from a cooperative society during the course of HIV-related sickness was the commonest form. The findings add to data showing that despite the extended family support system, adult deaths due to AIDS continue to undermine the viability of sub-Saharan African households.     

‘Deadly gonorrhoea’: history,collective memory and early HIV epidemiology in East Central Africa

According to the Department of Social Development, disability grants are available to adult South African citizens and permanent residents who are incapacitated and unable to work due to illness or disability. A number of people living with HIV/AIDS (PWAs) have accessed disability grants once they have fulfilled the criteria set down by the Department of Social Development. Current government policies entitle PWAs, a least in theory, to access antiretroviral medications. Where PWAs have been able to access antiretroviral treatment (ART) through the government's antiretroviral programme, this has led to an improvement in their health and subsequent disqualification for a disability grant. In South Africa's highly unequal society, the disability grant often operates as the only source of income for poor families. This has created an untenable situation as many PWAs are forced to choose between receiving their disability grant and accessing life-saving medication. We explore the intersection of social security with access to ART and argue that it presents complex problems in the context of HIV/AIDS, and thus requires urgent debate and resolution. Potential solutions to this problem, including the provision of a basic income grant to all South Africans, are proposed.     

The Cost Effectiveness of Laparoscopic versus Open Gastric Bypass Surgery

Background: Over the last decade, laparoscopic gastric bypass (LGBP) has been proven to be a safe and well-tolerated approach to the Roux-en-Y gastric bypass, despite its increased cost when compared to the open approach (OGBP). This increased expense has led many to question whether LGBP is a cost effective alternative to OGBP. The aim of this study is to determine which approach is most cost effective, considering costs associated with the operation itself, perioperative complications, and income lost during convalescence. Methods: A PubMed search of the National Library of Medicine online journal database was conducted. Studies that met predetermined criteria for selection were included in the analyses of patient demographics, perioperative complications, length of hospital stay, excess weight loss, and time to recovery. Data on 6,425 OGBP and 5,867 LGBP patients were used to compare the outcomes associated with each approach. Results: Significant differences were found in the perioperative complication profiles, time to recovery, and overall expense of the two approaches. OGBP was associated with an increased incidence of major perioperative complications, especially extraintestinal complications, and greater perioperative mortality. LGBP was associated with shorter hospital stays, increased incidence of intestinal complications, and a 2.25% incidence of conversion to OGBP. Patient demographics and percent excess weight loss (%EWL) at 3 years follow-up were found to be similar with both OGBP and LGBP. Conclusion: LGBP is a cost effective alternative to OGBP for surgical weight loss. Despite the increased cost of LGBP, patients suffer fewer expensive and lifethreatening perioperative complications.