Social Grants, Welfare, and the Incentive to Trade-Off Health for Income among Individuals on HAART in South Africa

Venkataramani, Atheendar S.; Maughan-Brown, Brendan; Nattrass, Nicoli; Ruger, Jennifer Prah

doi:10.1007/s10461-009-9642-y

Cited by 12 publications

(10 citation statements)

References 22 publications

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“…However, the survey data did not indicate that PLHIV would choose poor health over grant loss. In the KSPS, not a single individual indicated that he/she would "stop taking ARVs" to "get (back) (his/her) disability grant" [27]. This finding was further supported by the qualitative findings from this study, although PLHIV certainly felt conflicted about the prospects of losing their disability grant.…”

Section: Resultssupporting

confidence: 60%

The ARV roll out and the disability grant: a South African dilemma?

Paoli

Mills

Grønningsæter

2012

Journal of the International AIDS Society

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BackgroundPrior to the antiretroviral (ARV) drug roll out in 2004, people living with HIV (PLHIV) in South Africa received disability grants when they were defined as "AIDS-sick". In the absence of available and effective medication, a diagnosis of AIDS portended disability. The disability grant is a critical component of South Africa's social security system, and plays an important role in addressing poverty among PLHIV. Given the prevalence of unemployment and poverty, disability grants ensure access to essential resources, like food, for PLHIV. Following the ARV roll out in South Africa, PLHIV experienced improved health that, in turn, affected their grant eligibility. Our aim is to explore whether PLHIV reduced or stopped treatment to remain eligible for the disability grant from the perspectives of both PLHIV and their doctors.MethodsA mixed-methods design with concurrent triangulation was applied. We conducted: (1) in-depth semi-structured interviews with 29 PLHIV; (2) in-depth semi-structured interviews with eight medical doctors working in the public sector throughout the Cape Peninsula; (3) three focus group discussions with programme managers, stakeholders and community workers; and (4) a panel survey of 216 PLHIV receiving ARVs.ResultsUnemployment and poverty were the primary concerns for PLHIV and the disability grant was viewed as a temporary way out of this vicious cycle. Although loss of the disability grant significantly affected the well-being of PLHIV, they did not discontinue ARVs. However, in a number of subtle ways, PLHIV "tipped the scales" to lower the CD4 count without stopping ARVs completely. Grant criteria were deemed ad hoc, and doctors struggled to balance economic and physical welfare when assessing eligibility.ConclusionsIt is crucial to provide sustainable economic support in conjunction with ARVs in order to make "positive living" a reality for PLHIV. A chronic illness grant, a basic income grant or an unemployment grant could provide viable alternatives when the PLHIV are no longer eligible for a disability grant.

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Section: Resultssupporting

confidence: 60%

The ARV roll out and the disability grant: a South African dilemma?

Paoli

Mills

Grønningsæter

2012

Journal of the International AIDS Society

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“…Khayelitsha is one of the largest such settlements in South Africa, with a population exceeding 1 million residents (Brunn and Wilson 2013) who are primarily Xhosa-speaking, black Africans living in informal housing (i.e., shacks) on unserviced land. Unemployment, food insecurity, and subsistence-level poverty rates are extremely high (BeLue et al 2008; Cooper et al 1991; Dewing et al 2013; Muzigaba and Puoane 2011; Pick and Obermeyer 1996; Venkataramani et al 2010). Khayelitsha leads all sub-districts of Cape Town in age-standardized mortality, with the leading causes being HIV/AIDS, homicide, and tuberculosis (Groenewald et al 2010).…”

Section: Methodsmentioning

confidence: 99%

Antenatal depression case finding by community health workers in South Africa: feasibility of a mobile phone application

Tsai

Tomlinson

Dewing

et al. 2014

Arch Womens Ment Health

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Purpose Randomised controlled trials conducted in resource-limited settings have shown that once women with depressed mood are evaluated by specialists and referred for treatment, lay health workers can be trained to effectively administer psychological treatments. We sought to determine the extent to which community health workers could also be trained to conduct case finding using short and ultra-short screening instruments programmed into mobile phones. Methods Pregnant, Xhosa-speaking women were recruited independently in two cross-sectional studies (N=1,144 and N=361) conducted in Khayelitsha, South Africa and assessed for antenatal depression. In the smaller study, community health workers with no training in human subjects research were trained to administer the Edinburgh Postnatal Depression Scale (EPDS) during the routine course of their community-based outreach. We compared the operating characteristics of 4 short and ultra-short versions of the EPDS with the criterion standard of probable depression, defined as an EPDS-10 ≥13. Results The prevalence of probable depression (475/1144 [42%] and 165/361 [46%]) was consistent across both samples. The 2-item subscale demonstrated poor internal consistency (Cronbach’s α ranged from 0.55-0.58). All 4 subscales demonstrated excellent discrimination, with area under the receiver operating characteristic curve (AUC) values ranging from 0.91-0.99. Maximal discrimination was observed for the 7-item depressive symptoms subscale: at the conventional screening threshold of ≥10, it had 0.97 sensitivity and 0.76 specificity for detecting probable antenatal depression. Conclusions The comparability of the findings across the two studies suggests that it is feasible to use community health workers to conduct case finding for antenatal depression.

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“…Multiple and concurrent partnerships, low and inconsistent condom use, alcohol abuse (together termed risky sexual behaviours) and low levels of male circumcision have been shown to be the key drivers of the epidemic. 10,11 While HIV risky behaviours are known to be drivers of the spread of HIV, cognitive factors including perceived susceptibility to HIV, perceived monetary or material benefits of having sex for material gain, self-efficacy and attitudes play a significant role in influencing risky sexual behaviours. 12,13,14 Based on the health belief model, an individual’s personal belief influences their behaviour.…”

Section: Introductionmentioning

confidence: 99%

Cognitive and behavioural determinants of multiple sexual partnerships and condom use in South Africa: Results of a national survey

Manjengwa

Mangold

Musekiwa

et al. 2019

Southern African Journal of HIV Medicine

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Background Human immunodeficiency virus (HIV) risky behaviours including multiple sexual partnership (MSP) and non-condom use (nCU) are known to be drivers of the spread of HIV; cognitive factors including perceived susceptibility of HIV, self-efficacy and attitudes play a significant role in influencing risky sexual behaviours. Objectives We sought to investigate personal beliefs, perceptions, thoughts and actions that are associated with MSP and nCU in South Africa. Methods We analysed nationally representative data from the 2012 National HIV Communication Survey (NCS) that included about 10 000 participants aged 16–55 years. Five constructs were created to measure psychosocial and cognitive determinants. Cronbach’s alpha coefficient for internal consistency reliability was calculated. Multivariable logistic regression was used to determine factors associated with MSP and nCU. Results Of the 6061 sexually active respondents, 13% (95% CI: 11.47–13.12) reported MSP and 52.7% ( n = 3158 of 6039) (95% CI: 51.0–53.55) nCU at last sex. Factors associated with MSP included perceived benefits, adjusted odds ratio (aOR) = 2.16 (95% CI: 1.80–2.58), perceived susceptibility to HIV, aOR = 2.22 (95% CI: 1.83–2.69) and engaging in intergenerational sex, aOR = 2.14 (95% CI: 1.78–2.56). Predictors of nCU were perceived benefits, aOR = 1.25 (95% CI: 1.09–1.43); perceived susceptibility to HIV, aOR = 1.6 (95% CI: 1.39–1.83); and personal beliefs, aOR = 1.35 (95% CI: 1.13–1.62). Conclusion Cognitive and behavioural factors were found to be predictors of risky sexual behaviours for HIV. This highlights the importance of considering personal perception and reasoning when attempting to understand and influence an individual’s sexual behaviour. This could be done through enhancing awareness of HIV risk in the general population and by influencing cognitive behaviour change through community mobilisation, advocacy and creating activities to improve self-esteem.

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Social Grants, Welfare, and the Incentive to Trade-Off Health for Income among Individuals on HAART in South Africa

Cited by 12 publications

References 22 publications

The ARV roll out and the disability grant: a South African dilemma?

The ARV roll out and the disability grant: a South African dilemma?

Antenatal depression case finding by community health workers in South Africa: feasibility of a mobile phone application

Cognitive and behavioural determinants of multiple sexual partnerships and condom use in South Africa: Results of a national survey

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