Advertisement

AIDS and Behavior

, Volume 14, Issue 6, pp 1393–1400 | Cite as

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

  • Atheendar S. VenkataramaniEmail author
  • Brendan Maughan-Brown
  • Nicoli Nattrass
  • Jennifer Prah Ruger
Original Paper

Abstract

South Africa’s government disability grants are considered important in providing income support to low-income AIDS patients. Indeed, anecdotal evidence suggests that some individuals may opt to compromise their health by foregoing Highly Active Antiretroviral Treatment (HAART) to remain eligible for the grant. In this study, we examined the disability grant’s importance to individual and household welfare, and the impact of its loss using a unique longitudinal dataset of HAART patients in Khayelitsha, Cape Town. We found that grant loss was associated with sizeable declines in income and changes in household composition. However, we found no evidence of individuals choosing poor health over grant loss. Our analysis also suggested that though the grants officially target those too sick to work, some people were able to keep grants longer than expected, and others received grants while employed. This has helped cushion people on HAART, but other welfare measures need consideration.

Keywords

AIDS Highly active antiretroviral therapy (HAART) Incentives Social security South Africa Trade-offs Welfare 

Notes

Acknowledgments

We would like to thank the AIDS and Society Research Unit (ASRU) at the University of Cape Town for access to data from the HAART Panel Study and for research support. We would also like to thank Nathan Geffen, Elijah Paintsil, A. David Paltiel, Gustav Ranis, Jeremy Seekings, Jody Sindelar, T. Paul Schultz, T.N. Srinivasan, seminar participants at the University of Cape Town Center for Social Science Research, the Center for Interdisciplinary Research on AIDS at Yale University, the Global Citizenship: Research Implications workshop, and the International Health Economics Association 7th World Congress, as well as two anonymous referees, for helpful comments and suggestions. Funding for this research was provided by ASRU, the Whitney and Betty MacMillan Center for International and Area Studies at Yale University, and the William and Flora Hewlett Foundation. All errors are our own.

References

  1. 1.
    Human Sciences Research Council (HSRC). Available at: http://www.hsrc.ac.za/Media_Release-180.phtml. Accessed 3 Nov 2009.
  2. 2.
    Department of Social Development—Republic of South Africa. Disability grants. Available at: http://www.capegateway.gov.za/eng/directories/services/11586/47485. Accessed 3 Nov 2009.
  3. 3.
    Department of Social Development—Republic of South Africa. Annual report. 2008. Available at: http://www.dsd.gov.za/index.php?option=com_docman&task=cat_view&gid=27&Itemid=39. Accessed 3 Nov 2009.
  4. 4.
    National Treasury—Republic of South Africa. Budget Review 2008. Pretoria: National Treasury. Available at: http://www.treasury.gov.za/documents/national%20budget/2008/review/Default.aspx. Accessed 3 Nov 2009.
  5. 5.
    Nattrass N. Trading off income and health?: AIDS and the disability grant in South Africa. J Soc Policy. 2005;35(1):3–19.CrossRefGoogle Scholar
  6. 6.
    Nattrass N. Disability and welfare in South Africa’s age of unemployment and AIDS. In: Southall R, Daniel J, editors. State of the Nation: South Africa 2007. Cape Town: Human Sciences and Research Council; 2007. p. 179.Google Scholar
  7. 7.
    Seekings J, Nattrass N. Class, race, and inequality in South Africa. New Haven: Yale University Press; 2005.Google Scholar
  8. 8.
    Booysen F, Van der Berg S. The role of social grants in mitigating the socio-economic impact of HIV/AIDS in two Free State communities. S Afr J Econ. 2005;73(S1):545–63.CrossRefGoogle Scholar
  9. 9.
    Case A, Deaton A. Large cash transfers to elderly in South Africa. Econ J. 1998;108(450):1330–61.CrossRefGoogle Scholar
  10. 10.
    Duflo E. Child health and household resources in South Africa: evidence from the old age pension program. Am Econ Rev. 2000;90(2):393–8.CrossRefGoogle Scholar
  11. 11.
    Edmonds EV. Child labor and schooling responses to anticipated income in South Africa. J Dev Econ. 2006;81(2):386–414.CrossRefGoogle Scholar
  12. 12.
    Edmonds EV, Mammen K, Miller DL. Rearranging the family? Income support and elderly living arrangements in a low-income country. J Hum Resour. 2005;40(1):186–207.Google Scholar
  13. 13.
    Hardy C, Richter M. Disability grants or antiretrovirals? A quandary for people with HIV/AIDS in South Africa. Afr J AIDS Res. 2006;5(1):85–96.Google Scholar
  14. 14.
    Koker C, de Waal L, Vorster J. A profile of social security beneficiaries in South Africa—Vols III; 2006. Available at: http://unpan1.un.org/intradoc/groups/public/documents/cpsi/unpan036524.pdf. Accessed 3 Nov 2009.
  15. 15.
    Leclerc-Madlala S. ‘We will eat when I get the grant’: negotiating AIDS, poverty and antiretroviral treatment in South Africa. Afr J AIDS Res. 2006;5(3):249–56.Google Scholar
  16. 16.
    Simchowitz B. Social security and HIV/AIDS: assessing “disability” in the context of ARV treatment. Center for Social Science Research Working Paper. Number 99. University of Cape Town; 2004.Google Scholar
  17. 17.
    Graff-Zivin J, Thirumurthy H, Goldstein M. AIDS treatment and intrahousehold resource allocations: children’s nutrition and schooling in Kenya. NBER Working Paper No. 12689. 2006.Google Scholar
  18. 18.
    Smit C, Geskus R, Walker S, Sabin C, Coutinho R, Porter K, et al. Effective therapy has altered the spectrum of cause-specific mortality following HIV seroconversion. AIDS. 2006;20(5):741–9.CrossRefPubMedGoogle Scholar
  19. 19.
    Thirumurthy H, Graff-Zivin J, Goldstein M. The economic impact of AIDS treatment: labor supply in Western Kenya. NBER Working Paper No. 11871. 2005.Google Scholar
  20. 20.
    Coetzee D, Boulle A, Hildebrand K, Asselman V, Van Cutsem G, Goemaere E. Promoting adherence to antiretroviral therapy: the experience from a primary care setting in Khayelitsha, South Africa. AIDS. 2004;18(Suppl 3):S27–31.CrossRefPubMedGoogle Scholar
  21. 21.
    Coetzee D, Hildebrand K, Boulle A, Maartens G, Louis F, Labatala V, et al. Outcomes after two years of providing antiretroviral treatment in Khayelitsha, South Africa. AIDS. 2004;18(6):887–95.CrossRefPubMedGoogle Scholar
  22. 22.
    Médecins Sans Frontières. Antiretroviral therapy in primary health care: the experience of the Khayelitsha programme in South Africa. Geneva: World Health Organization; 2003.Google Scholar
  23. 23.
    City of Cape Town. A population profile of Khayelitsha; Socio-economic information from the 2001 Census. Available at: http://www.capetown.gov.za/en/stats/CityReports/Documents/Population%20Profiles/A_Population_Profile_of_Khayelitsha_1052006142120_359.pdf. Accessed 3 Nov 2009.
  24. 24.
    Shaikh N, Abdullah F, Lombard CJ, Smit L, Bradshaw D, Makubalo L. Masking through averages—intraprovincial heterogeneity in HIV prevalence within the Western Cape. S Afr Med J. 2006;96(6):539–43.Google Scholar
  25. 25.
    Wooldridge JM. Econometric analysis of cross section and panel data. Cambridge: MIT Press; 2002.Google Scholar
  26. 26.
    The Strategies for Management of Antiretroviral Therapy (SMART) Study Group. CD4+ count-guided interruption of antiretroviral treatment. New Engl J Med. 2006;355(22):2283–96.CrossRefGoogle Scholar
  27. 27.
    Mitra S. The recent decline in the employment of persons with disabilities in South Africa, 1998–2006. S Afr J Econ. 2008;76(3):480–92.CrossRefGoogle Scholar
  28. 28.
    Mitra S. Disability screening and labor supply: Evidence from South Africa. Am Econ Rev: Papers & Proceedings. 2009;99(2):512–6.CrossRefGoogle Scholar
  29. 29.
    Bangsberg D, Porco T, Kagay C, Charlebois E, Deeks S, Guzman D, et al. Modeling the HIV protease inhibitor adherence-resistance curve by use of empirically derived estimates. J Infect Dis. 2004;190(1):162–5.CrossRefPubMedGoogle Scholar
  30. 30.
    Deaton A, Fortson J, Tortora R. Life (evaluation), HIV/AIDS, and death in Africa. Issue 14637 of Working Paper Series. National Bureau of Economic Research 2009.Google Scholar
  31. 31.
    Benjamins MR, Hummer RA, Eberstein IW, Nam CB. Self-reported health and adult mortality risk: an analysis of cause-specific mortality. Soc Sci Med. 2004;59(6):1297–306.CrossRefPubMedGoogle Scholar
  32. 32.
    Ferraro KF, Su YP. Physician-evaluated and self-reported morbidity for predicting disability. Am J Public Health. 2000;90(1):103–8.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Atheendar S. Venkataramani
    • 1
    Email author
  • Brendan Maughan-Brown
    • 2
  • Nicoli Nattrass
    • 2
  • Jennifer Prah Ruger
    • 3
  1. 1.Washington University School of Medicine in St. LouisSt. LouisUSA
  2. 2.AIDS and Society Research UnitUniversity of Cape TownCape TownSouth Africa
  3. 3.Division of Health Policy and AdministrationYale University School of Public HealthNew HavenUSA

Personalised recommendations