The socioeconomic impact of human immunodeficiency virus / acquired immune deficiency syndrome in India and its relevance to eye care
Identifieur interne : 000F02 ( Pmc/Corpus ); précédent : 000F01; suivant : 000F03The socioeconomic impact of human immunodeficiency virus / acquired immune deficiency syndrome in India and its relevance to eye care
Auteurs : G V S. MurthySource :
- Indian Journal of Ophthalmology [ 0301-4738 ] ; 2008.
Abstract
Human immunodeficiency virus (HIV) infection is aptly called the modern day ′plague′ and has the potential to decimate people in the productive age group. On the other hand, the increasing life expectancy in developing countries spirals age-related blindness. One therefore reduces economic productivity while the other increases economic dependency. Both lead to increased expenditure of households though in different proportions. Human immunodeficiency virus and blindness are both associated with discrimination, stigma and long-term consequences. They impact the socioeconomic fabric of the affected individuals, communities and countries. The loss in productivity and the cost of support to the affected individuals are seen in both. Each is a potent problem on its own but together they spell disaster in geometric proportions rather than a simple additive effect. Strategies need to be evolved to provide solace and improve the quality of life of an HIV-positive blind individual.
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PubMed: 18711268
PubMed Central: 2636145
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">The socioeconomic impact of human immunodeficiency virus / acquired
immune deficiency syndrome in India and its relevance to eye care</title><author><name sortKey="Murthy, G V S" sort="Murthy, G V S" uniqKey="Murthy G" first="G V S" last="Murthy">G V S. Murthy</name></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">18711268</idno><idno type="pmc">2636145</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2636145</idno><idno type="RBID">PMC:2636145</idno><date when="2008">2008</date><idno type="wicri:Area/Pmc/Corpus">000F02</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000F02</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">The socioeconomic impact of human immunodeficiency virus / acquired
immune deficiency syndrome in India and its relevance to eye care</title><author><name sortKey="Murthy, G V S" sort="Murthy, G V S" uniqKey="Murthy G" first="G V S" last="Murthy">G V S. Murthy</name></author></analytic><series><title level="j">Indian Journal of Ophthalmology</title><idno type="ISSN">0301-4738</idno><idno type="eISSN">1998-3689</idno><imprint><date when="2008">2008</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>Human immunodeficiency virus (HIV) infection is aptly called the modern day ′plague′ and has the
potential to decimate people in the productive age group. On the other hand, the increasing life expectancy
in developing countries spirals age-related blindness. One therefore reduces economic productivity while the
other increases economic dependency. Both lead to increased expenditure of households though in different
proportions. Human immunodeficiency virus and blindness are both associated with discrimination, stigma
and long-term consequences. They impact the socioeconomic fabric of the affected individuals, communities
and countries. The loss in productivity and the cost of support to the affected individuals are seen in both.
Each is a potent problem on its own but together they spell disaster in geometric proportions rather than a
simple additive effect. Strategies need to be evolved to provide solace and improve the quality of life of an
HIV-positive blind individual.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Mahal, A" uniqKey="Mahal A">A Mahal</name></author><author><name sortKey="Rao, B" uniqKey="Rao B">B Rao</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="John, Tj" uniqKey="John T">TJ John</name></author><author><name sortKey="Babu, Pg" uniqKey="Babu P">PG Babu</name></author><author><name sortKey="Jayakumari, H" uniqKey="Jayakumari H">H Jayakumari</name></author><author><name sortKey="Simoes, Ea" uniqKey="Simoes E">EA Simoes</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Simoes, Ea" uniqKey="Simoes E">EA Simoes</name></author><author><name sortKey="Babu, Pg" uniqKey="Babu P">PG Babu</name></author><author><name sortKey="John, Tj" uniqKey="John T">TJ John</name></author><author><name sortKey="Nirmala, S" uniqKey="Nirmala S">S 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Indian J Ophthalmol</journal-id><journal-id journal-id-type="publisher-id">Indian Journal of Ophthalmology</journal-id><journal-title-group><journal-title>Indian Journal of Ophthalmology</journal-title></journal-title-group><issn pub-type="ppub">0301-4738</issn><issn pub-type="epub">1998-3689</issn><publisher><publisher-name>Medknow Publications</publisher-name><publisher-loc>India</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">18711268</article-id><article-id pub-id-type="pmc">2636145</article-id><article-id pub-id-type="publisher-id">IndianJOphthalmol_2008_56_5_395_42416</article-id><article-categories><subj-group subj-group-type="heading"><subject>Symposium</subject></subj-group></article-categories><title-group><article-title>The socioeconomic impact of human immunodeficiency virus / acquired
immune deficiency syndrome in India and its relevance to eye care</article-title></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><name><surname>Murthy</surname><given-names>G V S</given-names></name><degrees>MD</degrees></contrib></contrib-group><aff>Community Ophthalmology Unit, Dr. R.P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India</aff><author-notes><corresp id="cor1">Correspondence to Dr. G.V.S. Murthy, Community Ophthalmology Unit,
Dr. R.P. Centre for Ophthalmic Sciences, All India Institute of Medical
Sciences, New Delhi, India. Email: <email>gvsmurthy2000@yahoo.com</email></corresp></author-notes><pub-date pub-type="ppub"><season>Sep-Oct</season><year>2008</year></pub-date><volume>56</volume><issue>5</issue><fpage>395</fpage><lpage>397</lpage><history><date date-type="received"><day>19</day><month>3</month><year>2007</year></date><date date-type="accepted"><day>31</day><month>7</month><year>2007</year></date></history><permissions><copyright-statement>Copyright: © Indian Journal of Ophthalmology</copyright-statement><copyright-year>2008</copyright-year><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc-sa/3.0"><license-p>This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike
3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is
properly cited.</license-p></license></permissions><abstract><p>Human immunodeficiency virus (HIV) infection is aptly called the modern day ′plague′ and has the
potential to decimate people in the productive age group. On the other hand, the increasing life expectancy
in developing countries spirals age-related blindness. One therefore reduces economic productivity while the
other increases economic dependency. Both lead to increased expenditure of households though in different
proportions. Human immunodeficiency virus and blindness are both associated with discrimination, stigma
and long-term consequences. They impact the socioeconomic fabric of the affected individuals, communities
and countries. The loss in productivity and the cost of support to the affected individuals are seen in both.
Each is a potent problem on its own but together they spell disaster in geometric proportions rather than a
simple additive effect. Strategies need to be evolved to provide solace and improve the quality of life of an
HIV-positive blind individual.</p></abstract><kwd-group><kwd>Blindness</kwd><kwd>human immunodeficiency virus</kwd><kwd>social status</kwd></kwd-group></article-meta></front><body><p>When the world awoke to the human immunodeficiency virus
(HIV) era in 1981, few would have risked predicting that this
′modern-day plague′ would infect 40 million worldwide,<xref ref-type="bibr" rid="ref1">1</xref>causing 20 million deaths.<xref ref-type="bibr" rid="ref2">2</xref> Globally, 2006 saw 4.3 million
new infections and three million deaths due to acquired
immunodeficiency syndrome (AIDS).<xref ref-type="bibr" rid="ref2">2</xref> The HIV pandemic
has entered a new phase compared to the initial stages in
that most of the present-day infection is seen in developing
countries. Though the focus of international attention has
mostly concentrated on sub-Saharan Africa, India is on the
brink of disaster.<xref ref-type="bibr" rid="ref1">1</xref> Disability has the potential to compound
the misery of the HIV-positive individuals. The socioeconomic
consequences of both HIV and blindness are known to have
an adverse impact on society. The purpose of this paper is to
present the status of HIV in India and to look at the possible
confluence of effect of both HIV and blindness in relation to
social factors and economic consequences.</p><sec sec-type=""><title>Magnitude of HIV/AIDS in India</title><p>Human immunodeficiency virus/AIDS was first recognized
in India in 1986.<xref ref-type="bibr" rid="ref3">3</xref>,<xref ref-type="bibr" rid="ref4">4</xref> India harbors the world′s
second largest burden of HIV-infected with one of every six new HIV
infections occurring in India and two Indians becoming
HIV-infected every minute.<xref ref-type="bibr" rid="ref5">5</xref> The prevalence of HIV among
Indian adults is 0.9%.<xref ref-type="bibr" rid="ref5">5</xref> In 2005 India had 5.7 million persons
living with HIV.<xref ref-type="bibr" rid="ref2">2</xref> Though HIV is now seen across the country,
2/3 cases are in six States,<xref ref-type="bibr" rid="ref2">2</xref> categorized as high-prevalence
States.<xref ref-type="bibr" rid="ref6">6</xref></p></sec><sec sec-type=""><title>Ocular involvement</title><p>Ocular complications are common in HIV/AIDS, affecting
50-75% of patients at some point during the course of illness.<xref ref-type="bibr" rid="ref7">7</xref>Lifetime cumulative risk of at least one abnormal ocular lesion
developing among HIV positives ranges from 52-100%.<xref ref-type="bibr" rid="ref8">8</xref></p><p>Mean duration of survival after diagnosis is 92 months in
India.<xref ref-type="bibr" rid="ref9">9</xref> Before the availability of antiretroviral therapy, median
survival after diagnosis of AIDS was 12 to 18 months.<xref ref-type="bibr" rid="ref10">10</xref> This
has changed dramatically since the advent of highly active
antiretroviral therapy.<xref ref-type="bibr" rid="ref11">11</xref></p><p>Available evidence suggests that presently the main cause
of blindness in HIV is bilateral cytomegalovirus (CMV)
retinitis.<xref ref-type="bibr" rid="ref7">7</xref>,<xref ref-type="bibr" rid="ref8">8</xref>,<xref ref-type="bibr" rid="ref12">12</xref>-<xref ref-type="bibr" rid="ref14">14</xref> Between 10-20% of HIV-infected patients can be
expected to lose vision in one or both eyes as a result of ocular
CMV infection.<xref ref-type="bibr" rid="ref13">13</xref>,<xref ref-type="bibr" rid="ref15">15</xref></p><p>Less frequent but important causes of bilateral vision loss
include varicella zoster, herpes simplex retinitis, ischemic
microvasculopathy, ocular syphilis, ocular tuberculosis,
cryptococcal meningitis, and ocular toxic or allergic drug
reactions.<xref ref-type="bibr" rid="ref13">13</xref> At present, most patients with HIV/AIDS in
developing countries losing vision have a limited life
expectancy.<xref ref-type="bibr" rid="ref13">13</xref>,<xref ref-type="bibr" rid="ref16">16</xref></p></sec><sec sec-type=""><title>Socioeconomic consequences</title><p>′Socioeconomic status′ refers to the social and economic position
of people within society.<xref ref-type="bibr" rid="ref17">17</xref> Social indicators include education,
health, employment status, housing conditions, access to
services (water, sewerage, electricity among others) while
economic indicators include income, wages, home ownership,
asset possession, family income, percentage who did not receive
medical treatment due to lack of money among others.<xref ref-type="bibr" rid="ref17">17</xref></p><p>People with lower literacy and from poor families have
higher risk of HIV.<xref ref-type="bibr" rid="ref18">18</xref> Poverty is higher among households
affected by HIV/AIDS than among unaffected families.<xref ref-type="bibr" rid="ref19">19</xref> For
people already living in poverty, further income loss can
threaten their ability to meet basic needs such as food.<xref ref-type="bibr" rid="ref19">19</xref> Poverty
also forces people to accept choices that put them at risk for
HIV infection. Studies reveal that poor women are forced into
sex work and into providing sexual favors in return for money,
and to be less able to insist on condom use.<xref ref-type="bibr" rid="ref18">18</xref>,<xref ref-type="bibr" rid="ref20">20</xref>,<xref ref-type="bibr" rid="ref21">21</xref></p></sec><sec sec-type=""><title>Human immunodeficiency virus and
dwindling family assets</title><p>The most visible impact of HIV is on treatment expenses. Annual
treatment costs of AIDS are unaffordable for poor patients.
The median annual treatment costs of AIDS patients with
opportunistic infections, including medications, travel, food and
hospitalization were INR 13623.7.<xref ref-type="bibr" rid="ref22">22</xref> This does not include costs
of antiretroviral drugs (ARV), which substantially escalate the
economic burden on families. Data from South India estimate
median annual costs of treatment for AIDS patients to be INR
17606 with ARV.<xref ref-type="bibr" rid="ref22">22</xref> Another study from Chennai observed that
the median direct cost of treatment to a patient is INR 6000 per
year while it is five times higher with antiretrovirals.<xref ref-type="bibr" rid="ref23">23</xref> It has
been estimated that the annual cost of HIV/AIDS to India is 1%
of the GDP (gross domestic product).<xref ref-type="bibr" rid="ref24">24</xref></p><p>An immediate impact is on household earnings since HIV/
AIDS affects individuals in their most productive years, from
lost earnings during sickness or premature death.<xref ref-type="bibr" rid="ref23">23</xref> Incomes
in Indian families affected by HIV declined by a third,
while average monthly expenditure on treatment increased
substantially.<xref ref-type="bibr" rid="ref23">23</xref> It has been shown that the life-years lost per
case of HIV was 44.4 years in India leading to a productivity
loss of INR 642,024 per case.<xref ref-type="bibr" rid="ref25">25</xref> Considering national per capita
income this translates to a loss of 98 billion INR which is far
higher than the actual treatment costs.<xref ref-type="bibr" rid="ref25">25</xref></p></sec><sec sec-type=""><title>Debts and borrowings to access services</title><p>Medical treatment expenditures constituted a significant
economic burden on affected households, with a significant
proportion of AIDS-related expenditures being financed by
borrowings.<xref ref-type="bibr" rid="ref23">23</xref> Studies have shown that high expenditure and
low income characterizes AIDS-affected families.<xref ref-type="bibr" rid="ref19">19</xref>,<xref ref-type="bibr" rid="ref26">26</xref>This therefore fuels increased borrowings.</p><p>To cope with loss of income and increased costs, households
often deplete their savings, first using liquid assets and then
selling off domestic investments such as livestock.<xref ref-type="bibr" rid="ref27">27</xref> To avoid
sale of more valuable resources like land or jewellery, debt is
incurred.<xref ref-type="bibr" rid="ref27">27</xref> This leads to a vicious cycle of social deprivation.</p></sec><sec sec-type=""><title>Impact on other members of the family</title><p>Children and women are the worst sufferers in an AIDS-
affected household. Fifteen million children have been
orphaned by HIV/AIDS worldwide who are at an increased
risk of malnutrition, illness, abuse, and sexual exploitation.<xref ref-type="bibr" rid="ref28">28</xref>Households compromise on their children′s education and
force them into early employment to manage household
expenses,<xref ref-type="bibr" rid="ref29">29</xref>,<xref ref-type="bibr" rid="ref30">30</xref> which become worse after an
AIDS-related death in the family.<xref ref-type="bibr" rid="ref29">29</xref> There is evidence of married women being
blamed and socially ostracized.<xref ref-type="bibr" rid="ref30">30</xref>-<xref ref-type="bibr" rid="ref32">32</xref></p><p>Social stigma leads to loss of employment and education.
Due to stigma and discrimination at the workplace many
people living with HIV/ AIDS do not disclose their status for
fear of losing jobs.<xref ref-type="bibr" rid="ref33">33</xref></p><p>There have been numerous reports about episodes of
violence and discrimination towards adults and children with
HIV, reflecting significant stigmatization of HIV-positives in our
society.<xref ref-type="bibr" rid="ref5">5</xref> Stigma and marginalization result in low self-esteem
among patients.<xref ref-type="bibr" rid="ref27">27</xref></p></sec><sec sec-type=""><title>Psychosocial impact of HIV-associated
blindness</title><p>In both HIV and blindness, a psychosocial impact is prominent.
Breakdown of familial relationships is possible in both. The
blind face a loss of self-esteem due to familial neglect<xref ref-type="bibr" rid="ref34">34</xref> and
this is compounded if the person is HIV-positive.<xref ref-type="bibr" rid="ref27">27</xref> They
become isolated from the daily routine of the community and
encounter severe depression and helplessness.<xref ref-type="bibr" rid="ref34">34</xref> Blindness
is associated with a marked loss of economic independence
and social standing together with marginalization of the
blind in the family decision-making process.<xref ref-type="bibr" rid="ref35">35</xref> This loss of
productivity leads to deterioration in the quality of life.
Human immunodeficiency virus also significantly affects all
these factors and therefore this combination leads to a rapidly
progressing downward spiral.</p><p>In addition to ocular HIV, other blinding conditions will
also coexist among HIV-positives. Normally, cataract blind
report barriers like cost of service, distance to a facility, lack
of an escort among others.<xref ref-type="bibr" rid="ref36">36</xref>,<xref ref-type="bibr" rid="ref37">37</xref> The social ostracism
of HIV-positives will compound these barriers. Many may refrain
from accessing services in the fear of their HIV status being
revealed. Therefore many of them will die blind. Even where
they do come for surgery, there may be reluctance on the part
of the surgeon to operate.</p><p>The lack of social security or health insurance schemes adds
to the plight of the blind HIV-positive. The substantial cost of
ARV may make it impossible for the blind to afford surgery.
Because of their social isolation, it is difficult to get them into
regular ′screening-service networks′.</p><p>Both HIV/AIDS and blindness are poverty-related diseases.
They are both the cause and consequence of considerable
poverty. Both are responsible for ′social drift′ wherein affected
people quickly move down the social ladder due to social
ostracism and loss of employment. It is also known that
disabled people are at a greater risk of HIV and at not being
able to access available health facilities. The combined effect of
HIV/AIDS and blindness can act as a disastrous cocktail on the
socioeconomic fabric and the civic society should be sensitized
to the Right to Dignity and Sight of the affected millions.</p></sec></body><back><fn-group><fn><p>Source of Support: Nil</p></fn><fn><p>Conflict of Interest: None declared.</p></fn></fn-group><ref-list><ref id="ref1"><label>1</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Mahal</surname><given-names>A</given-names></name><name><surname>Rao</surname><given-names>B</given-names></name></person-group><article-title>HIV-AIDS epidemic in India: An economic
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