Erika Beidelman
Erika Beidelman is a first year PhD student in Epidemiology in the Department of Epidemiology and Biostatistics. Prior to coming to Indiana University, she worked as a Senior Research Associate at the William Davidson Institute at the University of Michigan where she led various projects related to health systems strengthening and healthcare access across low- and middle-income countries. Erika’s primary research interests include global health, sexual and reproductive health, and the impact of socioeconomic factors on disease development and spread. At Indiana University, Erika has worked with her advisor, Dr. Molly Rosenberg, on a grant examining the association of various socioeconomic exposures with cognitive functioning in a cohort of older adults in rural South Africa. She hopes to one day bring her experiences to the World Health Organization.
The Influence of HIV+ Status Awareness on Household Spending Allocated to Healthcare in South Africa: A Cross-Sectional Analysis of the HAALSI Cohort
Introduction: Previous research from rural South Africa indicates that people living with HIV (PLHIV) may have better cognition-related and chronic disease-related health outcomes than their HIV-negative counterparts. This could be due to reduced healthcare access barriers arising from frequent health facility visits necessitated by HIV infection. Thus, PLHIV may be more likely to accept treatments for non-HIV conditions, leading to a morbidity and mortality advantage. Such a differential in utilization should manifest as a systematic difference in healthcare expenditures between PLHIV who know their status and other populations.
Methods: We used age-sex-adjusted linear regression models to estimate the association between HIV+ status awareness and the percent of annual household spending allocated to healthcare across 4,358 adults aged ≥40 years in rural South Africa, where HIV care is free. To understand whether the association differed by household wealth, we also conducted a stratified analysis.
Results: Across the full sample, the age-sex-adjusted model estimated a 1.4 percentage point increase in household healthcare spending associated with HIV+ status awareness (95% CI: 0.3,2.5). For the SES-stratified sample, the lowest wealth quintile showed a significant association of HIV+ status awareness with household healthcare spending (3.3 [95% CI: 0.9,5.7]).
Conclusions: These results suggest that older, low-income PLHIV in rural South Africa dedicate a greater proportion of their annual household spending to healthcare than their HIV-negative counterparts. This points to increased healthcare utilization as a potential source of the observed heterogeneity in health outcomes between PLHIV and HIV-negative individuals. Future studies are needed to confirm if the increase in expenditure correlates to increased utilization of non-HIV services.
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