Objectives: We used a novel approach to assess the impact of HIV/AIDS on individuals' healthcare utilization and spending in the Oyo and Plateau states of Nigeria and income foregone from work time lost.
Methods: Data from a 2004 random survey of over 6400 individuals were compared with a sample of 482 individuals living with HIV/AIDS. Estimating the effect of HIV is complicated by the fact that our sample of HIV-positive individuals was non-random; there are selection effects, both in acquiring HIV and being in our sample of HIV-positive people, which was based on contacts through non-governmental organizations. To overcome these, we compared HIV-positive people with a control group with similar observed characteristics, using propensity score matching. The matched HIV-negative individuals had worse health and greater health spending than the full HIV-negative group. This suggests that our HIV sample would not have had ‘average’ outcomes even if they had not acquired HIV.
Results: Compared with our matched control group, HIV is associated with significantly increased morbidity, healthcare utilization, public health facility use, lost work time and family time devoted to care-giving. Direct private healthcare costs and indirect income loss per HIV-positive individual were 36 065 Naira, approximately 56% of annual income per capita in affected households. Approximately 40% of these costs were income losses associated with sickness and care-giving. 10% of the cost of HIV is accounted for by public subsidies for health. The largest single cost, representing 54% of the total economic burden of HIV, is for out-of-pocket expenses for healthcare.