1. Economic effects of HIV on South Africa households: cohort study Max Bachmann Medical School & AIDS Development Group, University of East Anglia

2. Outline of talk Background: HIV/AIDS in South Africa Controlled cohort study –Epidemiological / statistical inferences about AIDS and poverty Some other AIDS research

3. UNAIDS

5. 10 million 20041985 Women Men UNAIDS Number of women and men living with HIV/AIDS in Southern Africa, 1985-2004

6. Economic effect on households: Cohort study Free State province –Thabong: poor urban township –QwaQwa: poor crowded ‘rural’ former homeland 200 index cases from AIDS training & information centres –> their households > their neighbours (controls) 6 X 6-monthly interviews per household –~ 5500 person-years of observation

9. Mean adult equivalent real incomes

10. Mean adult equivalent real expenditures

11. Increased odds of death among members of affected vs. unaffected households

12. Influences of household income or expenditure on risk of illness

13. Effects of baseline income & expenditure on No. subsequent deaths & illness episodes

14. Predictors of change in real adult equivalent expenditure

15. Predictors of change in real adult equivalent income

16. Independent* effects on adult equivalent real expenditure of changes in mortality or morbidity within households, & of differences in mortality or morbidity between households

17. Independent* effects on adult equivalent real income of changes in mortality or morbidity within households, & of differences in mortality or morbidity between households (unaffected households only; no independent effects in affected)

18. Conclusions Dynamic relationships between AIDS & poverty Affected households at rock bottom at the start Spend more sensitive to AIDS effects than income Methodological problems Index cases often had advanced AIDS at start No HIV test results Controlled cohort data help causal inference Widespread poverty even without AIDS Causes before effects Between- and within-household comparisons Diverse results cohere

19. Some other AIDS research Modelling treatment effects –Early vs late ARV or antibiotics –Triple ARV vs placebo –Emergence and transmission of resistance ARV roll-out in South Africa AIDS and fisherfolk in Africa and Asia –(UEA-AIDS Development Group)