Disability Grant: a precarious lifeline for HIV/AIDS patients in South Africa

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dc.contributor.authorGovender, Veloshneeen_ZA
dc.contributor.authorFried, Janaen_ZA
dc.contributor.authorBirch, Stephenen_ZA
dc.contributor.authorChimbindi, Natsayien_ZA
dc.contributor.authorCleary, Susanen_ZA
dc.date.accessioned2015-11-04T11:49:38Z
dc.date.available2015-11-04T11:49:38Z
dc.date.issued2015en_ZA
dc.description.abstractBACKGROUND:In South Africa, HIV/AIDS remains a major public health problem. In a context of chronic unemployment and deepening poverty, social assistance through a Disability Grant (DG) is extended to adults with HIV/AIDS who are unable to work because of a mental or physical disability. Using a mixed methods approach, we consider 1) inequalities in access to the DG for patients on ART and 2) implications of DG access for on-going access to healthcare. METHODS: Data were collected in exit interviews with 1200 ART patients in two rural and two urban health sub-districts in four different South African provinces. Additionally, 17 and 18 in-depth interviews were completed with patients on ART treatment and ART providers, respectively, in three of the four sites included in the quantitative phase. RESULTS: Grant recipients were comparatively worse off than non-recipients in terms of employment (9.1% vs. 29.9%) and wealth (58.3% in the poorest half vs. 45.8%). After controlling for socioeconomic and demographic factors, site, treatment duration, adherence and concomitant TB treatment, the regression analyses showed that the employed were significantly less likely to receive the DG than the unemployed (p<0.001). Also, patients who were longer on treatment and receiving concomitant treatment (i.e., ART and tuberculosis care) were more likely to receive the DG (significant at the 5% level). The qualitative analyses indicated that the DG alleviated the burden of healthcare related costs for ART patients. Both patients and healthcare providers spoke of the complexity of the grants process and eligibility criteria as a barrier to accessing the grant. This impacted adversely on patient-provider relationships. CONCLUSIONS: These findings highlight the appropriateness of the DG for people living with HIV/AIDS. However, improved collaboration between the Departments of Social Development and Health is essential for preparing healthcare providers who are at the interface between social security and potential recipients.en_ZA
dc.identifier.apacitationGovender, V., Fried, J., Birch, S., Chimbindi, N., & Cleary, S. (2015). Disability Grant: a precarious lifeline for HIV/AIDS patients in South Africa. <i>BMC Health Services Research</i>, http://hdl.handle.net/11427/14669en_ZA
dc.identifier.chicagocitationGovender, Veloshnee, Jana Fried, Stephen Birch, Natsayi Chimbindi, and Susan Cleary "Disability Grant: a precarious lifeline for HIV/AIDS patients in South Africa." <i>BMC Health Services Research</i> (2015) http://hdl.handle.net/11427/14669en_ZA
dc.identifier.citationGovender, V., Fried, J., Birch, S., Chimbindi, N., & Cleary, S. (2015). Disability Grant: a precarious lifeline for HIV/AIDS patients in South Africa. BMC health services research, 15(1), 227.en_ZA
dc.identifier.ris TY - Journal Article AU - Govender, Veloshnee AU - Fried, Jana AU - Birch, Stephen AU - Chimbindi, Natsayi AU - Cleary, Susan AB - BACKGROUND:In South Africa, HIV/AIDS remains a major public health problem. In a context of chronic unemployment and deepening poverty, social assistance through a Disability Grant (DG) is extended to adults with HIV/AIDS who are unable to work because of a mental or physical disability. Using a mixed methods approach, we consider 1) inequalities in access to the DG for patients on ART and 2) implications of DG access for on-going access to healthcare. METHODS: Data were collected in exit interviews with 1200 ART patients in two rural and two urban health sub-districts in four different South African provinces. Additionally, 17 and 18 in-depth interviews were completed with patients on ART treatment and ART providers, respectively, in three of the four sites included in the quantitative phase. RESULTS: Grant recipients were comparatively worse off than non-recipients in terms of employment (9.1% vs. 29.9%) and wealth (58.3% in the poorest half vs. 45.8%). After controlling for socioeconomic and demographic factors, site, treatment duration, adherence and concomitant TB treatment, the regression analyses showed that the employed were significantly less likely to receive the DG than the unemployed (p<0.001). Also, patients who were longer on treatment and receiving concomitant treatment (i.e., ART and tuberculosis care) were more likely to receive the DG (significant at the 5% level). The qualitative analyses indicated that the DG alleviated the burden of healthcare related costs for ART patients. Both patients and healthcare providers spoke of the complexity of the grants process and eligibility criteria as a barrier to accessing the grant. This impacted adversely on patient-provider relationships. CONCLUSIONS: These findings highlight the appropriateness of the DG for people living with HIV/AIDS. However, improved collaboration between the Departments of Social Development and Health is essential for preparing healthcare providers who are at the interface between social security and potential recipients. DA - 2015 DB - OpenUCT DO - 10.1186/s12913-015-0870-8 DP - University of Cape Town J1 - BMC Health Services Research LK - https://open.uct.ac.za PB - University of Cape Town PY - 2015 T1 - Disability Grant: a precarious lifeline for HIV/AIDS patients in South Africa TI - Disability Grant: a precarious lifeline for HIV/AIDS patients in South Africa UR - http://hdl.handle.net/11427/14669 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/14669
dc.identifier.urihttp://dx.doi.org/10.1186/s12913-015-0870-8
dc.identifier.vancouvercitationGovender V, Fried J, Birch S, Chimbindi N, Cleary S. Disability Grant: a precarious lifeline for HIV/AIDS patients in South Africa. BMC Health Services Research. 2015; http://hdl.handle.net/11427/14669.en_ZA
dc.language.isoengen_ZA
dc.publisherBiomed Central Ltden_ZA
dc.publisher.departmentHealth Economics Uniten_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an Open Access article distributed under the terms of the Creative Commons Attribution Licenseen_ZA
dc.rights.holder2015 Govender et al.en_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/2.0en_ZA
dc.sourceBMC Health Services Researchen_ZA
dc.source.urihttp://www.biomedcentral.com/bmchealthservres/en_ZA
dc.subject.otherHIV/AIDSen_ZA
dc.subject.otherHealthcare accessen_ZA
dc.subject.otherDisability granten_ZA
dc.subject.otherSouth Africaen_ZA
dc.titleDisability Grant: a precarious lifeline for HIV/AIDS patients in South Africaen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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