HIV test at an Oxfam-supported organisation in Phalaborwa, South Africa. Credit: Gcina Ndwalene/Oxfam Australia
Oxfam is monitoring the effectiveness of disability grants for HIV positive patients.

Income or Health: Can HIV patients have both?

There is a serious challenge in the South African government's HIV and AIDS response.

Currently, the government offers several social support grants to its citizens in need, including the disability grant which HIV-positive patients can apply for. At around USD107 per month, this grant may seem minuscule in this middle-income country that ranks in the world's top 20 GDP. Yet, one-third of the families in South Africa live on less than USD 100 a month, one-third of the population is unemployed, and the country's rich-poor gap is one of the widest in the world.

Simply put, the government's social grants have become integral to many families' survival: for very poor families, the grant can be twice the average monthly income. Studies show that the disability grant has been used to support entire families, and households with access to social grants have been more likely to work their way out of poverty.

People with HIV must have a T-cell count below 200 to be eligible for the disability grant. (The lower one's T-cell count is, the weaker the immune system.) Another requirement for HIVAIDS patients is that they must be undergoing antiretroviral (ARVs) treatment. All this seems quite logical and appears to be a pretty good deal. Yet, there is a problem.

Let's say a person's T-cell count is 175. She or he goes on ARVs, gets the disability grant, and begins to feel healthy again. The immune system is strengthening, and therefore, there are fewer infections and other illnesses. Then, because the ARVs are doing their job, the T-cell count goes up over 200, above the limit. The grant is promptly stopped.

Considering the importance of the income provided by the grant, HIV patient- recipients have sometimes been willing to take risks to ensure that the funds continue coming in. So, in order to keep the T-cell count below the 200 limit, some patients have been known to reduce the prescribed amount of ARVs or stop taking them altogether. They put their own health at risk for the sake of the income, which may be supporting their whole family. What started as a way to curb the pandemic as well as poverty, has sometimes led to a conundrum with huge and highly problematic implications.

Oxfam is aware of this trend and is monitoring the situation to develop ways to address the issue. Since 1998, we have been running large-scale anti-HIV and AIDS programme in South Africa to prevent the spread of infection, to improve treatment, to reduce stigma and discrimination, and to advocate for better legislation. For several years, we have been focusing on KwaZulu-Natal, the province with the highest prevalence rates, and in Limpopo. An external evaluation conducted in 2004/2005 recommended that we scale-up the programme, and we have begun working in Eastern Cape, too.

Story by Navin Vasudev, Oxfam Hong Kong, August 2008.

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