Background:Botswana is regarded as a leader of
progressive HIV/AIDS policy, as the first country in sub-Saharan Africa to
establish a free, national antiretroviral therapy program. In light of such
programmatic successes, it is important to evaluate the potentially changing relationship
of HIV/AIDS to the wellbeing of individuals, households, and institutions in
the country. Methods: We evaluate the effects of HIV-related illness on
absenteeism and earnings several years after the
start of the national treatment program among a random sample of adults
in Botswana using survey data from 3999 individuals aged 15 to 49, using
quasi-experimental methods. We compare absenteeism between individuals with and
without HIV-related illness, using a propensity score matching approach. We
then estimate the effect of HIV-related illness on earnings using a Heckman
selection model to account for selection into the workforce. We stratify our
analyses by sex. Results: Men and women with HIV-related illness were absent by
about 5.2 and 3.3 additional days, respectively, in the month prior to the
survey compared to matched controls, and earned approximately 38% and 43% less,
respectively, in the month prior to the survey compared to those without
HIV-related illness. Conclusions: HIV-related illness appears to increase
absenteeism in this sample and dramatically reduce earnings. The findings
suggest a need for policies that confer greater financial security to
individuals with HIV/AIDS in Botswana.
Cite this paper
Farahani, M. , Roumis, D. , Mahal, A. , Holmes, M. , Moalosi, G. , Molomo, C. and Marlink, R. (2013) Effects of AIDS-related disability on workforce participation and earned income in Botswana: A quasi-experimental evaluation. Health, 5, 409-416. doi: 10.4236/health.2013.53055.
  UNAIDS (2010) Progress Report of the National Re-sponse to the 2001 Declaration of Commitment on HIV and AIDS, Botswana Country Report.
 CSO (2009) 2008 Botswana AIDS impact survey III (BAIS III). Cen-tral Statistics Office, Government of Bots wa-na.
 Cuddington, J.T. (1993) Modeling the macroe-conomic effects of AIDS, with an application to Tanzania. World Bank Econ Rev, 7, 173-189. doi:10.1093/wber/7.2.173
 Bonnel, R. (2000) HIV/AIDS and economic growth: A global perspective. South African Journal of Economics, 68, 360-379. doi:10.1111/j.1813-6982.2000.tb01282.x
 Cuddington, J.T. and Hancock, J.D. (1994) Assessing the impact of AIDS on the growth path of the Malawian economy. Journal of Development Economics, 43, 363-368.
 Arndt, C. and Lewis, J.D. (2000) The macro implications of HIV/AIDS in South Africa: A preliminary assessment. South African Journal of Economics, 68, 380-392.
 MacFarlan, M. and Sgherri, S. (2001) The macroeconomic impact of HIV/AIDS in Botswana. In press.
 Jefferis, K., Kinghorn, A., Siphambe, H. and Thurlow, J. (2008) Ma-croeconomic and household-level impacts of HIV/AIDS in Botswana. AIDS, 22, S113-S119.
 Lisk, F. (2002) Labour market and employment implica tions of HIV/AIDS. Working Paper 1: International Labor Organ-ization (ILO) Programme on HIV/AIDS and the World of Work, Geneva.
 Kgathi, D.L., Ngwenya, B.N. and Wilk, J. (2007) Shocks and rural livelihoods in the Oka-vango Delta, Botswana. Development Southern Africa, 24, 289-308.
 Greener, R. (2002) AIDS and macroeconomic impact. Working Paper, Inter-national AIDS Economics Network.
 Greener, R., Jefferis, K. and Siphambe, H. (2000) The impact of HIV/AIDS on poverty and inequality in Botswana. South African Journal of Economics, 68, 393-404.
 Thurlow, J. (2007) Is HIV/AIDS undermining Botswana’s “success story”? IFPRI Discussion Paper 00697, Washington DC.
 Bachmann, M.O. and Booysen, F.L.R. (2004) Relation ships between HIV/AIDS, income and expendi-ture over time in deprived South African households. AIDS Care: Psychological and Socio-Medical Aspects of AIDS/HIV, 16, 817-826.
 Bachmann, M.O. and Booysen, F.L.R. (2006) Economic causes and effects of AIDS in South African households. AIDS, 20, 1861-1867.
 Bachmann, M.O. and Booysen, F.L.R. (2003) Health and economic impact of HIV/AIDS on South African house holds: A co-hort study. BMC Public Health, 3, 8.
 Duraisamy, P., Ganesh, A.K., Homan, R., Kumarasamy, N., Castle, C., Sripriya, P., et al. (2006) Costs and financial burden of care and support services to PLHA and households in South India. AIDS Care: Psychological and Socio-Medical Aspects of AIDS/HIV, 18, 121-127.
 Naidu, V. and Harris, G. (2005) The impact of HIV/AIDS morbidity and mortality on households—A review of household studies. South African Journal of Economics, 73, 533-544. doi:10.1111/j.1813-6982.2005.00037.x
 Russell, S. (2004) The economic burden of illness for households in developing countries: A review of studies focusing on malaria, tuberculosis, and human immunodeficiency vi-rus/acquired immunodeficiency syndrome. American Journal of Tropical Medicine and Hygiene, 71, 147 155.
 Tekola, F., Reniers, G., Mariam, D.H., Araya, T. and Davey, G. (2008) The economic impact of HIV/AIDS morbidity and mortality on households in Addis Ababa, Ethiopia. AIDS Care: Psychological and Socio-Medical Aspects of AIDS/HIV, 20, 995-1001.
 Wyss, K., Hutton, G. and N’Diekhor, Y. (2004) Costs attributable to AIDS at household level in Chad. AIDS Care-Psychological and Socio-Medical Aspects of AIDS/ HIV, 16, 808-816. doi:10.1080/09540120412331290167
 Rajaraman, D., Russell, S. and Heymann, J. (2006) HIV/ AIDS, income loss and economic survival in Botswana. AIDS Care: Psychological and Socio-Medical Aspects of AIDS/HIV, 18, 656-662. doi:10.1080/09540120500287010
 Bussmann, H., Wester, C.W., Ndwapi, N., Grundmann, N., Gaolathe, T., Puvimanasinghe, J., et al. (2008) Five-year outcomes of initial patients treated in Botswana’s Nation al Antiretro-viral Treatment Program. AIDS, 22, 2303 2311. doi:10.1097/QAD.0b013e3283129db0
 Nixon, S., Hanass-Hancock, J., Whiteside, A. and Barnett, T. (2011) The increasing chronicity of HIV in sub-Saha ran Africa: Re-thinking “HIV as a long-wave event” in the era of widespread access to ART. Globalization and Health, 7, 41. doi:10.1186/1744-8603-7-41
 Oliva, J. (2009) Labour participation of people living with HIV/AIDS in Spain. Health Economics, 19, 491-500.
 Dray-Spira, R., Lert, F., Ma-rimoutou, C., Bouhnik, A.-D. and Obadia, Y. (2003) So-cio-economic conditions, health status and employment among persons living with HIV/ AIDS in France in 2001. AIDS Care: Psychological and Socio-Medical Aspects of AIDS/HIV, 15, 739-748.
 Dray-Spira, R., Persoz, A., Boufassa, F., Gueguen, A., Lert, F., Allegre, T., et al. (2006) Employment loss fol lowing HIV infection in the era of highly active antiretro viral therapies. European Journal of Public Health, 16, 89-95. doi:10.1093/eurpub/cki153
 Ezzy, D., De Visser, R. and Bartos, M. (1999) Poverty, disease progression and employment among people living with HIV/AIDS in Australia. AIDS Care: Psychological and Socio-Medical Aspects of AIDS/HIV, 11, 405-414.
 Massagli, M.P., Weissman, J.S., Seage 3rd, G.R. and Ep stein, A.M. (1994) Correlates of employment after AIDS diagnosis in the Boston health study. American Journal of Public Health, 84, 1976-1981.
 Rabkin, J.G., McEl-hiney, M., Ferrando, S.J., Van Gorp, W. and Lin, S.H. (2004) Predictors of employment of men with HIV/AIDS: A longitudinal study. Psychosomatic Me dicine, 66, 72-78.
 Yelin, E.H., Greenblatt, R.M., Hollander, H. and McMaster, J.R. (1991) The impact of HIV-related illness on employment. American Journal of Public Health, 81, 79-84.
 Auld, M.C. (2002) Dis-entangling the effects of morbidity and life expectancy on labor market outcomes. Health Economics, 11, 471-483. doi:10.1002/hec.753
 Leigh, J.P., Lubeck, D.P., Farnham, P. and Fries, J.F. (1995) Potential and actual workdays lost among patients with HIV. Journal of Ac-quired Immune Deficiency Syndromes and Human Retro-virology, 8, 392-398.
 Scitovsky, A.A. and Rice, D.P. (1987) Estimates of the direct and indirect costs of acquired immunodeficiency syndrome in the United States, 1985, 1986, and 1991. Public Health Reports, 102, 5-17.
 Mullins, C.D., Whitelaw, G., Cooke, J.L. and Beck, E.J. (2000) Indirect cost of HIV infection in England. Clinical Therapeutics, 22, 1333-1345.
 Oliva, J., Roa, C. and Llano, J. (2003) Indirect costs in ambulatory pa-tients with HIV/AIDS in Spain: A pilot study. Pharma-coeconomics, 21, 1113-1121.
 Kass, N.E., Munoz, A., Chen, B., Zucconi, S.L. and Bing, E.G. (1994) Changes in employment, insurance, and in come in relation to HIV status and disease progression. The multicenter AIDS cohort study. Journal of Acquired Im-mune Deficiency Syndromes, 7, 86-91.
 Fox, M.P., Rosen, S., MacLeod, W.B., Wasunna, M., Bii, M., Foglia, G., et al. (2004) The impact of HIV/AIDS on labour productivity in Kenya. Tropical Medicine & Inter national Health, 9, 318-324.
 Habyarimana, J., Mbakile, B. and Pop-Eleches, C. (2010) The impact of HIV/AIDS and ARV treatment on worker absenteeism. Journal of Human Resources, 45, 809-839.
 Larson, B.A., Fox, M.P., Rosen, S., Bii, M., Sigei, C., Shaffer, D., et al. (2008) Early effects of antiretroviral therapy on work performance: Preliminary results from a cohort study of Kenyan agricultural workers. AIDS, 22, 421-425. doi:10.1097/QAD.0b013e3282f3cc0c
 Mahal, A., Canning, D., Odumosu, K. and Okonkwo, P. (2008) As-sessing the economic impact of HIV/AIDS on Nigerian households: A propensity score matching appro ach. AIDS, 22, S95-S101.
 Rosen, S., Ketlhapile, M., Sanne, I. and Desilva, M.B. (2008) Differences in normal activities, job performance and symptom prevalence between patients not yet on antire-troviral therapy and patients initiating therapy in South Africa. AIDS, 22, S131-S139.
 Riviello, E.D., Ster-ling, T.R., Shepherd, B., Fantan, T. and Makhema, J. (2007) HIV in the workplace in Botswana: Incidence, prevalence, and disease severity. AIDS Re search and Human Retroviruses, 23, 1453-1460.
 Canning, D., Mahal, A., Odumosu, O. and Okonkwo, P. (2006) The impact of HIV/AIDS on Nigerian households. In: Adeyi, O., Kanki, P., Odutolu, O. and Idoko, J., Eds., AIDS in Nigeria: Harvard Center for Population and De velopment Studies, Harvard University Press, Cambridge, 193-212.
 Dehejia, R.H. and Wahba, S. (2002) Pro-pensity score matching methods for nonexperimental causal studies. Review of Economics and Statistics, 84, 151-161.
 Rosenbaum, P.R. and Rubin, D.B. (1983) The central role of the propensity score in observational studies for causal effects. Biome-trika, 70, 41-55.
 Guo, S. and Fraser, M.W. (2009) Propensity score analysis: Statistical methods and applications. Sage Publications, Thousand Oaks.
 Rubin, D.B. (1979) Using multivariate matched sampling and regression adjustment to control bias in observational studies. Journal of the American Statistical Association, 74, 318-328. doi:10.2307/2286330
 Rubin, D.B. (2006) Matched sampling for causal effects. New York Cambridge Uni-versity Press, Cambridge.
 Heckman, J.J., Ichimura, H. and Todd, P. (1998) Matching as an econo-metric evaluation estimator. Review of Economic Studies, 65 261-294.
 Gronau, R. (1974) Wage comparisons—A selectivity bias. The Journal of Political Economy, 82, 1119-1143.
 Wooldridge, J.M. (2002) Eco-nometric analysis of cross section and panel data. MIT Press, Cambridge.
 Heckman, J.J. (1979) sample se-lection bias as a specification error. Econometrica, 47, 153-161.
 Cameron, A.C. and Trivedi, P.K. (2005) Microeconomet rics: Methods and applications. Cambridge University Press, Cambridge. doi:10.1017/CBO9780511811241
 Becker, S.O. (2002) Estimation of average treatment effects based on propensity scores. Stata Journal, 2, 358 377.
 Filmer, D. and Pritchett, L.H. (2001) Estimating wealth effects without expenditure data or tears: An application to edu-cational enrollments in states of India. Demography, 38, 115-132.
 Wooldridge, J.M. (2008) Introductory econometrics: A modern approach. South-Western College Publishing, Cincinnati.
 Farahani, M., Tilahun, H. and Marlink, R. (2010) Seven year mortality outcomes of the Botswana national HIV/ AIDS treatment program. Unpublished Report.
 UNAIDS (2008) Epidemio-logical fact sheet on HIV and AIDS: Core data on epide-miology and response. Botswana: UNAIDS, WHO Working Group on Global HIV/ AIDS and STI Surveillance.