A qualitative analysis of the economic impact of HIV and antiretroviral therapy on individuals and households in Uganda.

Despite the acceleration of antiretroviral therapy (ART) scale-up in sub-Saharan Africa, little is known about the social and economic effects of ART on individuals and households. In January 2008, we conducted semistructured interviews with 24 adult ART clients attending urban and rural HIV clinics operated by Joint Clinical Research Center in Uganda. Using content analysis we explored changes in physical health, work activity and asset management from before HIV to after ART. Twenty-one (88%) participants were working prior to HIV (mostly microenterprises and subsistence farming), of whom 18 had to stop work at least temporarily after onset of HIV. After ART, 20 (83% of the sample) were engaged in some type of work, but for many it was not at the same level as before HIV. Also, most that previously had salaried employment were unable to return to the formal labor market. Two thirds of the sample reported having to sell off at least some of their land, capital, or household property after HIV, and few were able to buy it back after ART. A majority (67%) reported that economic support from family was instrumental after the onset of HIV, and for 38% this support continued to be necessary after ART. These findings highlight that while ART helps people to regain a capacity to work, other economic supports are needed to enable individuals and households to reestablish their livelihoods, especially in resource-constrained settings.