Three economic studies on HIV in sub-saharan Africa

Since the early 1980s, HIV has been the largest adverse health shock many countries have faced to date, resulting in significant impacts on life expectancy and mortality, in tandem with major economic effects. Two-thirds of people living with HIV (PLHIV) live in Sub-Saharan Africa (SSA). As a result of significant progress made in prevention, diagnosis, and care, PLHIV now have a near-normal life expectancy. As the situation regarding HIV has improved in SSA, interventions aimed at preventing further infections, and supporting the ill, have evolved as well. Today, there is a large focus on living well with HIV, in addition to prevention and suppression programmes. In this thesis, I first investigate the economic consequences of HIV in Chapter 2. I focus on the gold mining industry, as it is an important industry in SSA, and there is a high prevalence of HIV among the mining workforce. I use a panel of 43 countries over a 28-year period and find evidence that the presence of HIV has a significant, downward impact on gold production. Next, in Chapter 3, I utilise data from a test and treat intervention, the PopART trial, and examine the impact of the trial on the distributional inequity of healthcare utilisation. I find a pro-rich inequity in healthcare utilisation, as ranked by wealth both before and even more so after the trial was implemented. “Pro-rich” implies, for example, that the 20% poorest make up less than 20% of healthcare utilisation. This suggests that the trial enabled the wealthier subset of the population to take better advantage of accessing healthcare. In Chapter 4, I continue to pursue the concept of subgroups, as I utilise the PopART data further to explore heterogeneous impacts of the trial on various health-related quality of life (HRQoL) outcomes. I study sex, wealth, and employment-type subgroups. I conclude that the trial has reduced HRQoL in certain treated populations compared to control subgroups.