In South Africa, Poor AIDS Patients Adopt Risky Ploy
April 7, 2006
Disability grants are practically the sole government welfare support for working-age adults in South Africa, where 40 percent of adults are jobless. Circumstances are so dire for some poor South African AIDS patients that they are intentionally skipping medication so they can be certified as sick enough to qualify for disability benefits, according to medical workers, academics and activists.
"For large numbers of HIV-infected South Africans with little prospect of finding employment qualifying for a relatively generous state grant offers hope to many struggling to survive," said Suzanne Leclerc-Madlala, anthropology chairperson at Durban's University of KwaZulu-Natal.
To qualify for the grant, patients must have a doctor certify the disability. For AIDS patients, that means having a CD4 count of 200 or below, and some hospitals have shifted it down to 50, a dangerously low immunity compared to the normal 500-1,500 range.
Some people have resorted to hiring stand-ins, patients with perilously low counts, and paying them $80-$160 to take the blood test, said Durban AIDS counselors. Some patients admit to having unprotected sex with others who also have HIV, in hopes of acquiring a disabling superinfection, said Leclerc-Madlala.
"There is growing evidence" that disability grant policy has given incentives for people "to become and/or remain ill, and that could be exacerbating the AIDS epidemic and undermining the [ARV] rollout," said Nicoli Nattrass, a University of Cape Town economics professor. In one study in a predominantly black township near Cape Town, the grants constituted almost half of total household income for recipients, said Leclerc-Madlala.
Academics and social advocates believe the government should tie welfare less to personal health, which is criticized as an expensive solution. Government officials are instead piloting a program that tests the physical abilities, like walking or seeing, of potential grant recipients.
"At the end of the day, she's the one who is going to suffer," said an AIDS counselor for Zolie, an AIDS patient endangering her health to gain disability status. "When I'm getting the grant, I'll be able to give my kids healthy food," such as apples, pears, bananas, oranges and maybe beef, said Zolie, a mother of two who requested anonymity. "Even if I die, my children will be better taken care of."
Wall Street Journal
04.07.2006; Michael M. Phillips
This article was provided by CDC National Prevention Information Network. It is a part of the publication CDC HIV/Hepatitis/STD/TB Prevention News Update.