Study quantifies the economic implications of living with HIV

A recent study, published in Nature Communications, shows that in the Netherlands, people who are diagnosed with HIV are less likely to be employed, work fewer hours, earn less income, and are more likely to receive disability benefits up to seven years after diagnosis.

The study, supported by the Amsterdam Research Centre for Health Economics and Management (ARCHEM) utilizes data from Stichting hiv monitoring (SHM) and Statistics Netherlands. It compares labor market outcomes of 5960 people diagnosed with HIV between 2010 and 2022 to a matched control group of 59,600 people drawn from the general population.

To date little is known of the impact living with HIV has on individuals' ability to participate in economic activity and the labor market. With this study we aim to provide first quantified estimates of the economic implications of living with HIV."

Andrei Tuiu, lead author of the study and PhD researcher, University of Amsterdam (UvA), SHM and the Amsterdam School of Economics

Economic implications

The article finds that the probability of being employed declines by four percent, work hours decrease by five percent and income declines by nine percent after HIV diagnosis. HIV also leads to a pronounced increase of 46 percent in the probability of receiving disability insurance or sickness benefits.

More specifically, when it comes to income, the study finds that annual earnings decline by about €3,584 after an HIV diagnosis. For this group of individuals the annual pre-diagnosis average income is €40,135.

Variations based on the stage of HIV diagnosis

The study also looks at whether the extent of the impact on individuals' labor market performance varies based on the stage of HIV at the time of diagnosis. A diagnosis is considered late-stage when the diagnosis takes place when HIV has already weakened an individual's immune system significantly.

"Overall, we found that the reductions in individuals' labor market performance were significant for people with HIV, regardless of the stage of the infection at diagnosis. The effect is however more pronounced for individuals with a late HIV diagnosis," Tuiu adds.

People with a late HIV diagnosis experience a larger decline in the probability of being employed than those with a timely diagnosis: approximately six percent compared to three percent respectively. Also a larger decline in work hours is reported: six percent compared to five percent respectively. A late HIV diagnosis also leads to a greater increase in the probability of receiving disability insurance or sickness benefits than a timely one: approximately 60 percent compared to 37 percent respectively. Income declines by about nine percent for both groups.

Improvements in existing prevention policies

Prof. dr. Marc van der Valk, chair of the board of Stichting hiv monitoring and specialist infectious diseases at Amsterdam University Medical Center, adds: "These are first of their kind results that quantify the economic impact of living with HIV in the Netherlands. As demonstrated, the impact is significant, and to our surprise also present in people who are diagnosed timely. While it is well-known that the impact on physical health is usually minimal in the case of a timely diagnosis, these less-apparent effects are new and need to be shared widely to inform and drive improvements in existing prevention policies to strengthen initiatives aimed at reducing new HIV infections. Furthermore, early detection remains essential since the impact of a late diagnosis was larger."

Interdisciplinary collaboration

Prof. dr. Menno Pradhan, UvA and VU School of Economics, concludes: This research demonstrates what interdisciplinary collaboration can achieve. By applying methods commonly used in labor economics to data from Stichting hiv monitoring—an organization with in-depth knowledge of the HIV epidemic in the Netherlands—we are able to generate new insights into the broader consequences of living with HIV."