Abstract #316  -  With a little help from my friends: demand for membership of HIV/AIDS support groups among public sector ART clients in Free State province, South Africa
Authors:   Presenting Author:   Prof Frikkie Booysen - University of the Free State
Additional Authors:  Dr Damien De Walque, Dr Mead Over, Prof Alok Bhargava,
Aim: An integrated, multi-faceted response is required for an effective, sustainable ARV treatment programme. HIV/AIDS support groups represent a potentially important source of psychosocial support. Yet, little is known regarding the demand, access and willingness-to-pay for belonging to an HIV/AIDS support group. This paper aims to assess the magnitude and correlates of demand, access, cost and willingness-to-pay for membership of an HIV/AIDS support group among public sector ARV clients.
Method / Issue: In 2007/08, 655 newly initiated ART patients were recruited in the Effective Aids Treatment and Support in the Free State (FEATS) study. Structured, face-to-face interviews were conducted with patient and patient households by trained enumerators, who obtained written, informed consent from study participants. Descriptive statistics and multivariate regression models were estimated to assess the magnitude and correlates of demand, access, cost and willingness-to-pay for membership of an HIV/AIDS support group from a patient perspective.
Results / Comments: Seven in ten ART clients (463/655) expressed a demand for membership of an HIV/AIDS support group. Yet, one in ten (48/463) only of those expressing a demand for membership belonged to an HIV/AIDS support group, while 36.2% (159/439) were willing to pay to belong to such group. Mean and median willingness-to-pay for membership was ZAR25 and ZAR15 per visit respectively [IQR 10-30]. Mean and median out-of-pocket expenses for current support group members amounted to ZAR13 and ZAR8 per visit respectively [IQR 0-12]. Demand for HIV/AIDS support groups are significantly greater among ART clients with partners, ART clients who have not disclosed to all significant others, ART clients exhibiting support coping strategies, and healthier ART clients. ART clients whose partners did not live with them reported significantly greater access to support groups compared to single ART clients, while avoidant coping significantly constrained access. Access to a treatment supporter was positively and significantly associated with access to a support group. Willingness-to-pay was negatively and significantly associated with household dependency ratios and stigma. ART clients with depression were willing to pay significantly more to belong to a support group and so too PLWA who had accessed ARV treatment elsewhere prior to joining the public sector ART programme. Willingness-to-pay was also positively and significantly associated with income and treatment duration.
Discussion: There is a large, unmet demand for HIV/AIDS support groups among public sector ART clients in Free State province, South Africa. Willingness-to-pay data suggest that ART clients attribute relatively large, non-zero benefits to membership of an HIV/AIDS support group. Furthermore, the nature of membership and activities of existing support groups suggest that such groups may play an important role, not only in treatment support, but also in HIV prevention activities. Further research is required to determine the cost of effective, scalable models for providing HIV/AIDS support groups to ART clients in resource-poor settings. These cost estimates are required to conduct a cost-benefit analysis (CBA) of such intervention, which would aid in determining the feasibility of investing in the scale-up of HIV/AIDS support group interventions as part of effective, sustainable ARV treatment programmes.
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