 Bruce Larson Before 2004, workers at a large tea plantation in the southern Rift Valley Province of Kenya who contracted AIDS were likely to die within a year. But those odds have changed dramatically since the introduction of an HIV/AIDS treatment program that provides free antiretroviral therapy (ART) to the more than 10,000 tea company employees and their dependents.
As access to ART has grown in Africa, a team of researchers from the Center for Global Health and Development (CGHD) at BUSPH has sought to evaluate the impact on worker productivity. In a new study, the team found ART was making a significant difference in the ability of HIV-infected workers to continue in income-generating jobs - especially male workers. In the study, published in the journal BMC Public Health, the BU researchers analyzed payroll records for 97 HIV-infected tea estate workers and a comparison group of nearly 2,500 workers, over a three-year period covering two years before and one year after the infected workers initiated ART. They found that the productivity of male workers quickly improved after initiating ART, and that their employment outcomes were not distinguishable from the matched comparison group after seven months on ART. But for women, the work records told a different story. Women with HIV worked 30 percent fewer days plucking tea than the female comparison group, even by the 12th month on ART. The infected women had poorer employment outcomes, "mainly through being less productive while plucking, working fewer days plucking tea, and shifting to non-plucking work assignments," the study found. "Significant impaired [productivity] continued to exist among the female index group after one year on ART," the authors found. "Future research needs to explore further the socio-economic implications of HIV-infected female workers on ART being less productive than the general workforce over sustained periods of time." The study follows more preliminary research, published in the journal AIDS, showing that workers infected with HIV had increased their days plucking during the 12 months after initiating ART, but that even by the end of one year, they continued to work fewer days than a comparison group. The new study is more detailed, in terms of the gender breakdown, better comparison groups for analysis, and a more complete picture of employment outcomes, the authors said. They said that overall, their findings show that ART is not only keeping workers alive, but allowing many to remain productive. "If the tea pluckers included in this study had not initiated therapy, some 50 percent would likely have died by the end of the study period," the authors said. "Instead of dying, however, the results presented in this paper show that HIV-infected workers who accessed ART in this resource-limited setting returned to physically demanding, labor intensive activities after starting treatment." Researchers on the study include Bruce Larson, associate professor of international health; Matthew Fox, assistant professor of international health; Sydney Rosen, associate professor of international health; Kelly Mccoy, project manager at CGHD; and Jonathon Simon, director of CGHD and chair of international health. They were joined by researchers from the Kenya Medical Research Institute, the US Army Medical Research Unit-Kenya, and the Kenya Medical Research Unit. The full study is available online.
Submitted by Lisa Chedekel
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