Larson Bruce A, Fox Mathew P, Rosen Sydney, Bii Margret, Sigei Carolyne, Shaffer Douglas, Sawe Fredrick, McCoy Kelly, Wasunna Monique, Simon Jonathan L
Department of International Health, Boston University School of Public Health, Boston, MA 02118, USA.
BMC Public Health. 2009 Jul 15;9:240. doi: 10.1186/1471-2458-9-240.
As access to antiretroviral therapy (ART) has grown in Africa, attention has turned to evaluating the socio-economic impacts of ART. One key issue is the extent to which improvements in health resulting from ART allows individuals to return to work and earn income. Improvements in health from ART may also be associated with reduced impaired presenteeism, which is the loss of productivity when an ill or disabled individual attends work but accomplishes less at his or her usual tasks or shifts to other, possibly less valuable, tasks.
Longitudinal data for this analysis come from company payroll records for 97 HIV-infected tea estate workers (the index group, 56 women, 41 men) and a comparison group of all workers assigned to the same work teams (n = 2485, 1691 men, 794 women) for a 37-month period covering two years before and one year after initiating ART. We used nearest neighbour matching methods to estimate the impacts of HIV/AIDS and ART on three monthly employment outcomes for tea estate workers in Kenya--days plucking tea, days assigned to non-plucking assignments, and kilograms harvested when plucking.
The female index group worked 30% fewer days plucking tea monthly than the matched female comparison group during the final 9 months pre-ART. They also worked 87% more days on non-plucking assignments. While the monthly gap between the two groups narrowed after beginning ART, the female index group worked 30% fewer days plucking tea and about 100% more days on non-plucking tasks than the comparison group after one year on ART. The male index group was able to maintain a similar pattern of work as their comparison group except during the initial five months on therapy.
Significant impaired presenteeism continued to exist among the female index group after one year on ART. Future research needs to explore further the socio-economic implications of HIV-infected female workers on ART being less productive than the general female workforce over sustained periods of time.
随着非洲抗逆转录病毒疗法（ART）可及性的提高，人们开始关注评估ART的社会经济影响。一个关键问题是，ART带来的健康改善能在多大程度上使个人重返工作岗位并赚取收入。ART带来的健康改善还可能与减少出勤主义受损有关，出勤主义受损是指患病或残疾的个体出勤工作，但在其日常任务中完成的工作量减少，或者转向其他可能价值较低的任务时导致的生产力损失。
本分析的纵向数据来自97名感染艾滋病毒的茶园工人（索引组，56名女性，41名男性）的公司工资记录，以及分配到相同工作团队的所有工人组成的对照组（n = 2485，1691名男性，794名女性），为期37个月，涵盖开始ART前两年和开始ART后一年。我们使用最近邻匹配方法来估计艾滋病毒/艾滋病和ART对肯尼亚茶园工人三个月度就业结果的影响——采茶天数、分配到非采茶任务的天数以及采茶时收获的公斤数。
在ART前的最后9个月，索引组女性每月采茶天数比匹配的女性对照组少30%。她们在非采茶任务上的工作天数也多出87%。虽然开始ART后两组之间的月度差距缩小了，但在接受ART一年后，索引组女性采茶天数比对照组少30%，在非采茶任务上的工作天数多出约100%。男性索引组能够保持与对照组相似的工作模式，除了在治疗的最初五个月。
接受ART一年后，索引组女性中仍存在严重的出勤主义受损情况。未来的研究需要进一步探讨感染艾滋病毒的女性工人在ART治疗下长期生产力低于普通女性劳动力的社会经济影响。
