Socio economic impact of hivaids & mental health (Syed Aljunid)

International Institute For Global Health (UNU-IIGH) Socioeconomic Impact of HIV AIDS and Mental HealthProfessor Dr Syed Mohamed AljunidMD (UKM) MSc (Public Health)( Singapore) PhD (London);DLSHTM (London); FAMMProfessor of Health Economics & Senior Research FellowUnited Nations University-International Institute ForGlobal HealthKuala Lumpur Copyright of United Nations University-IIGH

OutlineHIV/AIDS and Mental Health: CommonIssuesChronic Diseases and PovertyHIV/AIDS: Current ScenarioBurden of Mental DisordersRoles of Community in HIV/AIDS andMental HealthConclusions Copyright of United Nations University-IIGH

HIV/AIDS and Mental Health COMMON FEATURES COMMUNITY SOCIAL RESOURCES STIGMA HIV/AIDSCHRONIC & INTERVENTIONS MENTAL HEALTH Copyright of United Nations University-IIGH

Chronic Diseases, Poverty and Development: The Link Copyright of United Nations University-IIGHThe Lancet: 376 (2010)

Five Reasons For Actions Against Chronic DiseasesChronic diseases are a major cause of poverty and poor health inLMICTechnological interventions will not overcome poverty and healthinequalities; addressing the determinants that underlie health will bemore effective at improving the health of the poorStraight forward interventions are feasible, and other cost-effectiveinterventions are availableThrough collaboration against infectious, chronic, and neglecteddiseases health systems will be prepared to meet all main challengesWithout prevention, the burden of chronic diseases will rise in low-income and middle-income countries, and they will continue to be asubstantial barrier to development The Lancet: 376 (2010)

HIV/AIDSCopyright of United Nations University-IIGH

Millennium Development Goals Copyright of United Nations University-IIGH

Global Prevalence of HIV: 2009 Copyright of United Nations University-IIGH

HIV/AIDs: Global Scenario Copyright of United Nations University-IIGH

HIV in Africa : 2009 Copyright of United Nations University-IIGH

No. of People Newly Infected with HIV Copyright of United Nations University-IIGH

Annual AIDS-Related Deaths(1990-2009) Copyright of United Nations University-IIGH

HIV in Asia : 2009 Copyright of United Nations University-IIGH

HIV/AIDS: Treatment Coverage inLow and Middle Income Countries (2010) Copyright of United Nations University-IIGH

HIV Spending in LMIC Copyright of United Nations University-IIGH

Social Economic Impact ofHIV/AIDs: Conceptua Framework Social Policy Public / Private Actual Health Retired Health Expenditure Expenditure Expenditure Supply of Labour Gross Savings capital Domestic Product Illness or Death Prevention and Treatment HIV/AIDS Copyright of United NationsSource: Karl Theodore, 2001 University-IIGH

Estimated and projected loss of labour force in 2000 and 2020 (%)Country 2000 2020Namibia 3.0 26.0Botswana 6.6 23.2Zimbabwe 9.6 22.7Mozambique 2.3 20.0South Africa 3.9 19.9Kenya 3.9 16.8Malawi 5.8 13.8Uganda 12.8 13.7Tanzania 5.8 12.7Central African Republic 6.3 12.6Côte dIvoire 5.6 11.4Cameroon 2.9 10.7

HIV in Malaysia8000 male70006000 female5000 Total4000300020001000 0 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 Copyright of United Nations University-IIGH

HIV in Malaysia (N=300) 8.40% 6.70% heterosexual Didn’t answer 19.50% bisexual72.10% 12.80% homosexual Copyright of United Nations University-IIGH

Mode of Transmission byGender (Malaysia, 2007) 90.0 83.0% 80.0 70.0 60.0 female 50.0 42.6% 40.7% male 40.0 30.0 20.0 13.6% 10.5% 10.0 6.2% 3.4% 0.0 needle sharing needle sharing or sexual activity others sexual activity Copyright of United Nations University-IIGH

Economic Burden of HIV in Malaysia (2007) (RM) Description Costing Type Cost (RM)Total inpatients cost of care in 2007 Direct 201,605,633Total Outpatients cost of care in 2007 Direct 67,104,951Total cost of ARVT for 6203 patients in Direct 50,332,6932007*Total out of pocket expenditure per year Direct 72,612,720*Total estimated productivity loss per Indirect 287,364,839yearTotal Direct + Indirect 679,020,836

National HIV/AIDS CostComponents (Malaysia, 2007) Total inpatients cost of care in 2007 30% Total estimated productivity loss per year 42% Total Outpatients cost of care in 2007 excluding ARVT 10% Total out of pocket Total cost of ARVT expenditure per year for 6203 patients in 11% 2007 7% Copyright of United Nations University-IIGH

Mental Health Copyright of United Nations University-IIGH

DALYS Associated with MentalHealth (2008): Global Copyright of United Nations University-IIGH

Global Cost of Mental Health:2010-2030 (USD Billion) Copyright of United Nations University-IIGH

Key Messages in MentalHealth Atlas 2011 (WHO)Insufficient Resources to treat and preventmental disordersResources for mental health is inequitabledistributedResources for Mental Health areinefficiently utilisedInstitutional care for mental disorders isslowly decreasing Copyright of United Nations University-IIGH

Key Messages in MentalHealth Atlas 2011 (WHO)Insufficient Resources to treat and preventmental disorders Global Spending: Less than USD 2 per person per year LIC: Less than USD 0.25 per person/year Global: Less than 3% of Government Health Budget is allocated for Mental Health More than half of the world population lives in a country with one or less psychiatrists per 200,000

Key Messages in MentalHealth Atlas 2011 (WHO)Resources for mental health isinequitable distributed Only 36% of people in LIC covered by mental health legislation vs 92% HIC Outpatient mental health facilities are 58 times more likely to be found in HIC vs LIC User/consumer organisation: 83% of HIC vs 49% in LIC Copyright of United Nations University-IIGH

Key Messages in MentalHealth Atlas 2011 (WHO) Resources for Mental Health are inefficiently utilised Global: 63% of mental health beds are in mental hospitals and 67% of mental health spending is in mental hospitals Institutional care for mental disorders is slowly decreasing Decrease of mental hospital beds between 2005-2011 Copyright of United Nations University-IIGH

Leading Causes of Diseases Burden, Malaysia 2000 TOTAL DALY Status & Rank Order Rank No DALY Total % Total 1 Ischaemic Heart Diseases 278,733 9.8% 2 All mental illness 206,898 7.3% 3 Cerebrovascular Disease/stroke 180,431 6.4% 4 Road Traffic Injuries 162,736 5.7% 5 All cancers 137,675 4.9% 6 Septicemia 127,714 4.5% 7 Diabetes Mellitus 103,449 3.7% 8 Acute Lower Respiratory tract infections 87,539 3.1% 9 Hearing loss 83,560 3.0% 10 Other respiratory disease 82,032 2.9% 11 Asthma 61,005 2.2% 12 Chronic obstructive pulmonary disease 60,728 2.1% 13 Cirrhosis 54,687 1.9% 14 Other cardiovascular diseases 51,315 1.8%

Socioeconomic Impact of Psychiatric Illness in Malaysia (2004) A total of 552 patients from 13 General Hospitals with Psychiatry Specialist Clinic were recruited. Cases Schizophrenia: 258 patients Depression: 192 patients Anxiety: 102 patients Followed up for One Year of United Nations Copyright University-IIGH

Social Impact 50 p=0.039* p<0.0005* p<0.0005* 45 p<0.0005* 40 35 30 Before Illness 25 20 First Visit 15 10 5 0 l ty ta n ia x ie s io To n re An es ph pr zo De hiSc

PATIENT INCOME (MEDIAN) 4,000 p=0.604 Time Before p<0.0005* First Visit Now 3,000 p<0.0005*Patient Income 2,000 p<0.0005* 1,000 0 schizophrenia depression anxiety Total Type of diagnosis

HOUSEHOLD DEBTCharacteristics Schizophrenia Depression Anxiety TotalHousehold (Before)Mean 142.97 178.66 129.29 152.86Median 0 0 0 0Minimum 0 0 0 0Maximum 3,000.00 3,500.00 2,100.00 3,500.00Household (First Visit)Mean 160.67 257.39 136.65 189.87Median 0 0 0 0Minimum 0 0 0 0Maximum 3,000.00 5,000.00 2,100.00 5,000.00p value (Wilcoxon Signed 0.017* 0.006* 0.066 <0.0005*Ranks Test)* significant at p < 0.05

Patients SF-36 (Social Functioning Domain) p<0.0005* p<0.0005* p=0.010* p<0.0005*807060504030 First Visit20 Follow-up10 0 l ty ta ia n xie sio To n re An es ph pr zo De hiSc

Cost per day of Stay (Schizophrenia) (RM) (2002_Levels of Mean N SD Minimum MaximumCareDistrict 167.19 200 136.31 16.89 765.77General 206.21 241 166.57 16.53 1,416.75Institutions 644.08 224 687.80 67.76 6,750.77Overalll 341.97 665 470.27 16.53 6,750.77

CE Ratio: Cost per Unit HONOS ScoreP<0.001

Community Roles in HIV/AIDS and Mental Health Involve community in treatment and prevention Incentives for community to participate Get community involved in Planning, Monitoring and Evaluation Copyright of United Nations University-IIGH

Community Role in HIV/AIDS and Mental Health Main issues Lack of community engagement Downplay the role of community Informal care not recognised Community role need resources Neglect of long term care (vs Curative Care) Copyright of United Nations University-IIGH

Community Role: InnovativeApproach Design more elaborate community programme Invest adequate resources Provide incentives for community involvement Monitor and share information Copyright of United Nations University-IIGH

ConclusionLink between Chronic illness and PovertyHIV/AIDS and Mental Disorders are chronic diseaseswith significant impact on socio-economyRe-organise health systems in developing countriesto response to these two conditionsIncrease in resources is important but efficientspending should be give a priorityCommunity involvement is very important forsustainability Copyright of United Nations University-IIGH

syed.aljunid@unu.edu saljunid@gmail.com www.unu.eduhttp://unuiigh-casemixonline.org Copyright of United Nations University-IIGH

Socio economic impact of hivaids & mental health (Syed Aljunid)

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