title: Do the socioeconomic impacts of antiretroviral therapy vary by gender? A longitudinal study of Kenyan agricultural worker employment outcomes.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors: Department of International Health, Boston University School of Public Health, Boston, MA 02118, USA. blarson@bu.edu
authors: Bruce A
authors: BA
authors: Larson
authors: Mathew P
authors: MP
authors: Fox
authors: Sydney
authors: S
authors: Rosen
authors: Margret
authors: M
authors: Bii
authors: Carolyne
authors: C
authors: Sigei
authors: Douglas
authors: D
authors: Shaffer
authors: Fredrick
authors: F
authors: Sawe
authors: Kelly
authors: K
authors: McCoy
authors: Monique
authors: M
authors: Wasunna
authors: Jonathan L
authors: JL
authors: Simon
mesh_terms: D000383:Agriculture; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D004651:Employment; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D007630:Kenya; D008137:Longitudinal Studies; D008297:Male; D012737:Sex Factors; D012959:Socioeconomic Factors
chemical_list: D019380:Anti-HIV Agents