title: Antiretroviral therapy, labor productivity, and sex:  a longitudinal cohort study of tea pluckers in Kenya.
abstract: OBJECTIVE
  To estimate the impact of antiretroviral therapy (ART) on labor productivity and income using detailed employment data from two large tea plantations in western Kenya for HIV-infected tea pluckers who initiated ART.
  
  
  METHODS
  Longitudinal study using primary data on key employment outcomes for a group of HIV-infected workers receiving antiretroviral therapy (ART) and workers in the general workforce.
  
  
  METHODS
  We used nearest-neighbor matching methods to estimate the impacts of HIV/AIDS and ART among 237 HIV-positive pluckers on ART (index group) over a 4-year period (2 years pre-ART and post-ART) on 4 monthly employment outcomes - days plucking tea, total kilograms (kgs) harvested, total days working, and total labor income. Outcomes for the index group were compared with those for a matched reference group from the general workforce.
  
  
  RESULTS
  We observed a rapid deterioration in all four outcomes for HIV-infected individuals in the period before ART initiation and then a rapid improvement after treatment initiation. By 18-24 months after treatment initiation, the index group harvested 8% (men) and 19% (women) less tea than reference individuals. The index group earned 6% (men) and 9% (women) less income from labor than reference individuals. Women's income would have dropped further if they had not been able to offset their decline in tea plucking by spending more time on nonplucking assignments.
  
  
  CONCLUSIONS
  HIV-infected workers experienced long-term income reductions before and after initiating ART. The implications of such long-term impacts in low-income countries have not been adequately addressed.
authors.affiliation: Center for Global Health and Development, Boston University, Boston, MA, USA. blarson@bu.edu
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Larson
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Fox
authors.forename: Margaret
authors.initials: M
authors.lastname: Bii
authors.forename: Sydney
authors.initials: S
authors.lastname: Rosen
authors.forename: Julia
authors.initials: J
authors.lastname: Rohr
authors.forename: Douglas
authors.initials: D
authors.lastname: Shaffer
authors.forename: Fredrick
authors.initials: F
authors.lastname: Sawe
authors.forename: Monique
authors.initials: M
authors.lastname: Wasunna
authors.forename: Jonathon L
authors.initials: JL
authors.lastname: Simon
mesh_terms: D000041:Absenteeism; D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy / Q000191:economics / Q000453:epidemiology*; D000328:Adult; D000383:Agriculture; D019380:Anti-HIV Agents / Q000191:economics / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D004526:Efficiency; D004651:Employment; D005260:Female; D006679:HIV Seropositivity / Q000188:drug therapy / Q000191:economics / Q000453:epidemiology*; D006801:Humans; D007182:Income; D007630:Kenya / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011050:Policy Making; D017678:Sex Distribution; D013662:Tea; D014937:Work; D016526:Workload / Q000191:economics
chemical_list: D019380:Anti-HIV Agents; D013662:Tea