title: Health expenditure and catastrophic spending among older adults living with HIV.
abstract: The burden of HIV is increasing among adults aged over 50, who generally experience increased risk of cormorbid illnesses and poorer financial protection. We compared patterns of health utilisation and expenditure among HIV-positive and HIV-negative adults over 50.
  
  
  
  Data were drawn from the Study on global AGEing and adult health in South Africa with analysis focusing on individual and household-level data of 147 HIV-positive and 2725 HIV-negative respondents.
  
  
  
  HIV-positive respondents reported lower utilisation of private health-care facilities (11.8%) than HIV-negative respondents (25.0%) (p = .03) and generally had more negative attitudes towards health system responsiveness than HIV-negative counterparts. Less than 10% of HIV-positive and HIV-negative respondents experienced catastrophic health expenditure (CHE). Women (OR 1.8; p < .001) and respondents from rural settings (OR 2.9; p < .01) had higher odds of CHE than men or respondents in urban settings. Over half the respondents in both groups indicated that they had received free health care.
  
  
  
  These findings suggest that although HIV-positive and HIV-negative older adults in South Africa are protected to some extent from CHE, inequalities still exist in access to and quality of care available at health-care services - which can inform South Africa's development of a national health insurance scheme.
authors.affiliation: a Sydney School of Public Health , University of Sydney , Sydney , Australia.
authors.forename: Joel
authors.initials: J
authors.lastname: Negin
authors.affiliation: a Sydney School of Public Health , University of Sydney , Sydney , Australia.
authors.forename: Madeleine
authors.initials: M
authors.lastname: Randell
authors.affiliation: b Centre for Health Systems and Safety Research , Australian Institute of Health Innovation, Macquarie University , Sydney , Australia.
authors.forename: Magdalena Z
authors.initials: MZ
authors.lastname: Raban
authors.affiliation: c Africa Centre for Health and Population Studies , University of KwaZulu-Natal , Mtubatuba , South Africa.|d School of Social Sciences , University of Southampton , Southampton , UK.
authors.forename: Makandwe
authors.initials: M
authors.lastname: Nyirenda
authors.affiliation: e Division of Geriatric Medicine , The Albertina and Walter Sisulu Institute of Ageing in Africa, University of Cape Town , Cape Town , South Africa.|f Groote Schuur Hospital, International Longevity Centre , Cape Town , South Africa .
authors.forename: Sebastiana
authors.initials: S
authors.lastname: Kalula
authors.affiliation: g Global Clinical and Viral Laboratories , Durban , South Africa.
authors.forename: Lorna
authors.initials: L
authors.lastname: Madurai
authors.affiliation: h Research Centre for Gender, Health & Ageing , University of Newcastle , Newcastle , Australia.|i World Health Organization, SAGE , Geneva , Switzerland.
authors.forename: Paul
authors.initials: P
authors.lastname: Kowal
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002388:Catastrophic Illness / Q000191:economics*; D005260:Female; D006679:HIV Seropositivity / Q000191:economics*; D005102:Health Expenditures; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D057566:Self Report; D013019:South Africa
keywords: HIV; South Africa; catastrophic health expenditure; health expenditure; older adults