Amsterdam institute for Immunology and Infectious diseases

Groundbreaking Dutch study using linked healthcare and labor market data reveals the social costs of HIV and calls for reinforced prevention strategies.

Despite advances in HIV treatment, a recent study, published in Nature Communications, reveals that in the Netherlands, the economic impact of HIV remains significant, even for those diagnosed early and receiving immediate care. Using linked healthcare and labor market data, researchers found that people who are diagnosed with HIV are less likely to be employed, work fewer hours, earn less income, and are more likely to receive disability benefits up to seven years after diagnosis.

The study was supported by the Amsterdam Research Centre for Health Economics and Management (ARCHEM). It utilizes data from Stichting hiv monitoring (SHM) [1] and Statistics Netherlands. It compares labor market outcomes of 5960 people diagnosed with HIV between 2010 and 2022 to a matched control group [2] of 59,600 people drawn from the general population.

Adrei Tuiu, lead author of the study and PhD researcher at SHM, the Amsterdam School of Economics and the faculty Medicine of the University of Amsterdam (UvA), explains: 'To date little is known of the impact living with HIV has on individuals’ ability to participate in economic activity and the labor market. With this study we aim to provide first quantified estimates of the economic implications of living with HIV.'

The article finds that the probability of being employed declines by four percent, work hours decrease by five percent and income declines by nine percent after HIV diagnosis. HIV also leads to a pronounced increase of 46 percent in the probability of receiving disability insurance or sickness benefits.

More specifically, when it comes to income, the study finds that annual earnings decline by about €3,584 after an HIV diagnosis. For this group of individuals the annual pre-diagnosis average income is €40,135.

Variations based on the stage of HIV diagnosis

To further unravel the underlying mechanisms, the researchers linked labor market outcomes to CD4 cell count at the time of diagnosis, a key indicator of immune system health. A diagnosis is considered late-stage when the diagnosis takes place when HIV has already weakened an individual’s immune system significantly [3].

'Overall, we found that the reductions in individuals' labor market performance were significant for people with HIV, regardless of the stage of the infection at diagnosis. The effect is however more pronounced for individuals with a late HIV diagnosis,' Tuiu adds.

People with a late HIV diagnosis experience a larger decline in the probability of being employed than those with a timely diagnosis: approximately six percent compared to three percent respectively. Also a larger decline in work hours is reported: six percent compared to five percent respectively. A late HIV diagnosis also leads to a greater increase in the probability of receiving disability insurance or sickness benefits than a timely one: approximately 60 percent compared to 37 percent respectively. Income declines by about nine percent for both groups.

During the study period, immediate antiretroviral therapy (ART) after diagnosis was standard practice in the Netherlands, and access to treatment is universal. The study shows that even among people diagnosed early after presumed infection, there is still a measurable economic impact. This finding underscores that timely diagnosis and treatment, while crucial for physical health, do not fully mitigate the broader socioeconomic consequences of HIV.

Improvements in existing prevention policies

Prof. dr. Marc van der Valk, chair of the board of Stichting hiv monitoring and specialist infectious diseases at Amsterdam UMC, adds: 'These are first of their kind results that quantify the economic impact of living with HIV in the Netherlands. As demonstrated, the impact is significant, and to our surprise also present in people who are diagnosed timely. While it is well-known that the impact on physical health is usually minimal in the case of a timely diagnosis, these less-apparent effects are new and need to be shared widely to inform and drive improvements in existing prevention policies to strengthen initiatives aimed at reducing new HIV infections. Furthermore, early detection remains essential since the impact of a late diagnosis was larger.'

Funding

This study was supported by the Amsterdam Research Centre for Health Economics and Management (ARCHEM). The institute, founded by Amsterdam UMC (Amsterdam University Medical Centers), UvA-EB (Faculty of Economics and Business of the University of Amsterdam) and SEO (SEO Amsterdam Economics), serves as a hub for research collaborations within the Dutch healthcare system. ARCHEM research looks at the complex challenges in healthcare through the lenses of economics, management and the health sciences. The institute aims to be a bridge between research and healthcare practice – with emphasis on enabling adoption of research and innovation outcomes.

For more information contact Marc van der Valk (m.vandervalk@amsterdamumc.nl) or read the scientific publication below:

Labor Market Outcomes of People with HIV Pre- and Post-Diagnosis in the Netherlands | Nature Communications

University of Amsterdam and Amsterdam UMC researchers involved

Adrei Tuiu^1,3, lead author of the study and PhD candidate

Esmée Zwiers¹, PhD, Assistant Professor

Wendy Janssens¹, Professor in Development Economics

Vita Jongen^2,3,4, PhD, Senior researcher

Ard van Sighem^2,3, PhD, Senior researcher

Ferdinand Wit^2,3, PhD, Senior researcher

Menno Pradhan^1,5, Professor in Project and Program Evaluation for International Development

Marc van der Valk^2,3, Professor of Internal Medicine

¹Amsterdam School of Economics, University of Amsterdam, Amsterdam, the Netherlands

²Amsterdam Institute for Immunology and Infectious diseases (AI&I), Amsterdam UMC, the Netherlands

³Stichting hiv monitoring, Amsterdam, the Netherlands

⁴Department of Infectious Diseases, Public Health Service Amsterdam (GGD), Amsterdam, the Netherlands

⁵School of Business and Economics, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands

[1] Stichting hiv monitoring (SHM) prospectively collects data of 96% of people with HIV in care in the Netherlands. In academic publications the SHM dataset is also well known as the Dutch ATHENA Cohort.

[2] matches who have the same birth year, registered sex, migration background (native, first generation, and second generation) and highest education level achieved (low, medium, high, or missing) from the general population

[3] A late-stage HIV diagnosis is defined as a CD4 cell count below 350 cells/mm3 , and/or a simultaneous AIDS diagnosis.