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Private Sector Utilization of HIV/AIDS Services and Health Expenditures By People Living with HIV/AIDS in India: Findings from Five High-Prevalence States

Human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) are a critical challenge in India with an estimated 2.4 million people living with HIV/AIDS in 2007. Approximately two-thirds (65 percent) of people living with HIV/AIDS (PLWHIV) are in five high-prevalence states: Andhra Pradesh, Karnataka, Maharashtra, Manipur, and Tamil Nadu. The private health sector in India is large and heterogeneous and has grown considerably over time. The proportion of private health expenditures is also high in India and households bear nearly 75 percent of all health expenditures. However, little is known about the private sector's role in delivering HIV/AIDS-related services or about health expenditures by PLWHIV in India. This report seeks to address this information gap by examining two existing data sources: • Utilization of HIV testing and sexually transmitted infection (STI) treatment services from public, private for-profit, and private non-profit sources in the National Family Health Survey 2005-2006 (NFHS-3) •Health expenditures by PLWHIV in the United Nations Development Program (UNDP) 2006 Socio-Economic Impact Study of HIV/AIDS Uptake of HIV/AIDS testing services is relatively low in India. However, our analysis showed that the private for-profit sector was the dominant source of HIV testing for men in all states except Manipur and for women in all states except Manipur and Tamil Nadu. In most states the private for-profit sector accounted for over 50 percent of HIV testing. Of the poorest men and women who were ever tested for HIV, 40 percent and 30 percent, respectively, reported receiving their test at a for-profit facility. Interestingly, the non-profit sector accounted for a very small proportion of HIV testing: it provided less than 3 percent and 6 percent of HIV tests to ever-tested men and women, and was also a very small source of HIV testing to the poorest men and women.