Trading off Income and Health?: AIDS and the Disability Grant in South Africa

Abstract

Despite high levels of unemployment, South Africa's welfare system is premised on full employment: only those who are too young, too old or too sick to work qualify for social assistance. A government committee recently recommended the introduction of a universal Basic Income Grant (BIG) to address this hole in the welfare net. Now that highly active antiretroviral thereapy (HAART) is being rolled out through the public health sector for people sick with AIDS, the case for a BIG is even more compelling. People sick with AIDS qualify for a disability grant. The HAART rollout offers them the chance of restored health – but it comes at the cost of losing the disability grant because they will be deemed well enough to work. Given South Africa's high unemployment rates, many will not be able to find work, and hence will face a trade-off between health (taking HAART) and income (keeping the disability grant). This could undermine adherence to HAART and/or reduce the effectiveness of the treatment by compromising the nutritional status of patients, thereby facilitating the growth of drug-resistant HIV. Introducing a BIG could help resolve this unintended tension between health and welfare policy.