OBJECTIVES: The National AIDS Control Organization estimates that around 2.14 million people with HIV/AIDS live in India. The burden of HIV is particularly high among the socially isolated. With the lack of financial protection mechanisms in India, people face an increasing burden of out-of-pocket health expenditures (OOPHE) and catastrophic health expenditures (CHE) while paying for healthcare. The objective of this study is to examine the wealth-based inequities associated with the healthcare expenditures for HIV care and to analyze the income related inequalities, mapping the determinants and contribution of individual factors in driving these inequalities.

METHODS: National Sample Survey Data (2017-2018) is used for the analysis. Both Absolute and Generalized concentration indices was employed to estimate the concentration indices for CHE incurred on the treatment of HIV/AIDS in India. Need-based Indirect regression standardization was used to compute the measure of Horizontal inequities. Further, inter-regional and intraregional income related inequities was discerned in the outcomes of interest. Additionally, regression-based decomposition approach was applied to ascertain the contributions of both Policy amenable and non-Policy amenable factors in the measured inequalities.

RESULTS: After adjusting for the various socio-demographic factors and other comorbidities, the OOPHE experienced by the people with HIV/AIDS was INR 5,348 monthly. The proportion of households experiencing CHE due to HIV among the people living with HIV/AIDS in India was around 7.89% and the mean positive overshoot is 3.26%. Higher degree of inequality in experiencing the burden of CHE was found among the poor households, households that have less than high school educated) people, and people employed in the informal sector.

CONCLUSIONS: Identifying the various determinants of the OOPHE and CHE for HIV treatment will help the government to establish policies and direct public health actions to address the gaps and protect vulnerable groups from experiencing burden due to OOPHE and CHE.