Before the gold standard in HIV treatment—called HAART, for “highly active antiretroviral therapy”—came along in the mid-90s, untreated people could expect to live about 10 years after they were infected by HIV. HAART, a combination of several HIV drugs, transformed HIV from a death sentence to a chronic, survivable condition, prolonging life by several decades. Within two years of becoming available, it lowered HIV mortality rates by 80 percent.
A New York Times story from 2001 describes how radically the introduction of this combination therapy changed HIV-positive peoples’ thinking and priorities:
Assuming that their days were numbered in the hundreds, some quit their jobs, took their savings and spent what they had to make the most of their remaining time. Only now, with an ever-evolving regimen of drugs, many are not dying and instead, like Mr. Schliemann, are living full lives.
Now, a new NBER working paper suggests the treatment also gave a group of HIV-positive women a new lease on life—so much so that some of them quit using drugs and left their physically abusive partners.
For the study, the researchers looked a group of largely minority, low-income women in the Women’s Interagency HIV Study, a longitudinal study that began in 1994, and measured their mental and physical health, as well as rates of drug abuse and the amount of domestic violence they experienced, before and after the introduction of HAART.
At the outset, these women had very rough lives. Before HAART, 29 percent experienced domestic violence, while 28 percent used stimulants like crack cocaine. After the introduction of HAART, though, the rate of domestic violence among the women decreased by 10 percent, and the rate of drug use went down by 15 percent.
Surprisingly, the authors found changes to the women’s physical or mental health couldn’t explain the difference. Instead, there’s some evidence that their employment prospects improved. The relationship is speculative, but the authors suspect the women might have been motivated to give up drugs or get jobs because they knew they would be living longer. Once employed, the financial freedom might have allowed them to leave their abusive partners.
Right after the introduction of HAART, the researchers saw “hopefulness” increase among the HIV positive women—even though not all of the women were actually taking the treatment. The mere prospect of a healthy future, in other words, might have led them to make different decisions about their lives.
“If you give a group of people a longer lifespan, it gives them a chance to invest in themselves,” said lead author Nicholas Papageorge, a Johns Hopkins economist. “One element of that is the incentive to leave an abusive partner.”
The study didn’t capture what exactly the women were thinking, but it’s possible they could have ditched their violent partners once they realized they wouldn’t need someone to care for them as their AIDS progressed. Then, they might have thought, “we used to shoot up heroin together but now that he’s not around, I’m not going to do that anymore,” Papageorge suggested. “I bet you all of those things happened.”
The study is just another example, Papageorge said, of how access to health care doesn’t just extend lives, it can also affect seemingly intractable problems like violence or drug use. That finding echoes past work showing that advances in maternal health helped boost labor-force participation among women. The advent of prenatal care, antibiotics, and medicalized childbirth starting in the 1930s made it so women no longer lost 1.17 “life-years” to disabilities, such as rectovaginal fistulas, as a result of each pregnancy, that study found.
Though the AIDS crisis is now no longer at its peak, Papageorge said his study and others like it are a reminder that there can be surprising consequences to denying poor people access to health care. It’s something that’s worth keeping in mind as policymakers attempt, once again, to restructure the American health-care system in coming weeks.
