BACKGROUND: People living with HIV (PLHIV) who use tobacco are at increased risk of infections and comorbidities, negatively impacting HIV treatment and control. Despite a higher prevalence of tobacco use among PLHIV than the general population, tobacco cessation interventions are often not integrated into HIV care. This study investigates the impact of tobacco expenditure on household spending patterns among PLHIV in Kenya, aiming to provide empirical evidence for allocating resources towards tobacco cessation programs.
METHODS: Using data from a 2023 household survey of 515 PLHIV in Kenya, including tobacco users and non-users, we computed the difference in the distribution of expenses between the two sets of user categories and then using appropriate econometric technics assessed whether the difference in 13 broad commodity groups was as a result of tobacco use. The commodities included food, clothing, education, housing, healthcare, entertainment, water, transport, energy, home care, personal care, alcohol, and household equipment. This approach allows us to assess the financial burden of tobacco expenditure on households and its potential to crowd out essential expenditures.
RESULTS: Households with tobacco expenditures allocated approximately 6.76% more of their total budget to healthcare (15.8% for non-users vs 14.8% for users; p=0.05), 1.2% more to clothing (5.01% vs 4.95%; p=0.014) and 20% more to entertainment (0.48% vs 0.4%; p=0.000). Conversely, non-tobacco users allocated 23.2% more to housing (5.26% for non-users compared to 4.27% for users; p=0.004), indicating potential of negatively impacting housing. All these results are statistically significant.
CONCLUSIONS: This study reveals the complex impact of tobacco expenditure on household budgets among PLHIV in Kenya, highlighting potential trade-offs and unexpected spending prioritization. Our findings underscore the need for integrated tobacco cessation interventions within HIV care programs to alleviate financial burdens, improve overall well-being, and contribute to better HIV treatment outcomes.