When Care Comes Too Late: AIDS-Related Health Expenditure in a Mid-Sized Indonesian City

Indonesia’s HIV epidemic is heavily concentrated among high-risk groups, with men who have sex with men (MSM) contributing significantly to new cases. Yet, limited evidence exists on the financial burden when HIV progresses to AIDS. This study estimates the cost-of-illness among MSM with AIDS in Surakarta, a mid-sized Indonesian city representing many urban areas facing a rising HIV burden with constrained healthcare resources. Using a societal perspective, we used primary data from patient interviews and secondary data from national policies to estimate the costs. The total cost per person with AIDS was USD 1,567.65 (range: 1,074.70 -1,939.07), with hospitalization contributing the largest proportion, followed by outpatient services, productivity loss, and ARV. Sensitivity analysis revealed that hospitalization cost was the most influential parameter. The estimated cost exceeded ten times Indonesia’s per capita health expenditure (USD 150) and approached the annual minimum wage in Surakarta, suggesting a substantial risk of catastrophic health expenditure for low-income MSM. These findings highlight the urgent need to improve financial protection and scale up secondary prevention strategies, such as early diagnosis, early Antiretroviral Therapy (ART) initiation, and retention in care, to prevent progression to AIDS and reduce long-term economic consequences in a mid-sized urban setting.