Revealing the full extent of households' experiences of HIV and AIDS in rural South Africa

Households experience HIV and AIDS in a complex and changing set of environments. These include health and welfare treatment and support services, HIV-related stigma and discrimination, and individual and household social and economic circumstances. This paper documents the experiences of 12 households directly affected by HIV and AIDS in rural KwaZulu Natal, South Africa, between 2002 and 2004. The households were observed during repeated visits over a period of more than a year by ethnographically trained researchers. Field notes were analysed using thematic content analysis to identify themes and sub-themes. This paper focuses on three dimensions of household experience of HIV and AIDS that have received little attention in HIV and AIDS impact studies. First, that experience of HIV and AIDS is cumulative. In an area where population surveys report HIV prevalence rates of over 20% in adults, many households face multiple episodes of HIV-related illness and AIDS deaths. We describe how these challenges affect perceptions and responses within and outside households. Second, while over 50% of all adult deaths are due to AIDS, households continue to face other causes of illness and death. We show how these other causes compound the impact of AIDS, particularly where the deceased was the main income earner and/or primary carer for young children. Third, HIV-related illness and AIDS deaths of household members are only part of the households' cumulative experience of HIV and AIDS. Illness and death of non-household members, for example, former partners who are parents of children within the households or relatives who provide financial support, also impact negatively on households. We also discuss how measuring multiple episodes of illness and deaths can be recorded in household surveys in order to improve quantitative assessments of the impact of HIV and AIDS.     

Household dynamics and socioeconomic conditions in the context of incident adolescent orphaning in KwaZulu-Natal,South Africa

We compared demographics, socioeconomic status, and food insecurity between households with and without recent orphans in a region of high HIV/AIDS mortality in South Africa. We recruited a cohort of 197 recent orphans and 528 non-orphans aged 9–15 years and their households using stratified cluster sampling. Households were classified into three groups: orphan-only (N = 50), non-orphan-only (N = 377), and mixed (N = 210). Between September 2004 and May 2007, households were interviewed three times regarding demographics, income and assets, and food insecurity. Baseline bivariate associations were assessed using chi-square test and t-test. Longitudinal bivariate associations and multivariate models were tested using generalized estimating equations. At baseline, mixed households generally exhibited greater characteristics of vulnerability than orphan-only and non-orphan-only households. They were larger, had older, less-educated household heads, and reported a much smaller annual per capita income. Orphan households were more likely to report a death in the previous year and less likely to have an adult employed. These differences persisted over the study. Even non-orphan-only households exhibited characteristics of vulnerability, with 14% reporting a death one year before baseline, 45% of whom were prime-age adults. At baseline, a much smaller proportion of orphan households reported receiving the child support grant than the other household types, but notably, there were no differences among households in receipt of the grant by Round 3. Household food insecurity was highly prevalent: more than one in five orphan-only and mixed households reported being food insecure in the previous month. These findings suggest that the effects of HIV/AIDS only exacerbate existing high levels of poverty in the district, as virtually all households are vulnerable regardless of orphan status. Community-level programs must help families address a spectrum of needs, including food security, caregiving, and financial support, as well as better target social welfare grants and make them more accessible to vulnerable households.     

Illuminating cases: understanding the economic burden of illness through case study household research

Understanding the economic burden of illness for households can inform pro-poor health and social protection policy, yet research is in its infancy and appropriate methods require further debate. Quantitative studies are powerful when applied to the right health policy questions, including the measurement of illness cost burden indicators. However, this paper argues that not all dimensions of economic burden can be measured easily, some dimensions relevant to policy, such as social actors' responses to illness and their strategies to cope with illness costs, cannot be reduced to quantitative indicators at all, and large-scale surveys may overlook context-specific processes operating at household level that influence people's paths in and out of poverty as a result of illness. This leaves scope for longitudinal case-study household research to enhance understanding of economic burden and provide additional policy insights on how to better protect households from cost burdens and improve resilience. Drawing on the experience of research in urban Sri Lanka, the paper sets out several comparative advantages of case study research in this area. First, it complemented household survey data by revealing the complex and dynamic nature of illness costs and how these cost patterns (for example, sudden cost peaks) influenced household ability to manage costs. Secondly, it improved understanding of vulnerability or resilience to illness costs by capturing the diverse resources, within and outside the household, used by people to cope with illness costs, and the social institutions and decision-making processes that influenced access to them. Thirdly, the cases enabled the research to develop a picture of the inter-connected factors mediating the impact of illness on livelihood outcomes.     

Children affected by HIV

During the next 10 years, more than 40 million children will lose either one or both parents from AIDS, mostly in sub-Saharan Africa. In countries with a high rate of HIV infection, more than 33% of children will be orphaned and at risk of being moved from one household to another, or left to live alone in child-headed households. Many children are first affected by HIV when their parents develop HIV-related illnesses and become too sick to work or take their children for health care services, such as immunization and growth monitoring. In caring for their younger siblings, older children miss school. Children in households affected by HIV are often at considerable risk of poverty and malnutrition. Health workers and community-based workers can help protect the health of children affected by HIV by encouraging the establishment of community-based orphan support programs, recognizing HIV-affected families in greatest need and children at risk, and providing at-risk orphans with clothing, housing, food, and school fees.     

Female-headed households contending with AIDS-related hardship in rural South Africa

Mainstream research and the popular media often equate female-headship with household vulnerability, crisis, and disorganization. Epidemic levels of HIV/AIDS in some parts of sub-Saharan Africa compound this portrait of hopelessness. In South Africa, the impact of HIV/AIDS on households depends on race, class, and place. As female-headed households increase in number, we need to better understand how female-heads in poor rural areas contend with AIDS related challenges. We analyze qualitative interviews with 16 female heads and the members of their households in a rural community to examine the response to AIDS-related illness, death, or caring for orphaned children. Our analysis examines female-heads' financial and social resources and how these resources buffer against hardship in households affected by AIDS. We find considerable heterogeneity among rural female-headed households and their access to resources to combat AIDS-related hardship. Our findings have important policy implications both in terms of identifying individual and household vulnerabilities as well as leveraging the potential for resilience for female-heads in rural South African communities.     

Are health services protecting the livelihoods the urban poor in Sri Lanka? Findings from two low-income areas of Colombo

Investing in pro-poor health services is central to poverty reduction and achievement of the Millennium Development Goals. As health care financing mechanisms have an important influence over access and treatment costs they are central to the debates over health systems and their impact on poverty. This paper examines people's utilisation of health care services and illness cost burdens in a setting of free public provision, Sri Lanka. It assesses whether and how free health care protected poor and vulnerable households from illness costs and illness-induced impoverishment, using data from a cross-sectional survey (423 households) and longitudinal case study household research (16 households). The findings inform policy debates about how to improve protection levels, including the contribution of free health care services to poverty reduction. Assessment of policy options that can improve health system performance must start from a better understanding of the demand-side influences over performance.     

Household and community HIV/AIDS status and child malnutrition in sub-Saharan Africa: evidence from the demographic and health surveys

This paper examines the extent to which under five children in households or communities adversely affected by HIV/AIDS are disadvantaged, in comparison with other children in less affected households/communities. The study is based on secondary analysis of the Demographic and Health Survey (DHS) data collected during 2003-2008 from 18 countries in sub-Saharan Africa, where the DHS has included HIV test data for adults of reproductive age. We apply multilevel logistic regression models that take into account the effect of contextual community/country level HIV/AIDS factors on child malnutrition. The outcome variable of interest is child undernutrition: stunting, wasting and underweight. The results suggest that across countries in sub-Saharan Africa, children whose mothers are infected with HIV are significantly more likely to be stunted, wasted or underweight compared to their counterparts of similar demographic and socio-economic background whose mothers are not infected. However, the nutritional status of children who are paternal orphans or in households where other adults are HIV positive are not significantly different from non-orphaned children or those in households where no adult is infected with HIV. Other adult household members being HIV positive is, however, associated with higher malnutrition among younger children below the age of one. Further analysis reveals that the effect of mothers' HIV status on child nutritional status (underweight) varies significantly across communities within countries, the effect being lower in communities with generally higher levels of malnutrition. Overall, the findings have important implications for policy and programme efforts towards improved integration of HIV/AIDS and child nutrition services in affected communities and other sub-groups of the population made vulnerable by HIV/AIDS. In particular, children whose mothers are infected with HIV deserve special attention.     

Associations of poverty, substance use, and HIV transmission risk behaviors in three South African communities

The majority of the world's HIV infections occur in communities ravished by poverty. Although HIV/AIDS and poverty are inextricably linked, there are few studies of how poverty-related stressors contribute to HIV risk behavior practices. In this study, surveys were conducted in three South African communities that varied by race and socio-economic conditions: people living in an impoverished African township (N = 499); an economically impoverished but well infrastructured racially integrating township (N = 995); and urban non-impoverished neighborhoods (N = 678). Results showed that HIV/AIDS risks were closely related to experiences of poor education, unemployment, discrimination, violence, and crime. Although poverty-related stressors were associated with a history of alcohol and drug use, substance use did not moderate the association between poverty-related stressors and HIV risk behaviors. The findings suggest that HIV prevention strategies should not treat AIDS as a singled out social problem independent of other social ills.     

云南某城市社区艾滋病感染者家庭经济状况调查

目的通过凋查城市社区HIV感染者家庭和非HIV感染者家庭经济状况和医疗负担等,了解艾滋病对城市社区家庭造成的社会经济影响。方法随机抽取20个城市社区,根据当地疾病预防控制中心掌握的资料,抽取了100户HIV／AIDS家庭,再按2：1：1的比例在社区中选取吸毒非感染者家庭和一般家庭,采用自行设计的问卷,在经过专家论证和现场预试验后,用于正式入户调查．主要涉及3类家庭经济收入来源及金额、支出类别及金额、家庭成员健康状况及医疗负担等。结果调查发现HIV／AIDS家庭除经商和其他收入（包括低保、亲属和社会救济）较高外,固定工资、打工及副业收入均小于另外两类家庭。而支出方面HIV／AIDS家庭除教育支出较低外,其他与另外两类家庭差异无统计学意义。HIV感染者家庭的医疗负担要高于对照组家庭。结论艾滋病对城市家庭造成的影响在于就业率降低,家庭收入减少,医疗负担增加,消费能力下降,同时由于城市中社会支持网的缺乏,HIV感染者和艾滋病病人家庭难以在社会上立足．导致家庭社会功能丧失和家庭经济贫困。     

河南省4县艾滋病家庭收支及社区支持状况调查

目的了解4个项目县艾滋病感染者家庭的基本需求,为制定预防进一步传播、促进感染者健康生存和生活的综合社区健康促进策略提供依据。方法整群抽取患病家庭,然后按照一定的比例选取非患病家庭.采用联合国儿童基金会推荐的问卷对每个家庭的感染者进行现况调查。结果患病家庭的年经济收入、支出与非患病家庭相比有统计学差异（P〈0.05）,患病家庭的感染者艾滋病相关知识知晓率高于非患病家庭,二者有统计学差异（P〈0.01）,但对药物治疗、预防母婴传播及机会性感染的预防性治疗方面的信息仍然需要加强。结论社区综合健康促进策略可主要考虑提高患病者家庭的经济收入能力、药物依从性能力、机会性感染预防性治疗及预防母婴传播的能力。     

Men's involvement in the South African family: engendering change in the AIDS era

The literature on the South African family and its response to the HIV/AIDS epidemic is rife with accounts of men that reflect a deficit model of male involvement. Few acknowledge the historical, economic and social complexities of male involvement in family life. As the South African family undergoes demographic, social and economic transformation there is a need to describe the range of roles played by all household members, including men. This paper examines data collected over two and a half years from a small sample of households affected by HIV/AIDS in rural KwaZulu Natal, South Africa. Non-participant observations were made during outreach visits by research staff to twenty households caring for at least one adult with disease symptoms indicative of TB or AIDS. We find that men are positively involved with their families and households in a wide range of ways. They care for patients and children, financially support immediate and extended family members and are present at home, thereby enabling women to work or support other households. As the qualitative data demonstrate, however, such activities are often not acknowledged. The dominant perception of both female respondents and research assistants continues to be that men are not caring for their families because they are irresponsible and profligate. We consider reasons why this disjuncture exists and how more men might be encouraged to fulfil such roles and activities as their families and households suffer the social and economic impacts of HIV/AIDS.     

Food insecurity and mental health: Surprising trends among community health volunteers in Addis Ababa,Ethiopia during the 2008 food crisis

The 2008 food crisis may have increased household food insecurity and caused distress among impoverished populations in low-income countries. Policy researchers have attempted to quantify the impact that a sharp rise in food prices might have on population wellbeing by asking what proportion of households would drop below conventional poverty lines given a set increase in prices. Our understanding of the impact of food crises can be extended by conducting micro-level ethnographic studies. This study examined self-reported household food insecurity (FI) and common mental disorders (CMD) among 110 community health AIDS care volunteers living in Addis Ababa, Ethiopia during the height of the 2008 food crisis. We used generalized estimating equations that account for associations between responses given by the same participants over 3 survey rounds during 2008, to model the longitudinal response profiles of FI, CMD symptoms, and socio-behavioral and micro-economic covariates. To help explain the patterns observed in the response profiles and regression results, we examine qualitative data that contextualize the cognition and reporting behavior of AIDS care volunteers, as well as potential observation biases inherent in longitudinal, community-based research. Our data show that food insecurity is highly prevalent, that is it associated with household economic factors, and that it is linked to mental health. Surprisingly, the volunteers in this urban sample did not report increasingly severe FI or CMD during the peak of the 2008 food crisis. This is a counter-intuitive result that would not be predicted in analyses of population-level data such as those used in econometrics simulations. But when these results are linked to real people in specific urban ecologies, they can improve our understanding of the psychosocial consequences of food price shocks.     

The methodology of HIV/AIDS impact studies: a review of current practices

This review of studies on the socio-economic impact of HIV/AIDS shows that diversity in methodological design, which often is a result of practical considerations and resource constraints rather than of poor design, is the norm. This limits the comparability of research findings. More detailed reporting on method, which is not the norm, can go some way towards facilitating such comparison. Furthermore, the review underlines the importance of exploring intervention issues in more detail. Researchers need to employ results in answering specific policy questions. Scope remains for more impact studies to be conducted in developing countries in general and in certain high prevalence countries in specific, i.e. Southern Africa. Studies that explore the urban/rural dynamics of and clients' perceptions and behavior in seeking care and support are necessary to better understand the epidemic. The role of community-based organizations, non-governmental organizations and other stakeholders in studies of this nature can be expanded. Larger studies generally have more statistical power, but smaller, in-depth studies can be equally valuable. A careful stratification of sample populations can enhance the quality of cross-sectional studies. Qualitative methods should be used to complement the current reliance on survey-based methods of data collection. More longitudinal studies are required to explore the long-term impacts of HIV/AIDS. HIV/AIDS training for fieldworkers should be standard in studies of this nature, while cognizance should be taken of the dangers of employing local people as fieldworkers in studies of such sensitive nature. Scope remains for the further empirical analysis of data from impact studies, which requires these data sets being made accessible to more researchers. In the longer term, an attempt at standardizing core modules in impact studies can help to improve our understanding of the impact of HIV/AIDS in different settings.     

Relationships between poverty and AIDS Illness in South Africa: an investigation of urban and rural households in KwaZulu-Natal

The association between poverty and HIV/AIDS in Sub-Saharan Africa remains contested. A better understanding of the relationship between the prevalence of poverty and the disease is essential for addressing prevention, treatment, and care. The present study interrogates this relationship, using a cross-sectional survey of 2477 households in urban and rural KwaZulu-Natal, South Africa. Structural equation modelling was employed to estimate the correlations between poverty and AIDS illness. The analysis revealed a correlation of r_pb?=?0.23, denoting that a higher level of household poverty was associated with a higher likelihood of being AIDS-unwell. Post hoc t-test showed that receipt of a disability grant by AIDS-affected households was associated with significantly lower poverty, compared to AIDS-affected households not receiving the grant, t(654)?=?3.67, p?r_pb?=?0.15 (p?r_pb?=?0.16 (p?相似文献   

The environmental and social influences of HIV/AIDS in sub-Saharan Africa: a focus on rural communities

The Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) pandemic has caused far-reaching effects in sub-Saharan Africa. The pandemic has effectively diminished the workforce, increased poverty rates, reduced agricultural productivity, and transformed the structure of many rural households. HIV/AIDS further strains the already fragile relationship between livelihood and the natural and social environments of these regions. Therefore, the objective of this review is to characterize the impact of HIV/AIDS on the environment and the social infrastructure of rural sub-Saharan Africa. There are many aspects of rural life that contribute to disease transmission of HIV/AIDS and that pose unique challenges to the population dynamics in sub-Saharan Africa. Widespread AIDS-related mortality has caused a decrease in population growth for many African countries. In turn, these alterations in population dynamics have resulted in a decrease in the percentage of prime-age working adults, as well as a gender disparity, whereby, females carry a growing burden of household responsibilities. There is a rising proportion of older adults, often females, who assume the role of provider and caretaker for other dependent family members. These changing dynamics have caused many to exploit their natural surroundings, adopting less sustainable land use practices and utilizing protected resources as a primary means of generating revenue.     

Stigma, fatigue and social breakdown: exploring the impacts of HIV/AIDS on patient and carer well-being in the Caprivi Region, Namibia

It is generally assumed that caring is a substantial burden upon households afflicted by HIV/AIDS. However, as a 'private' household responsibility, little is known about the experiences of either those who provide the care, or those receiving care, despite the fact that the process may extend over several years and may have a greater impact upon the livelihood security and well-being of the household than the actual death of the ill person. Drawing upon data collected through solicited diaries, this paper explores how illness and the daily and long-term duties of caring amongst a sample of households in the Caprivi Region of Namibia impacts upon the physical and psychological well-being of ill people and their carers. While optimism and enhanced well-being were recorded during periods of illness remission, AIDS-related illnesses invariably result in periods of sickness and dependency. This results in disempowerment and lowered self-esteem, and decreased well-being amongst ill people. This paper argues that the increasing dependency of the ill person, widespread pressure to maintain household integrity through 'seeing for yourself', i.e. being self-sufficient, or at least contributing to reciprocal support networks, and the stigma attached to HIV/AIDS can result in considerable intra-household tension and breakdown of key social support networks.     

Project AID Khmer: Addressing the health impact of HIV/AIDS on Cambodia through rural capacity building

Abstract

HIV/AIDS prevention efforts in Cambodia have largely focussed on urban populations. This focus, however, has diverted attention from the impact of the disease on rural communities, where poverty and a lack of basic infrastructure forced many to migrate to urban areas. Rural communities thus play a crucial part in the understanding of HIV/AIDS transmission dynamics in Cambodia. This paper will provide an analysis of socio-economic and health-related needs of rural communities in Cambodia, giving a different context for understanding the national burden of HIV/AIDS. These concepts will be illustrated with experiences from Project AID Khmer, a Cambodian non-governmental organisation that is working to improve Cambodian health through education programmes and community capacity building in rural Takeo province.     

Stigma,fatigue and social breakdown: Exploring the impacts of HIV/AIDS on patient and carer well-being in the Caprivi Region,Namibia

It is generally assumed that caring is a substantial burden upon households afflicted by HIV/AIDS. However, as a ‘private’ household responsibility, little is known about the experiences of either those who provide the care, or those receiving care, despite the fact that the process may extend over several years and may have a greater impact upon the livelihood security and well-being of the household than the actual death of the ill person. Drawing upon data collected through solicited diaries, this paper explores how illness and the daily and long-term duties of caring amongst a sample of households in the Caprivi Region of Namibia impacts upon the physical and psychological well-being of ill people and their carers. While optimism and enhanced well-being were recorded during periods of illness remission, AIDS-related illnesses invariably result in periods of sickness and dependency. This results in disempowerment and lowered self-esteem, and decreased well-being amongst ill people. This paper argues that the increasing dependency of the ill person, widespread pressure to maintain household integrity through ‘seeing for yourself’, i.e. being self-sufficient, or at least contributing to reciprocal support networks, and the stigma attached to HIV/AIDS can result in considerable intra-household tension and breakdown of key social support networks.     

Overview on Current HIV/AIDS in Asia: "Some Implications for Food and Nutrition Security"

Although Asian countries in general face relatively low national HIV/ AIDS prevalence rates, there are serious localized epidemics in some countries that have important implications for food and nutrition security. The rapid development of the HIV/AIDS epidemic in African countries should serve as a warning to Asian countries. While some of the important modes of transmission of relevance to Asia are highlighted, the focus of this article is on the impact of the HIV/AIDS epidemic on the food security and nutrition situation at the household and community levels. Acknowledging the fact that HIV/AIDS is not merely a medical problem, the impact of the epidemic on nutritional issues, food production, income and the difficulties of poor households in coping with the situation are discussed. The article concludes with some remarks in relation to possible actions to mitigate the HIV/AIDS epidemic before it escalates beyond control in Asia.     

Orphan and vulnerable children infected or affected by HIV/AIDS in Delhi – situational analysis and state government's initiative of household economic strengthening

HIV epidemic brought a terrible toll on children and families worldwide. There are 25 million orphans in India from all causes, of which approximately two million may be attributed to HIV/AIDS. National AIDS Control Organization (NACO), Government of India, recently started focusing on orphan and vulnerable children (OVC) through Children Affected by AIDS (CABA) Pilot Scheme in 10 districts of the country including one district of Delhi. This study was conducted to describe the situation of OVC infected or affected by HIV/AIDS in Delhi and the process followed by Delhi State AIDS Control Society (DSACS) to enable grant of financial assistance to OVC infected or affected by HIV/AIDS from Government of Delhi and its implementation thereafter with overall objective of household economic strengthening of people living with HIV/AIDS (PLHIV). The data during April 2010–March 2012 from nine antiretroviral treatment (ART) centers, CABA pilot scheme, and two institutions providing residential care to CABA in Delhi were analyzed. Total number of OVC in Delhi is estimated to be 1908 of which 766 are infected with HIV and 1142 are affected by HIV/AIDS. Through CABA Pilot Scheme, few OVC could be linked to existing Government Welfare Schemes due to lack of essential documents. Hence, DSACS planned a special financial assistance scheme for PLHIV to retain CABA in home-based care. In the first six months, 6.8% PLHIV, 11.7% children living with HIV/AIDS, 9% double orphan children infected with HIV/AIDS, 9% double orphan children affected by HIV/AIDS, and 68% destitute children infected with HIV/AIDS received benefit of the scheme. To maximize impact, efforts are being made to develop linkages of cash transfer households with other social service providers. Strength, Weakness, Opportunity & Threat (SWOT) analysis has been done with aim to improve the scheme. A national policy to address the cause of OVC infected or affected by HIV/AIDS is need of the hour.