Comment: Households and HIV/AIDS

Abstract

The papers by Posel et al., Schatz, and Wittenberg & Collinson take three very different approaches to uncovering how HIV/AIDS is affecting members of households. Whereas Posel et al. are mainly concerned with local understandings of the disease and death [1], Schatz addresses the role of elderly women in caregiving [2], and Collinson & Wittenberg look at the trends over time in household composition in Agincourt and nationally [3]. Whereas the first two use primarily qualitative data to investigate the impact of HIV/AIDS on local residents, the Collinson & Wittenberg piece triangulates demographic surveillance data with sub-samples of nationally representative surveys to identify changing typologies of households that could be associated with HIV/AIDS mortality and morbidity. The message from all three papers is clear: HIV/AIDS features prominently in the way people think about their lives, in the gender and generational configuration of households, and in the ways in which people organize themselves, made evident by the distribution of household types at the population level. In reading the papers together, certain important connections should be highlighted. In terms of the unit of analysis, the Posel et al. paper focuses on the individual whereas the Schatz paper aggregates to the household level and the Wittenberg & Collinson paper examines the distribution of households at the population level. Indeed, this provides a useful layering of levels of analysis in order to examine HIV/AIDS and households. More substantively, the notion of ‘‘cultural death’’ raised in the Posel et al. paper can be seen in the other two papers, albeit more implicitly. The extensive role of grandmothers in caregiving, described by Schatz, could be seen as a break with traditional norms as can the increasing prevalence of ‘‘complex’’ households in the Wittenberg & Collinson analysis. The three papers present somewhat varying impressions of the extent of social crisis. Whereas Posel et al. and Schatz see the changes evident in Agincourt as generally very detrimental to the wellbeing of the residents, the third paper does not see a crisis situation, at least at this point in time. For example, Wittenberg & Collinson conclude that there is no evidence that individuals are becoming increasingly isolated residentially. Schatz’s data, however, show that elderly women in Agincourt feel financially isolated in the course of caring for children. This also illustrates the different pictures we gain from quantitative and qualitative research, and underscores the need for more integration of design and method. Whereas people may not be living alone in greater numbers, their ability to care for one another has become more limited. The three papers leave a set of issues that require further research. One, what is the role of religion, in particular through the charismatic churches that are proliferating in the area, in both influencing people’s ideas about disease and death as well as providing additional support in caregiving? Two, how do ageand gender-specific perceptions of the disease and death affect caregiving strategies? Three, to what extent do household typologies reflect people’s own constructions of what household means? Four, to what extent do household typologies assist in understanding community/household/individual levels of vulnerability and coping strategies? Five, how do we use these findings in the development of public health programmes in the district and region? Finally, these papers demonstrate a need to develop innovative ways to triangulate qualitative and quantitative data.