AIDS-affected Households Research Articles

Contribution of microfinance in enhancing food access and coping strategy in aids-affected households in Kakamega County, Kenya

Acquired immune deficiency syndrome (AIDS) pandemic increases a family’s food insecurity by reducing the family’s ability to produce food, which compromises their output and income. This reduces their food availability, accessibility and acquisition, and interferes with regular nutritional intake. In response, households develop various coping strategies, especially in the context of food shortages. Arguably, microfinance (MF) has been advocated by many as an antidote to disasters affecting the households in different disaster contexts, such as famine, poverty, and tsunami occurrences. This study, therefore, sought to find out the contribution of MF to AIDS-affected households in terms of food access and coping strategies in Kakamega County, Kenya. Specifically, the study determined the effect of MF on the proportion of income spent on food, and number of meals consumed in a day. It also sought to illuminate the coping strategies adopted by AIDS-affected households with and without MF in the context of food shortages. This study adopted both qualitative and quantitative approaches with an experimental framework. A sample of 404 AIDS-affected household heads was included in the study. Findings from descriptive and inferential analyses revealed that over 50% of AIDS-affected households before MF were spending their income on food irrespective of loan status, and there was a highly statistically significant difference in the proportion of income spent on food by affected households with and without MF. Those households with MF spent almost twice of their income on food compared to those without MF. There was also a highly statistically significant difference in the number of meals consumed between those households with and without MF, in favour of those with MF. Households with MF took relatively more meals. Lastly, households without MF adopted more severe coping strategies when faced with food shortages. The study concluded that affected households with MF had easy access to food, ate the required number of meals and adopted less severe coping strategies. This was because MF services came as a package of money, training and advisory on business and health-related issues, which did not only improve household income but also enhanced food access and enabled adoption of less severe coping strategies in AIDS-affected households in Kakamega County. Key words : AIDS, Microfinance, Food, Security, Access, Affected, Non–affected, Coping strategy

The relationship between HIV and AIDS and water scarcity in Nyamakate resettlements land, north-central Zimbabwe

HIV and AIDS and water variability have been studied separately, yet, they impact on rural households simultaneously in an interactive manner. The study provide narratives on various realities from a study in the Nyamakate community that illustrates the dialectical relationship between HIV and AIDS and water scarcity. A qualitative research methodology was employed, and the following data collection tools were used: semi-structured interviews, focus group discussions (FGDs) and participant observations. The study showed that in the Nyamakate area, HIV- and AIDS-affected households utilise more water if there is a bedridden patient. Such households utilise an average of 145 litres per day and reported a water shortage of 103 litres per day. Although community rules and customs stipulate that water should be accessible to everyone, exclusion of HIV- and AIDS-affected households is underlined by cultural issues, scorn at poor levels of hygiene, infectious opportunistic infections and labour shortage, which limited access to water points by households directly affected by HIV and AIDS. In cases where women were overwhelmed with caregiving roles, men fetch water. We conclude that HIV and AIDS and water scarcity are dialectically related and hence should be considered in an interactive manner in order to understand the challenges faced by affected households.

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

ABSTRACTThe 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 rpb = 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 < .01. Geographic location was found to confound the correlation: the strength of the relationship between poverty and AIDS was decreased to rpb = 0.15 (p < .001) for the urban and rpb = 0.16 (p < .001) for the rural sub-population. Findings suggest the importance of two sets of policies: those that address the potential upstream risk of poverty through economic interventions, and those that alleviate the impoverishing effects of AIDS illness for affected households.

Rural young people's opportunities for employment and entrepreneurship in globalised southern Africa: the limitations of targeting policies

This paper is based on a study with rural young people in Malawi and Lesotho, focusing on their possibilities for accessing (self)employment in the face of the various constraints imposed by their poor rural situations. Participatory group exercises, combined with individual interviews in two rural villages, provided personal stories about jobs and businesses that the young people were engaged in, as well as previous experiences and future plans. Constraints, as well as enabling factors, working at both individual and structural levels were analysed. Policies intended to address the needs of young people tend to seek to target the most vulnerable, often on the basis of individual- and household-level characteristics (e.g. women, orphans and AIDS-affected households). We argue that this: (1) neglects the structural factors operating at national and global levels; and (2) fails to recognise that factors interact to produce vulnerability, rather than this being rooted in separate characteristics. We demonstrate that an intersectional approach, drawn from feminist studies, is a useful theoretical lens, which, in combination with a livelihoods perspective, helps illuminate the needs of rural young people. In situations characterised by high levels of poverty and multiple vulnerabilities, we argue that it can be costly and ineffective to try to decide ‘who is most vulnerable’; rather, resources can be more effectively spent in trying to improve conditions that will benefit all rural young people.

Factors associated with the Household Income of Persons Living with HIV/AIDS in China

This study provides a profile of 866 people living with HIV/AIDS (PLWHA) in three provinces in rural China and identifies factors associated with per-capita income in AIDS-affected households. The majority of the participants were female, married, had completed primary school, and were 30-49 years of age. Thirty percent of respondents lived in a household with at least one other HIV/AIDS patient and 15% had experienced the death of a household member due to HIV/AIDS. Therefore, health professionals should be aware of issues of grief and caregiver burnout among rural PLWHA and their families. Three-quarters of the respondents continued to work after being diagnosed with HIV/AIDS. Household per capita income was significantly higher for married individuals and those still working. Possible government and workplace policy initiatives that endeavor to increase income and mitigate the economic impact of HIV/AIDS on households are discussed.

The significance of gathering wild orchid tubers for orphan household livelihoods in a context of HIV/AIDS in Tanzania

We investigated the role of gathering and selling the edible tubers of wild orchids by children orphaned by AIDS as one of their livelihood strategies, through a household survey administered to 152 households in three villages in the Southern Highlands of Tanzania during 2006 and 2007. Additionally, several household heads were selected as case studies and subjected to an in-depth life-history interview. Overall, most households in the study villages were very poor. We made comparisons within a total sample of 57 households headed by children orphaned by AIDS, 43 adult female-headed AIDS-affected households, and 52 adult male-headed non-AIDS-affected households in terms of food security and wealth outcomes after engaging in orchid tuber-gathering activities. The findings reveal that the majority of the orphan heads of households regarded the gathering and selling of wild orchid tubers as the best option for satisfying their basic needs. This category of households gathered more orchid tubers than the male-headed non-AIDS-affected households but not more than the female-headed AIDS-affected households. Children in these households spent more time on tuber-gathering activities than did members of the other households but had fewer household assets. Almost all the orphan-headed households depended on the cash obtained from selling orchid tubers to purchase food throughout the year. However, we surmise that gathering and selling wild orchid tubers fails to pull these children out of poverty and functions merely as a survival strategy.

Home-based care for people living with AIDS in Zimbabwe: voluntary caregivers' motivations and concerns

Similar to the healthcare systems of other resource-constrained countries with a high prevalence of HIV and AIDS, Zimbabwe's healthcare system encourages communities and non-governmental organisations (NGOs) to support the public healthcare sector by initiating home-based care activities and training volunteers to assist households in caring for individuals living with HIV. As part of the response, groups of volunteers were formed to provide basic material, social, nursing, and other kinds of support to members of AIDS-affected households. My research in Bulawayo, Zimbabwe, shows that motives for volunteering included: 1) religious values; 2) desire for prestige; 3) empathy derived from witnessing the suffering caused by AIDS illness; 4) hope of securing caregiving support in the future; 5) hope of enlarging one's network of those with access to political and economic power; and 6) hope of receiving material benefits in the future. This study further documents that volunteers' commitment to caregiving diminished between the early 1990s and 2009 due to: 1) the stigma of HIV and AIDS; 2) lack of funding, preventing volunteers from providing the needed care; 3) the large numbers of sick who are discharged from hospitals and clinics into home care; and 4) volunteers' ‘burnout.’ Strengthening volunteers' motivations for caregiving and addressing their concerns are crucial for providing effective care for individuals living with HIV or AIDS. In Zimbabwe, improvement of voluntary caregiving programmes requires better integration with the national healthcare system at the clinic level as well as collaboration with NGOs, community leaders and church groups, which have the potential to positively influence volunteers' commitment to caregiving.

Evidence base for children affected by HIV and AIDS in low prevalence and concentrated epidemic countries: applicability to programming guidance from high prevalence countries

As global commitment grows to protect and support children affected by HIV and AIDS, questions remain about how best to meet the needs of these children in low prevalence settings and whether information from high prevalence countries can appropriately guide programming in these settings. A 2007 search for the evidence in low prevalence settings on situational challenges of HIV and AIDS-affected children and interventions to address these challenges identified 413 documents. They were reviewed and judged for quality of documentation and scientific rigor. Information was compiled across eight types of challenges (health and health care, nutrition and food security, education, protection, placement, psychosocial development, socioeconomic status, and stigma/discrimination); and also assessed was strength of evidence for situational and intervention findings. Results were compared to three programming principles drawn from research in high prevalence countries: family-centered preventive efforts, treatment, and care; family-focused support to ensure capacity to care for and protect these children; and sustaining economic livelihood of HIV and AIDS-affected households. Findings show that children affected by HIV and AIDS in low prevalence settings face increased vulnerabilities similar to those in high prevalence settings. These findings support seeking and testing programmatic directions for interventions identified in high prevalence settings. However, low prevalence settings/countries are extremely diverse, and the strength of the evidence base among them was mixed (strong, moderate, and weak in study design and documentation), geographically limited, and had insufficient evidence on interventions to draw conclusions about how best to reduce additional vulnerabilities of affected children. Information on family, economic, sociocultural, and political factors within local contexts will be vital in the development of appropriate strategies to mitigate vulnerabilities.

Out-of-pocket costs of AIDS care in China: are free antiretroviral drugs enough?

Financial access to HIV care and treatment can be difficult for many people in China, where the government provides free antiretroviral drugs but does not cover the cost of other medically necessary components, such as lab tests and drugs for opportunistic infections. This article estimates out-of-pocket costs for treatment and care that a person living with HIV/AIDS in China might face over the course of one year. Data comes from two treatment projects run by Médecins Sans Frontières in Nanning, Guangxi Province and Xiangfan, Hubei Province. Based on the national treatment guidelines, we estimated costs for seven different patient profiles ranging from WHO Clinical Stages I through IV. We found that patients face significant financial barriers to even qualify for the free ARV program. For those who do, HIV care and treatment can be a catastrophic health expenditure, with cumulative patient contributions ranging from approximately US$200–3939/year in Nanning and US$13–1179/year in Xiangfan, depending on the patient's clinical stage of HIV infection. In Nanning, these expenses translate as up to 340% of an urban resident's annual income or 1200% for rural residents; in Xiangfan, expenses rise to 116% of annual income for city dwellers and 295% in rural areas. While providing ARV drugs free of charge is an important step, the costs of other components of care constitute important financial barriers that may exclude patients from accessing appropriate care. Such barriers can also lead to undesirable outcomes in the future, such as impoverishment of AIDS-affected households, higher ARV drug-resistance rates and greater need for complex, expensive second-line antiretroviral drugs.

AIDS, women, land, and natural resources in Africa: current challenges

AIDS-affected households in rural Africa often turn to natural resources as a livelihood safety net. Yet women affected by AIDS have less time for sound resource management, and indigenous knowledge is lost when parents die before educating their children. As demand and inappropriate use grow, resource depletion and land degradation increase. In many countries, widows cannot inherit land. As poverty deepens in the wake of AIDS, women and girls are often forced into prostitution, accelerating the spread of HIV. Multi-sectoral approaches by development, health, and environmental organisations can reduce the impact of HIV and AIDS on women, rural communities, and the natural environment, through health work integrated with alternative livelihoods and women's empowerment.

Under the radar: Community safety nets for AIDS-affected households in sub-Saharan Africa

Safety nets are mechanisms to mitigate the effects of poverty on vulnerable households during times of stress. In sub-Saharan Africa, extended families, together with communities, are the most effective responses enabling access to support for households facing crises. This paper reviews literature on informal social security systems in sub-Saharan Africa, analyses changes taking place in their functioning as a result of HIV/AIDS and describes community safety net components including economic associations, cooperatives, loan providers, philanthropic groups and HIV/AIDS initiatives. Community safety nets target households in greatest need, respond rapidly to crises, are cost efficient, based on local needs and available resources, involve the specialized knowledge of community members and provide financial and psycho-social support. Their main limitations are lack of material resources and reliance on unpaid labour of women. Changes have taken place in safety net mechanisms because of HIV/AIDS, suggesting the resilience of communities rather than their impending collapse. Studies are lacking that assess the value of informal community-level transfers, describe how safety nets assist the poor or analyse modifications in response to HIV/AIDS. The role of community safety nets remains largely invisible under the radar of governments, non-governmental organizations and international bodies. External support can strengthen this system of informal social security that provides poor HIV/AIDS-affected households with significant support.

SIMBA – supporting the income and basic needs of AIDS-affected households in Zimbabwe

CARE's SIMBA programme, which targets vulnerable households affected by HIV/AIDS in Zimbabwe, works with AIDS Service Organizations (ASOs) to deliver microfinance services and micro-enterprise training. The ASOs help in the formation of groups that start by building up a savings fund and then make small loans from this fund to group members for business and emergency needs. The self-managed, savings-based approach has been important for clients building up assets in preparation for a time of sickness, and in supporting clients who might otherwise be excluded from a mainstream microfinance institution.

Breaking the silence: using memory books as a counselling and succession-planning tool with AIDS-affected households in Uganda

This article reviews the experience of NACWOLA and Save the Children (UK) in using 'memory books' in AIDS-affected households in Uganda from the mid-1990s to the present. Semi-structured interviews were carried out with key stakeholders in early 2004, including NACWOLA staff and volunteers, Save the Children staff and project participants, such as children, counsellors and local government members. The aim was to investigate the process by which the Memory Book project was developed, its positive and negative impacts at different levels, the costs and what lessons had been learned from the experience to date. A number of significant constraints are highlighted, but the article concludes that memory books, when properly linked to other support mechanisms, have been very effective at improving communication and relationships between parents and children, confronting stigma in the community and encouraging joint planning for the children's future. We recommend that this or similar approaches be incorporated in all AIDS programmes.