The toll of HIV and AIDS on households can be very severe. Although no part of the population is unaffected by HIV, it is often the poorest sectors of society that are most vulnerable to the epidemic and for whom the consequences are most severe. In many cases, the presence of AIDS causes the household to dissolve, as parents die and children are sent to relatives for care and upbringing. A study in rural South Africa suggested that households in which an adult had died from AIDS were four times more likely to dissolve than those in which no deaths had occurred.8 Much happens before this dissolution takes place: AIDS strips families of their assets and income earners, further impoverishing the poor.
Household Income
An HIV positive woman in Joza
In Botswana it is estimated that, on average, every income earner is likely to acquire one additional dependent over the next ten years due to the AIDS epidemic. A dramatic increase in destitute households – those with no income earners – is also expected.9 Other countries in the region are experiencing the same problem, as individuals who would otherwise provide a household with income are prevented from working by HIV and AIDS – either because they are ill themselves or because they are caring for another sick family member. Such a situation is likely to have repercussions for every member of the family. Children may be forced to abandon their education and in some cases women may be forced to turn to sex work ('prostitution'). This can lead to a higher risk of HIV transmission, which further exacerbates the situation.
Another study in three countries, Burkina Faso, Rwanda and Uganda, has calculated that AIDS will not only reverse progress in poverty reduction, but will also increase the percentage of people living in extreme poverty (from 45% in 2000 to 51% in 2015).
Basic Necessities
A study in South Africa found that already poor households coping with members who are sick from HIV or AIDS were reducing spending on necessities even further. The most likely expenses to be cut were clothing (21%), electricity (16%) and other services (9%). Falling incomes forced about 6% of households to reduce the amount they spent on food and almost half of households reported having insufficient food at times.
"She then led me to the kitchen and showed me empty buckets of food and said they had nothing to eat that day just like other days."
Food Production
The AIDS epidemic adds to food insecurity in many areas, as agricultural work is neglected or abandoned due to household illness. In Malawi, where food shortages have had a devastating effect, it has been recognised that HIV and AIDS are diminishing the country’s agricultural output.13 It is thought that by 2020, Malawi’s agricultural workforce will be 14% smaller than it would have been without HIV and AIDS. In other countries, such as Mozambique, Botswana, Namibia and Zimbabwe, the reduction is likely to be over 20%.
A recent study in Kenya demonstrated that food production in households in which the head of the family died of AIDS were affected in different ways depending on the sex of the deceased. As in other sub-Saharan African countries, it was generally found that the death of a male reduced the production of ‘cash crops’ (such as coffee, tea and sugar), while the death of a female reduced the production of grain and other crops necessary for household survival.
Healthcare expenses and funeral costs
Taking care of a person sick with AIDS is not only an emotional strain for household members, but also a major strain on household resources. Loss of income, additional care-related expenses, the reduced ability of caregivers to work, and mounting medical fees push affected households deeper into poverty. It is estimated that, on average, HIV-related care can absorb one-third of a household’s monthly income.
The financial burden of death can also be considerable, with some families in South Africa spending three times their total household monthly income on a funeral.
How do HIV/AIDS affected households cope in Africa?
Three main coping strategies appear to be adopted among affected households. Savings are used up or assets sold; assistance is received from other households; and the composition of households tends to change, with fewer adults of prime working age in the households.
Almost invariably, the burden of coping rests with women. Upon a family member becoming ill, the role of women as carers, income-earners and housekeepers is stepped up. They are often forced to step into roles outside their homes as well. In parts of Zimbabwe, for example, women are moving into the traditionally male-dominated carpentry industry. This often results in women having less time to prepare food and for other tasks at home.
"I used to stay with the children, but now it is a problem. I have to work in the fields. Last year I had more money to hire labour so the crops got weeded more often. This year I had to do it myself.”
-Angelina, Zimbabwe
Tapping into savings if available and taking on more debt are usually the first options chosen by households struggling to pay for medical treatment or funerals. Then as debts mount, precious assets such as bicycles, livestock and even land are sold. Once households are stripped of their productive assets, the chances of them recovering and rebuilding their livelihoods become even slimmer.
The number of working adults in a family will often decrease.
“Our fields are idle because there is nobody to work them. We don't have machinery for farming, we only have manpower - if we are sick, or spend our time looking after family members who are sick, we have no time to spend working in the fields."
-Toby Solomon, commissioner for the Nsanje district, Malawi
One of the more unfortunate responses to a death in poorer households is removing the children (especially girls) from school. Often the school uniforms and fees become unaffordable for the families and the child's labour and income-generating potential are required in the household.
“Because I’m a poor African woman, I can’t raise enough money for three orphans. The one in secondary school, sometimes she misses first term because I’m looking for tuition. The others miss schools for two or three days at a time. I had a cow I used to milk, but as time went on the cow died, so I can’t find any other income…”
-Barbara, Uganda
http://www.avert.org/aidsimpact.htm
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