HIV/AIDS, declining family resources and the community safety net

Abstract

Families play central roles in the HIV/AIDS pandemic, caring for both orphaned children and the ill. This extra caregiving depletes two family resources essential for supporting children: time and money. We use recent data from published studies in sub-Saharan Africa to illustrate deficits and document community responses. In Botswana, parents caring for the chronically ill had less time for their preschool children (74 versus 96 hours per month) and were almost twice as likely to leave children home alone (53% versus 27%); these children experienced greater health and academic problems. Caregiving often prevented adults from working full time or earning their previous level of income; 47% of orphan caregivers and 64% of HIV/AIDS caregivers reported financial difficulties due to caregiving. Communities can play an important role in helping families provide adequate childcare and financial support. Unfortunately, while communities commonly offer informal assistance, the value of such support is not adequate to match the magnitude of need: 75% of children's families in Malawi received assistance from their social network, but averaging only US$81 annually. We suggest communities can strengthen the capacity of families by implementing affordable quality childcare for 0–6 year olds, after-school programming for older children and youth, supportive care for ill children and parents, microlending to enhance earnings, training to increase access to quality jobs, decent working conditions, social insurance for the informal sector, and income and food transfers when families are unable to make ends meet.

Food Insecurity and CD4% Among HIV+ Children in Gaborone, Botswana

“…1 HIV infection has major implications for child rearing, family socioeconomic status, and the allocation of resources for meeting basic needs such as food, medical care, housing, and schooling. 2 Food insecurity, defined as the lack of physical or economic access (through socially acceptable means) to sufficient food to meet people's dietary needs for a productive and healthy life, 3 is also prevalent in Botswana where an estimated 27.9% were food insecure in 2010-2012. 4 Food insecurity is an important predictor of several adverse child health outcomes including undernutrition/nutrient deficiencies, developmental delay, and poor overall health.…”

“…6 A patient's continued disease progression, in turn, worsens household food insecurity by redirecting income, assets, and time from employment or food procurement to caregiving. 2,7 Moreover, food insecurity itself may adversely influence antiretroviral (ARV) medication adherence or absorption, further contributing to disease progression. 6 …”

Kenya’s Life Lessons through the Lived Experience of Rural Caregivers

“…In Kenya, a country in Sub-Saharan Africa, additional struggles are noted to include tribal strife, lack of access to clean water, reduced access to education, and the increasing number of deaths due to the HIV/AIDS pandemic (Govender et al 2012;Oramasionwu et al 2011; World Health Organization (WHO) Regional Office for Africa (2017)). Notably, HIV related deaths of parents have deprived many households of able-bodied members while leaving behind young orphans, cared for by older siblings, or cared for by other available family (Harrison et al 2014;Heymann and Kidman 2009;Lee et al 2014;Schatz and Seeley 2015). In recent years, the World Health Organization (WHO) Regional Office for Africa (2017) noted drought, food insecurity, cholera, measles, leishmaniosis, and dengue fever as causing increasing numbers of deaths throughout the country of Kenya, thus adding pressure with the continued AIDS/HIV Pandemic.…”

Using People to Cope with the Hunger: Social Networks and Food Transfers Amongst HIV/AIDS Afflicted Households in KwaZulu-Natal, South Africa

“…In addition, more informal networks of families and neighbors also play critical role in local HIV/AIDS responses. For example, family and neighbors form the core safety net for HIV/AIDS orphans in sub-Saharan Africa, and provide the basis upon which home-based care networks are established and sustained [6]. And perhaps equally important, but certainly less well understood, is the role played by these informal networks in providing material support in the form of private transfers; that is, gifts of money and food that are exchanged between friends and neighbors [7,8].…”