Care and support by households and
extended families in the era of HIV
treatment: Responses to HIV and
AIDS in rural South Africa
Lucia Knight1, Victoria Hosegood2 and Ian Timæus3
1Human
Science Research Council, South Africa
of Southampton, United Kingdom
3London School of Hygiene &Tropical Medicine, United Kingdom
2University
Social science that makes a difference
Introduction
• The obligations and norms strengthening the African family are perceived
to have been eroded by social, economic and political factors1.
• AIDS could compound the pressures on the family 2,3.
• Despite this, there is limited investigation into the impact of AIDS on
family functioning.
Aims
• To explore:
• black South African families ability to respond to AIDS illness.
• factors motivating the provision of support by family.
• To asses:
• the applicability of family obligation and reciprocity as concepts.
• their contribution to social capital.
• where these concepts don’t apply.
Methodology
• 10 households from rural and peri-urban areas in Umkhanyakude, northern
KwaZulu-Natal with AIDS illness or death were enrolled.
• The household sample included:
– 5 from a local HBC program, 3 from ‘Household Dynamics’ study, 1 through VA
staff and 1 was an opportunistic contact.
• Using in-depth interviews and participant observation ethnographic,
retrospective and contemporary data were collected over 6 months.
• Data were compiled into household case studies and analysed crosssectionally using framework analysis.
Results
Family obligation
I just help my family, I think it is right to help other people… (Gugu)
• An obligation to, or reliance on, family was evident in all the households in
this study.
• The quality of the family relationship, influenced by contact, trust and
feelings of closeness also played a role in family obligation.
Results cont’d
Generalised reciprocity
…they are so helpful because when I don’t have something they give it to me and
what they don’t have I give to them…any kind [of help] even if it’s money, they had a
funeral and we helped them…Even if we don’t ask they give…It helps us get out of
trouble if we get what we need. (Precious)
• Reciprocity is maintained through family bonds, trust and economic or material
investment acting as social insurance.
• It seems that, regardless of family obligation, a degree of reciprocity is expected
of family if they are able.
Complex and conflicted circumstances
• Despite examples of family support some families failed to provide due to:
– limited resources
– obligations to other family, affecting their ability to behave, ‘like a member of the
family’.
• Family relationships are complex and did not always follow norms of obligation
or reciprocity. Some households felt excluded from kinship networks.
Discussion
• Family provided an important safety net to affected households and
individuals.
• Norms of family obligation and generalised reciprocity helped households
access the support required and form the building blocks of social capital.
• These norms had limits and inadequate resources. Excessive or conflicting
obligations restricted support resulting in social exclusion.
Conclusions and Recommendations
• Our findings show that these families are largely resilient.
• Given this resilience and social capital, the family needs adequate
consideration in future HIV interventions.
• Examples of social exclusion suggest that the resilience of the family should
not be taken for granted, those vulnerable or at risk must be supported
through community or government initiatives.
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Acknowledgements
•
•
Zandile Gumede and the staff of the Africa Centre for Health and Population Studies
Respondents from Umkhanyakude