Hearing the Ants Walk: Micro- economic level impact of HIV/AIDS on African households Gabriel Rugalema, PhD Senior Policy Adviser, UNAIDS UNDP Africa Regional Project for HIV and Development Pretoria, South Africa

Why micro-economic focus? - Illness and hence care provision are experienced at this level - Deaths and funerals too are occurring at this level - Impact on survivors is borne at household level - Overall, households bear the gravest impact of the epidemic.

Conceptualising the impact of HIV/AIDS on households - Entitlement failure – Survivors’ rights and access to economic and social resources are severely affected. - Long-wave disaster – The impact is intergeneration - Series of crises – demographic, social, and economic crises.

The three conceptual frameworks fit into one another pretty well. I will elaborate on “AIDS as a series of crises.” - First is the crisis of ill-health (1 st individual) Crisis of ill health gives rise to crises of labour, income, expenditure, social expectation, physical and social assets.

The second crisis is death [for simplicity call it 1 st AIDS death] - This crisis is also accompanied by crises related to assets (disposal, disinheritance), income, expenditure, labour, nutrition, social claims and expectation, disinvestment in [future] human capital. Crises 1 & 2 are essentially demographic. The change in demographic composition sets a chain reaction of crises of varying nature and magnitude including dissolution of affected households.

Why is HIV/AIDS different? - Demographic crisis does not stop on first illness and death. The first death is invariably followed by another or others in the course of time. Households that have experienced multiple deaths are very common on the African continent today. - Each crisis of illness and death is accompanied by specific social, psychological and economic crises. Some of these crises feeds into further mortality particularly among child survivors.

The other peculiarity of HIV-related illnesses is that they are characterised by a sequence of ever increasing severity interrupted by brief periods relief. This constitutes a series of crises and relief in which crises outweighs relief as the patient moves from intermittent illnesses to chronic ill-health and eventual death. ==See Kabumbilo’s case study for elaboration==

Kabumbilo’s Kabumbilo’s household st 1 st Phase April 1995 – July Kabumbilo fells ill on/off – severe over time - Wife pregnant and sickly--the children and Kabumbilo’s mom provides physical care - Assets disposed of include cattle, timber tree,bicycle and Kabumbilo’s income from carpentry collapses. Farm overtaken by weeds as well. - Wife delivers sickly daughter and quickly resumes her roles and responsibilities as mother, wife, carer, and provider. - Kabumbilo dies July 1996 survived by a widow and four young children.

2 nd Phase August 1996 – June Widow try to pick up the pieces - Cattle is transferred from the household - Oldest son (then 7) is fostered by paternal grandmother’s brother - Youngest child sickly - Farm no longer productive - Food and cash severely lacking - All three children in the household have malnutrition - Youngest child very ill for over 6 months - No money, no palliative care - Youngest child dies in June 1998

3 rd Phase July May Household membership has shrunk from 6 to 3 people. - Widow sickly most of the time - Mother in-law, hitherto a pillar of support dies suddenly (heart attack due to extreme stress?) in April Food and money very scarce - Widow and orphans have severe malnutrition - Life dependent on neighbours and relatives - Widow severely sick throughout Widow taken by her mother for care, two children left behind under the care of severely disabled uncle.

4 th Phase June 2000 – May Widow dies June One fostered by disabled uncle and the other is fostered by one of the aunties - First son who had been fostered immediately after his father’s death dies in April 2001 aged 11 - The daughter fostered by her aunt is maltreated and comes to stay with disabled uncle - Uncle fells ill now and then (leukemia) and losses his tailoring business - Food and cash very scare – the orphans and their four children nephews are all malnutritioned - Uncles wife embarks on casual labour - She is the sole family provider at the moment!!

Conclusion - HIV/AIDS constitutes a series of crises mostly borne at micro level. - Such crises are invariably experienced differently by different people according to gender and age. The time dimension is important - Most such crises impacts on development of household, family, community,and nation. - Analysing the developmental implications of AIDS and reporting on them objectively is critical.

Conclusion cont’d - Interventions that would postpone or even prevent premature death (e.g. ARVs) are critical and should be universally available - Interventions that would limit or do away with asset disposal are critical as well. These would probably cut the link between AIDS death and intensification of poverty in affected households - HIV prevention even in areas of very high HIV prevalence cannot be over-emphasised.