1. Gendered violence, gender inequalities and home-based care: the forgotten relationship of power Andrew Gibbs – HEARD, University of KwaZulu-Natal, Durban, South Africa Laura Washington – Project Empower, Durban, South Africa Mpume Mbatha – Project Empower, Durban, South Africa

2. Background: Providing care Provision of care for people living with HIV and AIDS is pre-dominantly undertaken outside the formal care system Factors driving this: 1.Structural adjustment policies (Susser, 2009) 2.Health care worker crisis (WHO, 2006) 3.Primary health care policies (Gibbs & Campbell, 2012) Home-based care organisations have filled the care gap

3. Background: Who are the carers? Whether in the home to family and relatives, outside the home via home-based care organisations or in formal work settings, women typically provide the majority of care: Constructions of masculinity and femininity (Peacock and Weston, 2008) Government policies (Redpath et al., 2008) But, increasing numbers of men are involved in care

4. Background: Impacts of providing care Provision of care is critical for expanding the reach of the health system (Walt, 1990) For individual carers: 1.Impact of care is negative (Ogden et al., 2006) 2.Structures to support carers are weak at best (Campbell & Foulis, 2004; Nair & Campbell, 2008) 3.Involvement in care work typically reinforces gender inequalities Potential for this to be a transformitive space for women’s empowerment

5. Applying a gender-based violence lens Gender-based violence comprises: 1.Emotional/mental violence 2.Economic violence 3.Physical and sexual violence Structural violence (Farmer, 1999)

6. Methods 3 partners of Irish Aid in South Africa who work with home-based carers to provide care to others 2 organisations rural communities, 1 organisation urban TypeNumberTotal participants Focus groups with carers545 In-depth interviews with management 1015

7. Results: Mental/emotional violence Emotionally demanding: Patients trust that we’ll help them and expect it. And we feel the pressure of having to solve all so that they trust us (Female carer). Caregivers get tired, frustrated and feel helpless (Staff member; female). Gossip and rumour: They are also concerned about their reputations: they fear bathing a man creates the impression that they are loose and brazen (Female manager)

8. Results 2: Economic violence Economic costs We have to take our own money for transport to give patients when they need to go to the hospital (Female carer). If they have no food you take from your own house (Female carer). Stipends: We get stipends. For me it is not enough, I stay in a flat and I have to pay rent, support back home and I have a child (Female carer).

9. Results 3: Physical violence Physical hardship: We bathe patients, change nappies…Sometimes we have to even wash their clothes and linen because they have no one in the family willing to do it (Female carer) Sexual and physical violence: It [sexual violence] does come up in reports where caregivers are going through a bushy area and it’s not safe (Female manager). We don’t feel safe for us who are going flats but at least we go with a male carer (Female carer)

10. Conclusion 1: expanding gender inequalities Applying a gender-based violence lens allows us to: Recognise that female home-based carers are at risk of sexual and physical violence in their work because they are women Physical and sexual violence is a key way of enforcing patriarchy and blocking gender transformation

11. Conclusion 2: creating new solutions Home-based care programmes need to tackle social/contextual level barriers, if they are to transform gender relationships: 1.Emotional violence 2.Economic violence 3.Physical and sexual violence Need creative solutions as home-based care organisations may not be best placed to do this Andrew Gibbs: gibbs@ukzn.ac.za