Lessons on defining the household from a study of socio-economic status and HIV and AIDS in rural Uganda15th May 2008

Janet Seeley, School of Development Studies, University of East Anglia

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Background

The MRC General Population Cohort (GPC) study was established in 1989 in 15 rural villages (expanded to 25 villages in 2000) in a sub-county of Masaka district in Uganda.

Its main objectives are: to describe the dynamics of HIV infection within a

rural population, to identify the major risk factors for contracting HIV

and to quantify the impact of mortality and fertility and to study treatment seeking behaviour.

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Household Trajectory study background In 1991-1992, the MRC/UVRI programme

conducted an ethnographic study of household coping mechanisms based on the experience of 27 households selected from three of 15 villages that made up the GPC.

Over a period of one year interviewers paid monthly visits to the study households to record changes in different aspects of the household’s daily life such as composition, employment, health, food consumption and social networks.

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Trajectory Re-study 2006-2007 Twenty seven households (defined by members but

usually meant the people living together on a compound and sharing meals) participated in the study in 1991/1992.

Members of 24 of those original households participated in the restudy. Information on two households which no longer exist because their household heads have died and their children have moved away was gathered from neighbours and relatives. One household refused to take part in the restudy.

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Table 1: Households, socio-economic status and HIV and AIDS within the household 1991/2006 (all names have been changed)

Same household head living on same plot 1991 and 2006 Household head name and age in 1991 Sex of HHH SES in 1991 SES now HIV within household? Hawa (33) Female Less poor Poor/less poor Yes (child) Pontiano (26) Male Less poor Rich No Victoria (70) Female Rich Rich/less poor No Madina (65) Female Poor Poor Yes (adult – daughter) Grace (56) Female Less poor Less poor No Kiwanuka (65) Male Less poor Less poor No Eva (42) Female Less poor Less poor Yes (adult daughter -- died) Nazziwa (45) Female Poor Poor No Varista (36) Female Poor Poor No Namutebi (44) Female Less poor Rich/Less poor No Betty (40) Female Less poor Poor Yes (HHH and 2 children [one died]) Gertrude (47) Female Less poor Less poor No Teresa (44) Female Less poor Less poor No Household head in 1991 now living in different household (because of old age) Household head name and age in 1991 Sex of HHH SES in 1991 SES now HIV within household? Ayisa (70) Female Rich Rich. No Nanono (68) Female Less poor Less poor No

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Table 1 – cont’d

Households with different household head in 2006 but living on the same plot as in 1991 Household head name and age in 1991 HHH sex SES in

1991 SES now HIV within household?

Anatoli (71) /Lydia (65) Male/Female Rich Rich/Less poor No (HHH died of liver cancer in old age) Lucia (67)/Violet (45) Female Less poor Rich/Less poor No (HHH died in old age) Rose (65)/Nabukenya (32) Female Poor Poor No (HHH died in old age) Moses (71)/Roda (45) Male/Female Less poor Poor Yes (adult daughter) (HHH died in old

age) Households where the 1991 household head died and original household dissolved Household head name and age in 1991 and member available in 2006

HHH sex SES in 1991

SES of new household

HIV and household/family

Harriett (28) none Female Poor n/a HHH died – AIDS Norah (50) none Female Less poor n/a HHH died – old age Regina (36)/ niece now married Female/male Less poor Less poor HHH died – AIDS Sulinah (65)/grandson Female/male Less poor Less poor/Rich HHH died – old age Maria (40)/son Female/male Less poor Less poor HHH died – AIDS, adult daughter died –

AIDS Leo (78)/son Male/male Less poor Rich HHH died – old age Florence (70)/granddaughter now married Female/male Less poor Less poor HHH died – old age

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Only the original households of Pontiano, Namutebi and Violet have improved their position while the households of Hawa, Victoria, Betty, Lydia and Roda have become poorer.

Two of the new households, both men now in their 40s engaged in business and trade, were now more prosperous than their grandmother/father had been in 1991.

The reasons for the change, or in some cases, lack of change in socioeconomic becomes clearer when we take into account the existence of HIV and AIDS among the wider kin and friendship groups.

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Table 2: Households, socio-economic status and HIV and AIDS in the household and wider family 1991/2006Same household head living on same plot 1991 and 2006

Household head name Sex of HHH SES in 1991

SES now HIV in HH

HIV in wider family?

Hawa Female Less poor Poor/less poor Yes Yes. Brother and sister-in-law. Fostering grandchildren (in each case at least one parent still alive)

Pontiano Male Less poor Rich No No (but many friends have been affected) Victoria Female Rich Rich/less poor No Yes. Sons, grandson and great-grandson. Madina Female Poor Poor Yes Yes. daughter and son-in-law, nephews and nieces Grace Female Less poor Less poor No Yes. Brothers, sister-in-law. Fostering brother’s children. Kiwanuka Male Less poor Less poor No Yes. Former partners, daughter, son-in-law, and possibly son Eva Female Less poor Less poor Yes Yes. Sons, daughter, daughter-in-law. Fostering grandchildren. Nazziwa Female Poor Poor No Yes. Former husband, daughter and son-in-law. Fostering

grandchildren. Varista Female Poor Poor No Yes. Brother. Namutebi Female Less poor Rich/less poor No Yes. At least two brothers, daughter. Fostering grandchildren. Betty Female Less poor Poor Yes Yes. Husband, co-wife, brothers and sister Gertrude Female Less poor Less poor No Yes. Brother. Teresa Female Less poor Less poor No Yes. Son, daughter and brother. Fostering grandchildren. Household head in 1991 now living in different household (because of old age) Household head name Sex of HHH SES in

1991 SES in new household

HIV in HH

HIV in wider family?

Ayisa Female Rich Rich. No Yes. Son. Fostered grandchildren. Nanono Female Less poor Less poor No Yes. Son. Fostered grandchildren

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Table 2 – cont’d Households with different household head in 2006 but living on the same plot as in 1991 Household head name HHH sex SES in

1991 SES now HIV in

HH HIV in wider family?

Anatoli/Lydia Male/Female Rich Rich/Less poor

No Yes. Sons, daughters. Grandchildren, nieces and nephews. Fostering relatives children

Lucia/Violet Female Less poor

Rich/Less poor

No Yes. Brother. Lucia fostered nieces/nephews and grandchildren (now all grown up so Violet lives alone).

Rose/Nabukenya Female Poor Poor No Yes. Brother. Plus close friend/helpful neighbour. Moses/Roda Male/Female Less

poor Poor. Yes Yes. Son, daughters.

Households where the 1991 household head died and original household dissolved Household head name 1991/member available 2006

HHH sex SES in 1991

SES of new household

HIV in HH

HIV in wider family?

Harriett/none Female Poor n/a Yes Yes. Partner Norah/none Female Less

poor n/a No Yes. Brother. Also husband and wife who came to help in the house

when HHH was sick (no relation). Regina/ niece Female/male Less

poor Less poor Yes Yes. Regina’s husband and sister.

Sulinah/grandson Female/male Less poor

Less poor/Rich No Yes. Sulinah’s niece

Maria/son Female/male Less poor

Less poor Yes Yes. Maria’s daughter.

Leo/son Male/male Less poor

Rich No n/k

Florence/granddaughter Female/male Less poor

Less poor No Yes. Florence’s sons.

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Pontiano

KEY to kinship diagrams

Male

Female

Household head

Resident household member

Formal marriage/sibling link

Informal marriage

Separation/divorce/death

Denotes relationship of child or children to a couple

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Hawa

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Eva

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Roda

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Victoria

Victoria

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The data suggest…

A focus solely on the household unit cannot adequately explain the impact of HIV and AIDS on household socio-economic status. While other family members may provide support

to a household, they may also need support themselves and thereby drain resources from related households.

A look at the impact of HIV and AIDS on people’s wider families provides pointers to why those who may not have had an AIDS-related death in their own household may have failed to prosper.