Class Notes (809,487)
Canada (493,752)
New College (193)
JNH350H1 (9)

Winford, Masanjala.pdf

10 Pages
Unlock Document

University of Toronto St. George
New College
Professor Paul

ARTICLE IN PRESS Social Science & Medicine 64 (2007) 1032–1041 The poverty-HIV/AIDS nexus in Africa: A livelihood approach Winford Masanjala University of Malawi, Zomba, Malawi Available online 28 November 2006 Abstract This paper reviews the nexus between poverty and HIV/AIDS in Africa using a sustainable livelihood framework. Much of the literature on HIV and AIDS has generated an almost universal consensus that the AIDS epidemic is having an immense impact on the economies of hard-hit countries, hurting not only individuals, families and firms, but also significantly slowing economic growth and worsening poverty. International evidence has concentrated on the pathways through which HIV/AIDS undermines livelihoods and raises vulnerability to future collapse of livelihoods. Yet, little attention has been paid to the role that social relations and livelihood strategies can play in bringing about risky social interaction that raises the chance of contracting HIV. Using the sustainable livelihood and social relation approaches, this article demonstrates that although AIDS is not simply a disease of the poor, determinants of the epidemic go far beyond individual volition and that some dimensions of being poor increase risk and vulnerability to HIV. r 2006 Elsevier Ltd. All rights reserved. Keywords: Africa; HIV/AIDS; Poverty; Sustainable livelihood framework; Social relations framework Introduction AIDS, 2002). The second school of thought argues that poverty encourages the spread of HIV and Two strands of orthodoxy have held sway over quicker progression from HIV seropositivity to full most writings on the relationship between the AIDS blown AIDS. While acknowledging that AIDS is epidemic and poverty in Africa. The conventional not simply a disease of the poor, this school of view of the poverty–AIDS nexus is that debilitating thought argues that the shape and form of the AIDS HIV or full-blown AIDS undermine livelihoods by epidemic reflects the economic, political and cultur- eroding affected households’ resource base, thereby al characteristics of the society (Barnett & White- raising vulnerability to future collapse of liveli- side, 2000, 2002) and that some dimensions of hoods. The central argument is that the experience poverty and inequality can drive those on the of AIDS by individuals, households and even margin of destitution into risky livelihood and communities can readily lead to an increase in coping strategies that raise their likelihood of numbers of impoverished households and intensifi- contracting HIV. cation of poverty among those that are already This article seeks to review the literature and deprived (see Loewenson & Whiteside, 2001; UN- contextualize the interaction between poverty and AIDS in Africa using the livelihoods framework Tel.: +2659425100; fax: +2651525021. (e.g. Carney, 1998; DFID/FAO, 2000). To this end, we build upon a number of studies that have E-mail addresses: [email protected].edu, [email protected] (W. Masanjala). attempted to systematically apply the livelihood 0277-9536/$-see front matter r 2006 Elsevier Ltd. All rights reserved. doi:10.1016/j.socscimed.2006.10.009 ARTICLE IN PRESS W. Masanjala / Social Science & Medicine 64 (2007) 1032–1041 1033 framework to study the impact of the AIDS framework with social relations framework. We epidemic on livelihoods (e.g. Loevinsohn & Gille- recognize that within the household, a socially spie, 2003; Seeley, 2002; Stokes, 2003) and then constructed gender division of labor exists which extend the analysis to consider the role that unequal places differential demands on time and energy of social relations and livelihoods may play in the males and females (Bolt & Bird, 2003; Moser, 1994) transmission of HIV. and there is limited substitutability between male The utility of the livelihood framework lies in its and female labor on specific tasks (Kabeer, 1994). ability to generate analysis that has both positive While we concede that there are other social and normative policy implications. At the positive differences beyond gender, e.g. age differences, child level, the livelihoods framework allows us to show birth-order, wife order in polygamous marriages that AIDS can and does affect every part of a (Bolt & Bird, 2003), we demonstrate that social livelihood—some livelihoods more so than others. factors associated with gender differences shape the We also demonstrate how certain dimensions of HIV risk environment more than the other dimen- being poor not only increase the likelihood of sions through asymmetric sexual relations, econom- engaging in risky social interaction and raise the ic inequalities and population movement. probability of contracting the HIV but also how they limit access to, and efficacy of, life-prolonging The sustainable livelihoods framework anti-retroviral treatment (ART). At the normative level, the livelihood framework demonstrates that Livelihood is defined as a means of living, and the just as the impact of AIDS can be seen at capabilities, assets and activities required for it every point of a livelihood, in Africa and simi- (Carney, 1998; Chambers & Conway, 1992). A larly impoverished populations efforts to address livelihood encompasses income, as well as social either poverty or the AIDS epidemic should attend institutions, gender relations and property rights to factors that affect a household’s livelihood required to support and sustain a certain standard outcomes. of living (Ellis, 1998). It also includes access to and The preceding notwithstanding, the livelihoods benefits derived from social and public services framework, whether in its basic form or the myriad provided by the state such as education, health variants, is still a limited instrument for analyzing services and other infrastructure. Following Cham- the complex dynamics between livelihoods and the bers and Conway (1992), a livelihood is deemed spread of HIV. First, like much of the social science, sustainable if it can cope with and recover from the livelihoods framework has depended on the stress and shocks and maintain or enhance its household as the basic building block for research capabilities and assets both in the present and in the and analysis. Implicit in this approach is the image future, while not undermining the livelihoods of of a household, comprising individuals who behave future generations. as if they share common preferences and aim at In this framework, a household’s livelihood maximizing a common utility function. In turn, this outcomes depend on the interaction of four inter- requires an assumption of impact homogeneity, linked dimensions: livelihood assets, the vulnerabil- where individuals within a household are portrayed ity context, livelihood strategies and transforming as being equally wealthy or poor, to have equal structures and processes. To begin with, a house- access to goods and services and suffer equally when hold’s choice of productive activity depends on its a shock hits the household. However, we know that stock of livelihood assets: endowments that the intra-household decision making and resource household has and which entitle it to goods and allocation are affected by different culturally, services, whether through its own production or temporally and spatially specific dimensions of exchange. These assets include human capital (e.g. social differences (Bolt & Bird, 2003). These social productive or marketable skills), financial assets differences result in differential levels of wealth and (e.g. savings or cash), social capital (in the form poverty, consumption, leisure and work, and of kin, patronage and other networks), physical differential access to and control over resources capital (e.g. agricultural assets) and natural capital and benefits. (e.g. land resources). To account for the role of these social differences Given their livelihood assets, households develop on the risk of transmission of HIV, in the second different capacities to deal with risk and uncer- part of the paper, we compliment the livelihoods tainty. The second element in the framework, the ARTICLE IN PRESS 1034 W. Masanjala / Social Science & Medicine 64 (2007) 1032–1041 vulnerability context, deals with the risk, suscept- Livelihood strategies can be categorized in many ibility and likelihood of livelihood collapse due to dimensions depending on whether the household is economic and environmental factors beyond the proactive or reactive and whether the strategy household’s control. In this context, vulnerability is increases or reduces livelihood assets (see Devereux, generally understood to mean a high degree of 1999). Accumulative strategies seek to increase the exposure to risk, shocks and stress and proneness to flow of income and stocks of assets through food insecurity (Chambers, Pacey & Thrupp, 1989). profitable enterprises while adaptive strategies seek Although the vulnerability context and the sustain- to spread risk through livelihood adjustment or ability of livelihood outcomes faced by a household income diversification. In contrast, coping strategies in part depend on the household’s livelihood assets seek to minimize the cost and impact of adverse they also depend on macro and meso-level institu- livelihood shocks such that future livelihoods tions and policies as well as community-level capacity is not seriously impaired while survival institutions (i.e. transforming structures and pro- strategies are undertaken to prevent destitution and cesses). Transforming structures reflect the level of death. Adaptive and accumulative strategies are government, private sector and civil society partici- proactive and positive strategies that do not erode pation. On the other hand, institutions or trans- the household’s asset base while coping and survival forming processes refer to the actual ‘‘rules of the strategies are defensive and reactive, associated with game’’ used by groups of individuals to organize reduction of assets (Orr & Orr, 2002). and regulate social interactions (Ostrom, 1992). Fig. 1 is a two-dimensional matrix depicting the Lastly, the combination of the household’s portfolio possible mix of livelihood strategies open to a rural of assets, the institutional and policy environment household in Africa. Suppose a rural household can and the implied vulnerability context circumscribes generate its livelihood either from agriculture the livelihood strategies adopted by the household. or non-farm business or a combination of both. Livelihood strategies are the sum of all the different The Y-axis of the matrix shows the level of activities that people do in the context of generating household income from agriculture, whereas the their livelihood (Chambers & Conway, 1992). X-axis shows the level of income from non-farm Accumulative 100 % FARM INCOME STRONG FARM BALANCE BETWEEN PRODUCTION SUPPLIMENTED BY NON- FARM AND NON-FARM FARM IGA Adaptive SMALLHOLDER MIXTURE OF SMALLSCALE MAIN BUSINESS AGRICULTURE WITH LITTLE BUSINESS AGRICULTURE & BUSINESS SUPPLEMENTED BY AGRICULTURE Coping Survival Increasing reliance on commercial farming LITTLE OR NO LAND/ VIABLE STABLE 100 % INCOME FROM IGA NON-FARM BUSINESS BUSINESS Increasing Reliance on Business Fig. 1. Typology of livelihood strategies for rural household. ARTICLE IN PRESS W. Masanjala / Social Science & Medicine 64 (2007) 1032–1041 1035 income sources. A household’s position on the reductions in total income owing to illness, the matrix reflects its level of income from each of the diversion of household resources to caring for those two livelihood strategies. For instance, households affected or total loss of income due to death of a in the bottom left-hand corner are subsistence breadwinner (see Serpell, 1999). AIDS -related farmers with limited income from both agriculture illnesses also have a depressing effect on overall and business and their livelihood strategies are labor productivity due to absenteeism by the ill or primarily for survival. The framework also illus- care-giving and attending funerals by the healthy. trates the processes of economic change which Secondly, the AIDS epidemic also negatively involves transitions between states of economic impacts the household’s financial capital. When structure or performance and changes in livelihood faced with the costs associated with increase in strategies. Depending on their assets and capabil- morbidity and mortality due to HIV/AIDS, house- ities, households can move either up, along or holds cope by using up savings, borrowing money, diagonally across the matrix. A household moving taking additional debt at penal rates of interest or up the Y-axis specializes in agriculture at the searching for additional sources of income (Koestle, expense of non-farm income. A household that 2002). Similarly, debilitating HIV and AIDS-linked moves along the X-axis specializes in non-farm illness also contribute to the erosion of physical and business at the expense of agriculture while those natural capital. When households deplete their that move along the diagonal balance agriculture financial assets, the next step in the course of with non-farm business (diversification). In general impoverishment is to dispose of unproductive assets any movement towards the origin represents im- (a reversible strategy) before finally disposing of poverishment. In the next section we demonstrate productive assets like land, draft animals and how the AIDS epidemic is expected to impoverish equipment (see Mutangadura, 2000). households (i.e. cause households to move towards Lastly, the AIDS epidemic also depreciates social the origin). capital in that death and sickness erode social networks. In the AIDS era, the rate at which friends Impact of HIV/AIDS on livelihoods and relatives are lost is very high making the maintenance of the kin group more difficult. In The effect of the AIDS epidemic on livelihood addition, since AIDS may result in social exclusion outcomes is profound and varied. International resulting from stigma on the part of those affected evidence reveals that household impacts of the by the HIV or fear others may have of AIDS-related AIDS epidemic are being felt at different levels (see illness, some cultural and social events may change Koestle, 2002 for cases from Malawi and Tanzania; because of the risk of HIV/AIDS or become less Serpell, 1999 for Zambia and Bollinger, Stover, attractive to those afraid that social activity may Kerkhoven, Mutangadura & Mukurazita, 1999 for spread the virus (Seeley, 2002). Similarly, due to cases from Zimbabwe). In this section we demon- traditional inheritance patterns and economic sub- strate how HIV/AIDS impact the four components ordination of women, AIDS-induced transforma- of a livelihood. tions of the household may not only worsen pre- existing gender inequities but the loss of a bread HIV/AIDS and livelihoods assets winner may result in the dissolution of an entire household. Recent research on livelihoods in rural Africa has highlighted the crucial role that assets play in AIDS and vulnerability context anchoring livelihoods and imposing constraints on the repertoire of livelihood strategies open to In the context of rural Africa, the vulnerability different households (see Ellis & Freeman, 2002; context includes the lack of, or diminutive size of Ellis, Kutengule, & Nyasulu, 2003; McDonagh, land holdings, reliance on rain-fed subsistence 2002). Although the most immediate impact of HIV agriculture, seasonality of income and reliance on falls on human capital, the epidemic equally a narrow range of income sources (Ellis & Freeman, depreciates other categories of a household’s liveli- 2002; Ellis, 1998; McDonagh, 2002). Even in the hood assets—financial, social, physical and natural. absence of AIDS, reliance on rain-fed subsistence With respect to human capital, the AIDS epidemic agriculture has rendered most African households generates new poverty as affected households suffer vulnerable to the risk of livelihood collapse in the ARTICLE IN PRESS 1036 W. Masanjala / Social Science & Medicine 64 (2007) 1032–1041 face of shocks such as droughts, floods and The role of institutions and policies is captured by seasonality (De Waal & Whiteside, 2003; Ellis, the interplay between the state and the market in the 1998). Although rural households confront season- provision of life-prolonging drugs. On the one hand, ality as an inherent feature of their livelihoods the good news is that the recent emergence of ART when continuous household needs are mismatched and an increase of clinical knowledge that has with uneven income flows, the AIDS epidemic accelerated the diagnosis and treatment of oppor- compounds the problems faced by households tunistic infections have brought some hope for by increasing the likelihood of livelihood collapse Africa. Now, to be infected with the HIV is no due to natural disasters, seasonal changes and longer synonymous with a death sentence because a the shock of accidents or sudden illness (Koestle, person with HIV, provided that they receive all 2002). AIDS related illnesses and death undermine necessary treatment and care, can survive for many the capacity of households to reallocate labor years more than was previously possible. On the between tasks with variable returns to labor during other hand, now to live or to die depends largely on the year. Households may be less able to adjust to one’s access to ART which is mediated by state and seasonal changes in occupations that require labor market institutions and processes. Since ART is time to be switched from lower to higher return expensive, for a person who lives with HIV and is activities. poor, as is the case for most of those infected in Therefore, the AIDS epidemic can be expected to Africa, life or death depends on the state’s capacity create new poverty by increasing the risk of income to provide free or subsidized ART to those who are failure overall by diluting the diversity of household both in poverty and infected with the HIV. portfolio and increasing inter-year income varia- More importantly, even when one has access to bility due to instability in agricultural production these medicines, their efficacy may be compromised (also see De Waal & Whiteside, 2003). In addition, by livelihood outcomes, especially poor nutrition. due to underdeveloped or non-existent formal credit Although we still know little about the long-term markets, the loss of family and friends may also effects of ART, the fact that almost all anti-retroviral spell the end of access to informal, affordable credit. drugs need to be taken at regular intervals and on a This is more troubling when one considers that the full stomach suggests that these drugs may pose a extended family and other traditional social safety problem for the poor with inadequate nutrition or nets are also facing enormous pressures and irregular access to food. Similarly, if anti-retroviral collapsing at a time when state support systems, drugs are toxic, as some seem to suggest, they may be rather than replacing these, are also collapsing (see particularly toxic to someone who is not well Bryceson & Fonseca, 2005 for examples from nourished (Loevinsohn & Gillespie, 2003). Malawi). HIV/AIDS and livelihood strategies HIV/AIDS and transforming structures and processes A characteristic of rural livelihoods in Africa is covariance of risk. Most of the alternative income Policies and institutions can play a key role in earning opportunities open to households in parti- transforming livelihoods since a livelihood also cular locations exhibit high correlation between includes access to, and benefits derived from, social risks in returns attached to them (Ellis, 1998). For and public services provided by the state. Kabeer instance, in a rain-fed subsistence agricultural (1994) identifies four different levels of institutional setting, a drought or flood in a particular locality locations—the state, the market, the community will affect all income streams available to the and family/kinship—which not only determine household, be it own-farm, livestock income or one’s livelihood outcomes but also have a tendency income from casual employment on other people’s towards creating and reproducing systemic inequal- farms. Yet the AIDS epidemic further undermines ity. For instance, at the state level, the emergence of the household’s capacity for coping or survival by AIDS as a cross-cutting issue, has given rise to the stripping the household of its livelihood assets need to formulate new development policies and to through disaving or disinvestment, thereby push- create institutions and bureaucracies for their ing a household into portfolios with less variety, implementation (e.g. the National AIDS secretar- smaller returns and higher probability of livelihood iats/councils). collapse. ARTICLE IN PRESS W. Masanjala / Social Science & Medicine 64 (2007) 1032–1041 1037 In addition, the knowledge that a household partners; the absence of male circumcision; and the member is infected with HIV significantly changes role of core-groups such as commercial sex workers the household’s sense of time-preference, which in (see Macdonald, 1996; Williams & Campbell, 1998). turn impacts its inter-temporal resource allocation In addition, a recent and emerging school posits and utility maximization (Collin & Rau, 2000). In geographical determinism as the main explanation the employment and deployment of their scarce of the spatial clusters that characterize the spread resources, rural households are observed to take the HIV and maturation of the AIDS epidemic long-term strategic view of future income sources. within a country, province or district (e.g. Kupka et For instance, among rural households, parents’ al., 2004). Drawing from geographical disease investment in their children’s education may be part patterns, proponents of this view argue that there of a long-term strategy of adaptation and accumu- is a geographical link between regions of selenium lation often linked to rural–urban migration and deficient soils and peak incidence of HIV/AIDS remittance behavior (Ellis, 1998). However, in the through selenium deficient diets (see Foster, 2000). AIDS era, such long-established patterns of migra- However, in this paper we d
More Less

Related notes for JNH350H1

Log In


Don't have an account?

Join OneClass

Access over 10 million pages of study
documents for 1.3 million courses.

Sign up

Join to view


By registering, I agree to the Terms and Privacy Policies
Already have an account?
Just a few more details

So we can recommend you notes for your school.

Reset Password

Please enter below the email address you registered with and we will send you a link to reset your password.

Add your courses

Get notes from the top students in your class.