Extended family caring for children orphaned by AIDS: balancing essential work and caregiving in a high HIV prevalence nations

Abstract

While over 90 per cent of the 15 million children who have been orphaned by HIV/AIDS are cared for by family members, there is little information about whether adults can meet orphans’ essential caregiving needs while working to economically survive. Using a survey we conducted in Botswana of 1033 working adults, we analyse the experience of adults who are caring for orphans. Over one-third of working adults were caring for orphans and many with few financial resources: 82% were living on household incomes below US$10 purchasing power parity adjusted per person per day. Because of their caregiving responsibilities, they were less able to supplement income with overtime, weekend, evening, or night work. At the same time caregiving responsibilities meant orphan caregivers spent fewer hours caring for their own children and other family members. Nearly half of orphan caregivers had difficulties meeting their children's needs, and nearly 75% weren't able to meet with children's teachers. Pay loss at work compounded the problems: One-quarter of orphan caregivers reported having to take unpaid leave to meet sick childcare needs and nearly half reported being absent from work for children's routine health care. This paper makes clear that if families are to provide adequate care for orphans while economically surviving there needs to be increases in social supports and improvements in working conditions.

Notes

1. Sixty-Seven per cent were from the maternal child health clinic, 32 per cent from the general outpatient department, and 1 per cent from the paediatric department. Reasons for clinic visit were recorded for 476 respondents. Thirty-five percent were accompanying a child or an adult. Only 28 per cent of those for whom reason for the clinic visit was recorded were receiving treatment for illness.

2. The question in the instrument analysed here is: ‘Have you ever suffered shortages of basic or essential needs such as shelter, food, water, fuel or transportation because you are caring for this person?’.

3. Of a typical 50-week work year, one week of paid sick leave at 100 per cent wage replacement rate would represent 1/50th, or 2 per cent, of what an employer would pay on average in wages per worker. Factors which increase the cost to the employer of providing leave, such as the impact of an employee's absence on other employees and the need to hire replacements, are more than offset by other benefits to the employer including, among others, reduced spread of infectious illness, more rapid recovery of ill employees, decreased loss of productivity due to presenteeism, and higher retention rates. Given the balance of these factors, we believe 2 per cent is a reasonable approximation.