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Abstract
This paper considers the effects of antiretroviral treatment on the households of person with AIDS in western Uganda. Interviews were carried out with 110 co-resident “treatment partners” of people receiving treatment. We discuss these family members' accounts of the impact of sickness, followed by treatment, on their household's livelihood, defined as the activities needed to obtain and process the resources required to sustain the households. The household's ability to muster labour for subsistence agriculture was of paramount concern when family members considered what treatment meant for the households. While they were very happy with the treatment, they said that households have not yet recovered from the shock of AIDS sicknesses.
Acknowledgements
We would like to thank Colletta Nyamwiza and Janephar Birungi for their work on the interviews; Ragina Alirake for transcription of interviews; and Peter Rwakilembe for co-ordinating the surveys.
Notes
1. The other TPs did not reside with the patients – they were usually neighbours or friends.
2. The great majority of these parents were mothers, especially mothers whose husbands or male partners had died or abandoned them, leaving the mother in charge of a single-parent household.
3. Although almost all TPs had provided care to patients, they were not necessarily the only caregivers. As Bedingfield (forthcoming) demonstrates caregiving duties were often shared out among various family members, meaning that the impact of caregiving was also shared.
4. This situation differs from that in other AIDS-hit areas, where a much greater proportion of the population depends on either regular wage income or on income replacement, such as government support (e.g., Collins & Leibbrandt, 2007).
5. This dependence on farming is consistent with Bridge et al.'s (Citation2006a) survey of AIDS-afflicted and non-afflicted families in the same district, in which 85% of participants were classified as subsistence or “low-level” farmers, who “occasionally [sold] agricultural products on the market” (p. 621).
6. Interestingly, although other studies of rural Ugandan life (e.g., Shinyekwa & Bird, Citation2002) have identified beer-brewing and home distillation of waragi, a cane or molasses-based drink, as an important source of income for poor people, especially widows and those who do not have access to sufficient land, none of the TPs mentioned brewing. It is not clear whether this is because brewing is a stigmatised activity, or whether brewing is less common in this district than in others.
7. As noted above, 25% of TPs said that someone in their household worked for money. Among the minority who did, the most frequent job description was “digging”. The predominance of digging over other forms of labour was also remarked by Ravnborg et al. (2004, p. 47), who found that especially among the less wealthy households “only a minority are…engaged in non-agricultural income generating activities such as beer brewing, charcoal burning, brick-making, running businesses, etc.”.
8. Ravnborg et al. (2004, p. 38) reported that 29% of their Kabarole sample hired labour for agricultural tasks.
9. At the time of the interview, all three children were back in school, although each of them was at least one year behind their former peers.
10. However, Barnett and Whiteside (Citation2006, p. 204) note that retrospective accounts impoverishment will understate the true extent of household immiseration. They point out that the worst-hit households are likely to disperse, disintegrate or simply disappear at the lowest points of their crises, and thus are not around to talk about their experiences later. We do not know the extent to which this happened in Kabarole, but certainly interview participants described “closed houses”, from which all family members had disappeared, and lineages which had been completely annihilated by AIDS.
11. This apparent rise in expenditures differs from the impact of illness episodes in contexts where pre-illness expenditures were generally higher than in rural Kabarole (owing to a larger amount of circulating cash in the community), so that AIDS brought on a net decrease in expenditure (e.g., Bachman & Booysen, 2006).
12. Although Ravnborg et al. (2004, p. 36) found that 30% of Kabarole households own cattle, none of the TPs mentioned them (we should explore this further with our staff in Ft. Portal), which may be an indicator of the relative poverty of AIDS-hit households.
13. Kabarole district has also had one of the highest population growth rates in Uganda since the 1970s (Mulley & Unruh, Citation2004, p. 201). The current population density is greater than 60 people per square kilometre, above the average for Uganda (http://www.unep.org/depi/rainwater/Maps/Uganda_population.pdf). The inevitable consequence is an increasing scarcity of land.
14. It should be noted, however, that ill-health is relatively common in Kabarole, where 24% reported that somebody in the households suffers from TB, AIDS/HIV, anaemia or chest diseases, or is disabled (Ravnborg et al., 2004, p. 43).
15. These statements might be seen as reflecting a general nostalgia for the better days before AIDS hit the family, but respondents were quite specific about the parameters of decline. Rather than simply saying “My client is weaker than s/he used to be” or “we don't have as big a garden as we used to”, TPs often gave specific comparative quantities, whether in terms of area planted “we used to cultivate two hectares but now we can only manage one” or time worked “s/he used to work until sunset, but now s/he has to stop at noon”, suggesting that these declines were actually observed, and are not nostalgic artefacts.