Working HIV care-givers in Botswana: Spill-over effects on work and family well-being

Abstract

Families provide most of the care to the tens of millions of HIV-infected and -affected in Africa. Little research exists on how care-givers balance the demands of holding a job with providing care for those who have become ill or orphaned by HIV/AIDS. Using data from a large survey administered to 1,077 working care-givers in Botswana, we compared the experience of HIV care-givers with non-HIV care-givers. Compared to non-HIV care-givers, HIV care-givers were more likely to worry about routine childcare (44% vs. 31%) and sick childcare (64% vs. 49%). Amongst those working far from home, more HIV care-givers were concerned that their children were not receiving adequate academic support (39% vs. 20%) and emotional support (57% vs. 33%). Parents who were HIV care-givers were less able to spend time with their own children. Children of HIV care-givers were more likely to have physical, mental and academic problems. While HIV care-givers were more likely to take leave from work for care-giving (53% vs. 39%), and for longer periods of time (13 vs. 7.6 days), this leave is more likely to be unpaid. Strategies to support those directly and indirectly affected by HIV and to avoid economic responsibility are discussed.

En Afrique, la responsabilité pour le soin des millions de personnes infectées ou affectées par le VIH tombe surtout sur les familles. Mais on connait mal comment les soignants naturels arrivent à travailler en même temps qu'ils prennent soin de ceux atteints ou orphelins du VIH/sida. Nous comparons les expériences vécues par ces soignants naturels avec celles vécues par d'autres soignants naturels, en utilisant les données cueillies pendant notre enquête au Botswana sur 1077 soignants naturels qui sont aussi employés. Par rapport aux autres soignants naturels, ceux qui aident les personnes atteintes du VIH risquent plus de s'inquiéter à propos du soin ordinaire de leurs enfants (44% vs. 31%) ainsi que du soin des enfants malades (64% vs. 49%). De ceux travaillant loin de la maison, les soignants naturels des personnes atteintes du VIH s'inquiètent plus que d'autres soignants naturels que leurs enfants ne reçoivent pas d'assistance pédagogique adéquate (39% vs. 20%) ou de soutien affectif suffisant (57% vs. 33%). Les parents qui sont soignants naturels de ceux atteints du VIH sont moins capables de passer du temps avec leurs propres enfants. Ces enfants courent plus de risque de souffrir de problèmes physiques, mentaux et scolaires. Les aidants naturels des personnes atteintes du VIH courent un risque plus grand de prendre du congé pour prendre soins des leurs familles (53% vs. 39%) et pour plus longtemps (13 jours vs. 7.6 jours) que d'autres aidants naturels, et ce congé risque plus d’être non-rémunéré. On discute des stratégies pour éviter la vulnérabilité économique et pour appuyer ceux affectés, directement et indirectement, par le VIH.

Keywords:

• HIV/AIDS
• home based care
• caregiving
• work
• Botswana

Mots-clés:

• VIH/SIDA
• soins a domicile
• soins
• travail
• Botswana

Acknowledgements

We are most indebted to those who took the time to participate in the study. This study was made possible because of the invaluable support of Max Essex from the Harvard School of Public Health and Ibou Thior from the Botswana–Harvard School of Public Health AIDS Initiative Partnership. Divya Rajaraman was supported by a Fogarty Fellowship to conduct this research. Our warm thanks to members of the research and administration teams at the Botswana–Harvard School of Public Health AIDS Initiative Partnership in Botswana and the Project on Global Working Families at the Harvard School of Public Health who facilitated and contributed to this study. We are particularly grateful to our diligent and conscientious data collection team; to the staff of the clinics where we conducted interviews; to the Mashi study teams in Lobatse, Mochudi and Molepolole; to Ria Madison for administrative support; to Martha Faye, Erik Widenfelt, Kenneth Onyait, Luso Mnthali and Karen Bogen for assistance with data management and programming; and to Karen Bogen for assistance with analysis.

Notes

1. In Botswana, 80% of the population lives within a 15 kilometre radius of a primary health clinic, and 100% of pregnant women in Botswana were estimated to have received antenatal care at a health facility in 2000 (Osei-Hwedie, 2001; World Bank, 2005). Government health services are free to citizens, so health care is generally accessible to the majority of the population.