Hearing the Ants Walk: Micro-

economic level impact of

HIV/AIDS on African households
Gabriel Rugalema, PhD
Senior Policy Adviser, UNAIDS
UNDP Africa Regional Project for HIV and Development
Pretoria, South Africa
 Why micro-economic focus?
- Illness and hence care provision
are experienced at this level
- Deaths and funerals too are
occurring at this level
- Impact on survivors is borne at
household level
- Overall, households bear the
gravest impact of the epidemic.
 Conceptualising the impact of
HIV/AIDS on households
- Entitlement failure – Survivors’
rights and access to economic and
social resources are severely
affected.
- Long-wave disaster – The impact
is intergeneration
- Series of crises – demographic,
social, and economic crises.
 The three conceptual frameworks fit
into one another pretty well. I will
elaborate on “AIDS as a series of
crises.”
- First is the crisis of ill-health (1st
individual)
Crisis of ill health gives rise to crises of
labour, income, expenditure, social
expectation, physical and social
assets.
The second crisis is death [for simplicity call it 1st
AIDS death]
- This crisis is also accompanied by crises related
to assets (disposal, disinheritance), income,
expenditure, labour, nutrition, social claims and
expectation, disinvestment in [future] human
capital.

Crises 1 & 2 are essentially demographic. The

change in demographic composition sets a chain
reaction of crises of varying nature and
magnitude including dissolution of affected
households.
Why is HIV/AIDS different?
- Demographic crisis does not stop on first
illness and death. The first death is
invariably followed by another or others in
the course of time. Households that have
experienced multiple deaths are very
common on the African continent today.
- Each crisis of illness and death is
accompanied by specific social,
psychological and economic crises. Some
of these crises feeds into further mortality
particularly among child survivors.
The other peculiarity of HIV-related
illnesses is that they are characterised by a
sequence of ever increasing severity
interrupted by brief periods relief. This
constitutes a series of crises and relief in
which crises outweighs relief as the patient
moves from intermittent illnesses to chronic
ill-health and eventual death.

==See Kabumbilo’s case study for

elaboration==
 Kabumbilo’s household 1995 - 2002
1st Phase April 1995 – July 1996
- Kabumbilo fells ill on/off – severe over time
- Wife pregnant and sickly--the children and
Kabumbilo’s mom provides physical care
- Assets disposed of include cattle, timber
tree,bicycle and Kabumbilo’s income from
carpentry collapses. Farm overtaken by weeds as
well.
- Wife delivers sickly daughter and quickly
resumes her roles and responsibilities as mother,
wife, carer, and provider.
- Kabumbilo dies July 1996 survived by a widow
and four young children.
 2nd Phase August 1996 – June 1998
- Widow try to pick up the pieces
- Cattle is transferred from the household
- Oldest son (then 7) is fostered by paternal
grandmother’s brother
- Youngest child sickly
- Farm no longer productive
- Food and cash severely lacking
- All three children in the household have
malnutrition
- Youngest child very ill for over 6 months
- No money, no palliative care
- Youngest child dies in June 1998
 3rd Phase July 1998 - May 2000
- Household membership has shrunk from 6 to 3
people.
- Widow sickly most of the time
- Mother in-law, hitherto a pillar of support dies
suddenly (heart attack due to extreme stress?) in
April 1999
- Food and money very scarce
- Widow and orphans have severe malnutrition
- Life dependent on neighbours and relatives
- Widow severely sick throughout 1999
- Widow taken by her mother for care, two
children left behind under the care of severely
disabled uncle.
 4th Phase June 2000 – May 2002
- Widow dies June 2000
- One fostered by disabled uncle and the other is
fostered by one of the aunties
- First son who had been fostered immediately
after his father’s death dies in April 2001 aged 11
- The daughter fostered by her aunt is maltreated
and comes to stay with disabled uncle
- Uncle fells ill now and then (leukemia) and
losses his tailoring business
- Food and cash very scare – the orphans and
their four children nephews are all malnutritioned
- Uncles wife embarks on casual labour
- She is the sole family provider at the moment!!
 Conclusion
- HIV/AIDS constitutes a series of crises
mostly borne at micro level.
- Such crises are invariably experienced
differently by different people according to
gender and age. The time dimension is
important
- Most such crises impacts on development
of household, family, community,and nation.
- Analysing the developmental implications
of AIDS and reporting on them objectively is
critical.
 Conclusion cont’d
- Interventions that would postpone or even
prevent premature death (e.g. ARVs) are critical
and should be universally available
- Interventions that would limit or do away with
asset disposal are critical as well. These would
probably cut the link between AIDS death and
intensification of poverty in affected households
- HIV prevention even in areas of very high HIV
prevalence cannot be over-emphasised.