CHAPTER 2 AT A GLANCE
In this chapter I outline the conceptual framework of my study. For this purpose, I reviewed numerous sources on HIV&AIDS, the theory of coping and the asset-based approach (although the sources in this area are fairly limited). I therefore commence the chapter by reviewing existing literature on HIV&AIDS, followed by discussions of coping theory and the asset-based approach. In reviewing existing literature I was guided by the focus of my study, in terms of my research questions and the purpose of the study. I present the three main sections of the chapter in terms of existing knowledge, limitations in the knowledge base and where my research fits into the existing base of knowledge. In each section, I also continually identify potential areas in which my study might contribute to the existing knowledge base. I conclude the chapter by presenting my conceptual framework for this study.
By engaging in a critical discussion of the various theoretical components and after I have completed my study, I shall endeavour to elaborate on the existing body of knowledge. My focus will specifically centre on the asset-based approach within the context of coping with HIV&AIDS.
CONTEXTUAL BACKDROP: HIV&AIDS
HIV&AIDS is a global pandemic impacting on individuals, families and communities in countries worldwide, including the informal settlement community where I conducted my study. Sayson and Meya (2001:542) summarise the global impact of the pandemic: ‘As when a stone is dropped into a pool, ripples from AIDS move to the very edge of society, affecting first just one person in a family, then the entire family, then the community, and finally the nation’. The ripples of HIV&AIDS have indeed reached nations across the globe.
The impact of HIV&AIDS is widespread and recognised in various sectors, such as economical, health, social and educational areas. Countries with limited resources are particularly vulnerable. In addition to challenges like these, an increase in the number of children orphaned by HIV&AIDS results in even higher levels of financial strain, as well as the need for emotional support and provision of food, shelter and care for these children. Due to their vulnerability, as well as factors like poverty and neglect, these children sometimes end up as street children, and become involved in at-risk sexual behaviour or even child prostitution.
Before focusing on the challenges and stressors experienced by communities within the context of HIV&AIDS, I provide an overview of the extent and potential impact of the pandemic, as this serves as background information to understanding the vulnerability of the community where I conducted my study, as well as the challenges faced by the community in coping with the pandemic. I conclude the section with a discussion on required responses, once again providing the background information with which I entered the research field. Possible ways of coping with HIV&AIDS are dealt with in section 2.3.2, as part of my discussion on coping.
EXTENT OF THE PANDEMIC
I find the statistics provided on HIV&AIDS infections and deaths to be overwhelming. Although I do not accept these as absolute figures, statistics provide me with an estimate of the extent of the challenge faced by communities worldwide. In 2005 it was estimated that 40.3 million people were living with HIV worldwide, of which 2.3 million were children under the age of 15 years. Vertical transmission of the virus accounts for most of the infections in this age group. It was further estimated that 4.9 million people were newly infected during 2005 – 4.2 million adults and 700 000 children younger than 15. Up until now, more than 25 million people have already died of AIDS, of which 3.1 million deaths occurred in 2005, including 570 000 children (Page et al., 2006; Brouard, Maritz, Pieterse, Van Wyk & Zuberi, 2005; Department of Economic and Social Affairs of the United Nations, 2005a; Department of Economic and Social Affairs of the United Nations, 2005b; Shisana et al., 2005; UNAIDS/WHO, 2005; Tindyebwa, Kayita, Musoke, Eley, Nduati, Coovadia, Bobart, Mbori-Ngacha & Kieffer, 2004; UNAIDS, 2004; Department of Social Development, 2002; UNAIDS, UNICEF & USAID, 2002). To me, statistics like these emphasise the extremes that the pandemic has reached, despite ongoing research and preventative measures employed since the outbreak of the HIV&AIDS pandemic. Against the background of these statistics reporting on the global extent of HIV&AIDS, I shall now investigate the impact of the pandemic on the African continent and, in more specific terms, on local ground.
Sub-Saharan Africa is reported to have been hardest hit by the pandemic, with 25.8 million, or approximately two thirds of the people, living with HIV. In addition, the highest number of children living with the disease (90% of children under 15 years of age), as well as the highest number of children orphaned by AIDS, applies to Africa. It was estimated that 2.4 million deaths in sub-Saharan Africa during 2005 could be ascribed to HIV&AIDS-related illnesses and that 3.2 million people were infected with HIV during that year. In 2003, more than 400 000 children under the age of 15 died of AIDS in sub-Saharan Africa (Page et al., 2006; Brouard et al., 2005; UNAIDS/WHO, 2005; Cabassi, 2004; Miamidian, Sykes & Bery, 2004; Tindyebwa et al., 2004; UNAIDS, UNICEF & USAID, 2002).
On an even closer level, I view the impact of HIV&AIDS on South Africa as one of the most intense and probably the most serious in the world. I regard both the vast rate of increase in infections and deaths, as well as the extraordinary scale of the pandemic in South Africa, as being significant. By 2004, between 2.6 and 3.1 million men, between 3 and 3.6 million women, and more than a 100 000 babies were estimated to be living with HIV – an estimated 12% of the South African population being infected with the virus. Seventy six percent of these people were in the age group 15 to 34 years. In addition, the estimation of AIDS-related deaths in South Africa for that year was 500 000 (Department of Health, 2005; Marais, 2005; UNAIDS/WHO, 2005). Statistics like these resulted in my anticipation (prior to entering the research field) that the South African community in which my study is located might have to support numerous community members living with HIV&AIDS. It made me wonder in which manner the selected community might be coping with such (theoretically) vast numbers of cases in need of care and support.
It is estimated that more than five million South Africans are presently living with HIV&AIDS and that 50% of the South Africans within the age group 15 to 24 years will die of AIDS. Nine hundred people die of AIDS in South Africa daily, whilst more than 1 500 become HIV infected. It is projected that half a million South Africans will die annually from AIDS-related causes by the year 2008 (Page et al., 2006; Brouard et al., 2005; Department of Economic and Social Affairs of the United Nations, 2005a; Department of Economic and Social Affairs of the United Nations, 2005b; Department of Social Development, 2002; UNAIDS, UNICEF & USAID, 2002). The pandemic is further expected to only peak in South Africa between 2010 and 2020. In this regard South Africa is predicted to be one of five countries that will experience a negative population growth due to AIDS mortality by 2010, with the growth rate estimated at -1.4% (Richter, Manegold & Pather, 2004; Stanecki, 2002).
To me, the numerous sources on HIV&AIDS-related statistics confirm the fact that research in the field of HIV&AIDS is ongoing and relevant. However, the fact that the extent of the pandemic seems to be vaster than predicted makes me wonder as to how successful research and intervention initiatives with regard to prevention are. In addition, I am increasingly aware of the fact that communities are facing a challenge that they need to cope with, and that more research relating to possible ways of coping is continually required.
Furthermore, the high HIV prevalence rate in South Africa implies an increase in the number of orphans in the near future, rendering our country one that has not yet experienced the full impact of the orphan crisis. In my view, this prediction (that the impact of HIV&AIDS will be experienced as even more harsh in future) once again emphasises the importance of communities being prepared to cope with the impact that is foreseen. Seeking answers to questions like the following might provide insight into the existing coping practices of communities (as I also aimed to obtain in my study): How do communities address and cope with so many cases of loss? How is daily functioning and productivity impacted upon by HIV&AIDS? How do community members cope with the emotions related to loss and grief?
The current HIV&AIDS scenario, as described in the previous paragraphs, necessitates ongoing research as well as attempts to prepare and support communities to cope with the challenges related to the pandemic. As HIV&AIDS implies various associated stressors, communities will in future have to cope not only with an increase in HIV&AIDS-related deaths, but also with an increase in the number of children orphaned due to HIV&AIDS. Upon gaining insight into the extent of the pandemic, I ponder on the question as to whether South African communities are ready and equipped to cope with the challenges and vulnerabilities implied by the pandemic. In this manner, I realise the potential that my study may hold for possibly contributing to the knowledge base on coping with the challenge of HIV&AIDS. Concerning the estimated numbers of future orphaned children, I question the predictions, against the background of anti-retroviral treatment (supposedly) being provided to people living with AIDS. If anti-retroviral treatment extend people’s lives, future statistics on children orphaned due to HIV&AIDS might turn out not to be as steep as predicted. However, I do accept the reality that the numbers will be rising and counting for enormous numbers of children left vulnerable and in need of care.
IMPACT OF HIV&AIDS
The Department of Social Development (2002:10) describes HIV&AIDS as the ’most urgent health, welfare and socio-economic challenge in South Africa’. I regard the pandemic as a cross-sectoral developmental issue, impacting and posing challenges on numerous levels, such as health, economic, social, agricultural, policy level and many other areas (Brookes et al., 2004; Smart, 2003b). I henceforth discuss the impact of the pandemic in terms of the developmental impact implied, the interrelatedness between poverty and HIV&AIDS, and, lastly, the sectoral impact on health care, education, the private and industrial sector, as well as the macro-economic level.
Impact on the development of individuals, families and communities
HIV&AIDS impacts on the individuals, social safety nets and households of communities – people having to cope on a primary level with the challenges implied by the pandemic. Upon becoming ill, family members might experience physical and psychological pain and suffering, and are often not able to contribute to the household income any more. As a result, people’s involvement is reduced on various levels, for example in the agricultural and mining sectors. The pandemic therefore reduces labour and productivity, and by implication also the capacity to provide health services, which are urgently demanded by the pandemic (Barolsky, 2003; Ramsden, 2002; UNAIDS, UNICEF & USAID, 2002; Kelly, 2001a; Kelly, 2001b; Ngcobo, 2001; World Bank, 1999; Mkwelo, 1997).
In addition, families’ expenses increase when a family member becomes ill (in order to obtain treatment, health care and healthy dietary requirements), resulting in food insecurity and ultimately the weakening of the nutritional status of the people involved. As such, HIV&AIDS intensifies poverty and negatively impacts on family life and family relationships, as well as families’ access to social and economic resources. Concerning the influence on family structure, HIV&AIDS leads to an increase in single parent families, as well as children living in households headed by elderly relatives or siblings (Ramsden, 2002; UNAIDS, UNICEF & USAID, 2002; Kelly, 2001a; Kelly, 2001b; Mkwelo, 1997). Being aware of the potential impact of the pandemic on individuals, families and communities provided me with an overview of the challenges that the participants (community members) in my study need to cope with. It guided me in planning and conducting data collection activities, in terms of potential areas to explore. For the purpose of my study, I assumed that the members of the selected informal settlement community were indeed coping with these challenges at the time of my study.
Furthermore, I continuously kept in mind that some family members might start missing school or work, in order to care for those who are sick. I considered the thought that the death of a parent could result in further financial obligations (like funeral expenses), permanent loss of income, and children being orphaned and in need of care. In some cases, children (or widows without an income) might turn to sex work for an income, thereby increasing the risk to be infected with HIV. In this manner, HIV&AIDS does not merely lead to financial strain and sometimes the loss of savings, it also adds greatly to the psychological distress experienced by the person being infected or ill, as well as other family members involved. Family members experience stress with regard to being financially needy and not being able to provide for their basic needs, as well as from the illness they need to cope with. In the case of extended family members taking care of children affected by HIV&AIDS, financial demands are added to their households (SAHIMS, 2004; Barolsky, 2003; UNAIDS, UNICEF & USAID, 2002; Cross, 2001; Kelly, 2001a; Kelly, 2001b; Ngcobo, 2001; Ratsaka-Mothokoa, 2001; Townsend, 2001; World Bank, 1999; McDonald 1998). Within the context of my study, the potential impact of HIV&AIDS on family members and family life guided me to explore the manner in which relatives are coping with the challenges implied by a family member living with HIV&AIDS, as actualised in the community in which my study is located.
CHAPTER 1: SETTING THE STAGE
CHAPTER 1 AT A GLANCE
1.1 INTRODUCTION AND RATIONALE
1.2 PURPOSE OF THE STUDY
1.3 RESEARCH QUESTIONS
1.4 UNIQUE CONTRIBUTION OF THE STUDY
1.6 CLARIFICATION OF KEY CONCEPTS
1.7 PARADIGMATIC PERSPECTIVE
1.8 RESEARCH METHODOLOGY AND STRATEGIES
1.9 OUTLINE OF CHAPTERS
CHAPTER 2: EXPLORING EXISTING LITERATURE AS BACKGROUND TO THE STUDY
CHAPTER 2 AT A GLANCE
2.2 CONTEXTUAL BACKDROP: HIV&AIDS
2.3 UNDERLYING THEORY: COPING
2.4 UNDERLYING APPROACH: THE ASSET-BASED APPROACH
2.5 CONCEPTUAL FRAMEWORK FOR THE STUDY
CHAPTER 3: DESIGNING AND CONDUCTING RESEARCH IN THE FIELD
CHAPTER 3 AT A GLANCE
3.2 PARADIGMATIC APPROACH.
3.3 RESEARCH DESIGN AND METHODOLOGY
3.4 STRENGTHS OF MY METHODOLOGICAL CHOICES
3.5 CHALLENGES IMPLIED BY MY METHODOLOGICAL CHOICES
3.6 MY ROLE AS RESEARCHER
3.7 ETHICAL CONSIDERATIONS
3.8 QUALITY CRITERIA
CHAPTER 4: REPORTING ON THE RESULTS OF THE STUDY
CHAPTER 4 AT A GLANCE
4.2 COURSE AND PHASES OF THE FIELD WORK
4.3 RESULTS OF MY STUDY
CHAPTER 5: RELATING RESEARCH FINDINGS TO EXISTING LITERATURE
CHAPTER 5 AT A GLANCE
5.2 FINDINGS OF THE STUDY – SITUATED IN EXISTING LITERATURE
CHAPTER 6: CONCLUDING THE JOURNEY AND RECOMMENDING FOR THE FUTURE
CHAPTER 6 AT A GLANCE
6.1 INTRODUCTION .
6.2 OVERVIEW OF THE PRECEDING CHAPTERS
6.3 CONCLUSIONS IN TERMS OF MY RESEARCH QUESTIONS
6.4 FINAL REFLECTIONS
6.5 OUTCOMES OF MY STUDY
6.7 IN CLOSING
GET THE COMPLETE PROJECT