MT.

KENYA UNIVERSITY SCHOOL OF APPLIED SOCIAL SCIENCES

SUBJECT (UCU-004): ASSIGNMENT: FAMILY PRESENTED BY: GROUP MEMBERS:

HIV/AIDS & DRUG ABUSE IMPACTS OF HIV/AIDS TO A

GROUP 3 BBM/NRP/103/0081

1. JUDITH CEHPKIRUI RUTTO:

2. MARTIN N. KIBORE: BBM/NRP/102/0035

3.

JAMES N.NYAKOE 4. 5. 6. 7. 8. 9. EDITH KARIUKI JOSHUA WANJOHI

BBM/NRP/102/0024 BBM/NRP/102/0018 BBM/NRP/102/0011 BBM/NRP/102/0039 BBM/NRP/103/00 BBM/NRP/102/0026 BCOM/NRP/102/003 BBM/NRP/103/

NAFISA MOHAMED LEAH THUGI RASHID AHMED

SAHARA MOHAMED BBM/NRP/103/0039

10. BETTY M. MANYASI 11. CHARLES MUTUNGA 12. 13.

14. 15.

PRESENTED TO:

J. NDETTE (Mrs.)

DATE:

24th JULY 2011

TABLE OF CONTENT Table of content .................................................................................................................................. ii Preface .................................................................................................................................. iii Introduction .................................................................................................................................. iv

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THE IMPACT OF HIV/AIDS TO THE FAMILY .................................................................................................................................. 1 Impact on children .................................................................................................................................. 1 The impact on the education sector .................................................................................................................................. 3 The impact on teachers .................................................................................................................................. 4 Impact on hospitals .................................................................................................................................. 4 Health care workers .................................................................................................................................. 4 The impact on life expectancy .................................................................................................................................. 5 The economic impact .................................................................................................................................. 5 The impact on old people .................................................................................................................................. 6 Economic support .................................................................................................................................. 6 Practical and legal support .................................................................................................................................. 6 Family

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.................................................................................................................................. 6 Socio-economic impact .................................................................................................................................. 7 Impact on Woman .................................................................................................................................. 7 Impacts at Household Level .................................................................................................................................. 9 Impacts on Agricultural Sector and Food Security .................................................................................................................................. 10

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Preface This paper outlines the major impacts of HIV/AIDS on the social and economic structures of households and communities in sub-Saharan Africa. It continues with a discussion of some of the most significant responses, some organized by communities themselves, others facilitated by outside agencies. The evidence used in this paper

reflects the research and discussion in group 3 of changes in family structure and multiple impacts on women, girls and boys, deals with income costs of epidemic on households and communities and key responses at all levels that seek to mitigate the impacts of HIV/AIDS which includes the spread of new infections, need to deliver adequate integrated quality services to the affected and infected among others.

Introduction By the late 1990s, many governments and major international donors reacted to the growing evidence of the impact of HIV/AIDS on households by suggesting that traditional coping mechanisms would minimize the impact and allow households and communities to absorb the loss of members, their income, assets and social contributions. political dimension. Acknowledging this element of African societies traditional strengths is not obligated to respond to the multiple crisis they faced as a critical emergency. The need for a degree of caution in assessing the impact of HIV/AIDS on households and communities is because other factors are at work at the same time. In sub-Saharan Africa over the past several decades, have left some households and communities already suffering conditions of poverty mostly adult members to illnesses e.g. HIV/AIDS, female and elderly-headed households are likewise least able to cope with the economic, labor and social losses arising from the disease. Three broad statements do seem reasonable at this stage in the pandemic:1. The presence of HIV/AIDS in a household quickly results in depletion of household income earning capacity and of household savings and assets, many households quickly move into conditions characterized by poverty. 2. HIV/AIDS is not a stand-alone condition, but exist within a wider socioeconomic context that deepens the vulnerability of household, communities and nations This belief had an important

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3. The economic costs of HIV/AIDS, the stigma surrounding the disease that leads to discrimination and withdrawal, and ability to access social services combine to expand socioeconomic inequalities in society.

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THE IMPACT OF HIV/AIDS TO THE FAMILY A family is a group of people related by blood or otherwise staying together. A family comprises mostly of A father, Mother and Children The economic and social consequences of the disease directly affect the family in terms:Impact on parents especially, Woman The loss of adults in the family has dramatic implications for family wellbeing. In addition, the growing prevalence of women infected by HIV/AIDS has repercussions for future generations. Women in sub-Saharan Africa frequently are responsible for large portions of household-level subsistence farming and care-taking. Economic inequality. When women are widowed due to AIDS local legislation and limited

legal status, including the ability to inherit and own property and financial resources increases the economic vulnerability of women, this is true after the death of male landholders. Loss of land and resources for agricultural production reduces the opportunities for income generation, this further increases vulnerability to HIV due to poverty; Biological vulnerability. Women face unique biological

vulnerabilities. The vagina is a larger, more delicate membrane and consequently more susceptible to HIV infection. Furthermore, semen which comes into contact with the vagina during intercourse contains a higher

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concentration of HIV than vaginal fluids, making women 2-4 times more likely of contracting HIV than her male counterparts; Comprehensive knowledge of HIV among women remains low.

Women may face unequal access to education which may limit their understanding and ability to prevent HIV infection in the first place. Compounding this problem is the fact that girls living in households that are infected/affected by HIV/AIDS are twice as likely to be withdrawn from school; Burden of care. Woman becomes infected with HIV, inadequate

access to treatment and support compound her psychological and physical burden of HIV/AIDS care. Referred to as triple jeopardy, more often than not, women will not only be infected, as will their partners and children which may be born after the onset of infection. She must then care for all of these parties, often with limited resources. Many care givers experience high levels of stress, impacting their well-being especially if they are also HIV-positive; Stigma, rejection, and violence. At the root of this issue are the

sexual double standards faced by women. In many contexts, the social and cultural value surrounding female purity means that women and girls living with HIV/AIDS are subjected to greater discrimination than men. Cases where women are blamed for their infection can lead to heightened levels of domestic abuse, abandonment by spouses or in-laws, or dismissal from paid employment. Internalized stigmas may also undermine confidence to leave a physically or sexually abusive relationship, and increase the risk of infection; Unequal access to health care. Women are less likely to seek or

receive medical care and treatment as their needs may be overshadowed by the needs of male family members, especially when economic resources are 2
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limited. This can limit rates of testing and treatment of HIV, other sexually transmitted diseases, and opportunistic infections and can ultimately exacerbate rates of death due to AIDS among women; Women and girls face higher rates of malnutrition compared to

their male counterparts. In low resource settings, women and girls may be forced to skip meals or eat less, jeopardizing health. This is especially dangerous as HIV infection can progress more rapidly to the AIDS stage without treatment, including proper nutrition. (FAO, 1999). women are often unable to meet these demands; Even among women who are able to access health care facilities and

HIV-testing, fear of disclosing a positive status to her partner can limit adherence to treatment. Asking her husband for funds to pay for treatment, utilizing options like using powdered milk to prevent mother to child transmission, or insisting condom use to reduce repeated exposure are obvious indicators that a woman is HIV positive, which could lead to abuse or abandonment.

Impacts at Household Level The direct cost of HIV/AIDS can be measured in the lost income of those who die, who are unable to work or lose their job because of their illness or because they have to care for a family member that is sick. In Botswana, for example, it is estimated that every income earner is likely to acquire one additional dependent over the next ten years due to the AIDS epidemic. Consequently, households which might have otherwise stayed above the 3
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poverty line are pushed below it. This can lead to further risks for HIV transmission as breadwinners have to find work away from their families, and in some cases, women may be forced to turn to sex work. Reduced earnings at the household level leads to reduced access to resources such as condoms needed for prevention, nutritious food, and antiretroviral drugs. The financial burden of families to take care of a person sick with AIDS is not only an emotional strain for household members, but also a major strain on household resources. It is estimated that, on average, HIV-related care can absorb one-third of a households monthly income. In addition, the cost of death can also be considerable, with some families in South Africa spending three times their total household monthly income on a funeral which has removing an entire middle generation of Africans, and is causing undue suffering to the generations of children and elderly left behind. As a consequence, an increased burden is placed on the remaining members; often without the physical capacity or skills to provide for themselves, they are suffering. For example grandparents, mostly grandmothers, are often burdened with the care of orphaned children. Impact on children Facts about HIV/AIDS and children, about four in 10 infected children die by the age of 12 months, many survive beyond two years of age, and some only reached adolescence. 1. When a rural woman falls ill from HIV, all of the duties that she usually handles may fall upon the younger female children of the family. 2. Economic hardships. With the onset of HIV/AIDS in the household, savings may be spent on the care of parents rather than educational 4
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and health needs of children. After the death of parents, children may also be deprived of inheritance such as money or property that is rightfully theirs; Loss of land and other assets and perhaps the right to use the land taken away by the family members 3...Lack of love, attention and affection. Parents may be unable to give consistent and responsive care to their children. Illness in the household may also lead to reduced interpersonal relationships between children and their parents affection and comfort. The premature death of parents also results in the loss of life and survival skills. These skills are no longer passed from one generation to the other, and children are forced to take on responsibilities for which they may be unprepared; 4. Withdrawal from school and early marriage of teenage

daughter in order to gain the financial assets. Related to declines in economic stability in the household or increased pressure to care for siblings and ailing parents, children may be forced to withdrawal from school; as parents and family members become ill, children take on more responsibility to earn an income, produce food, and care for family members. It is harder for these children to access adequate nutrition, basic health care, housing and clothing. 5. Psychological distress, Illness and death of parents, or other family members can cause extreme emotional distress among children. Without support and grief counseling children can also succumb to increased fatalism, or stigma, discrimination and isolation related to 5
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their orphan status. Orphaned children are also more likely to be rejected by their extended families due to their parents dying of AIDS. These challenges can lead to emotional and behavioral changes in children, such as depression and delinquency and street children. Previous studies have documented that children from HIV-affected families are more prone to developing disorders, such as social adjustment and attention problems, and depression. 6. Malnutrition and illness. Orphaned and vulnerable children are less likely to meet their basic needs due to limited economic resources, which include access to nutritious food and medical care which leads to other opportunistic diseases; 7. Increased abuse and risk of HIV infection. It has been noted that orphaned and vulnerable children, in particular girls, are at an increased risk to sexual exploitation due to poverty, hunger, and armed conflict (UNICEF, 2004). These scenarios may force young girls into survival sex-work and/or harmful child labor in order to obtain money, food, shelter or protection for themselves or younger siblings left in their care. Sadly, this exacerbates and perpetuates the cycle of HIV. Death rates are also high in children with HIV and AIDS at the age of 1 year to 5 years which may leads to loss of families roots that is a whole family may perish without them realizing the cause of their children is hard to over emphasize the trauma and hardship that children affected by HIV/AIDS are forced to bear. The epidemic not only causes children to lose their parents or guardians, but sometimes their childhood as well. 6
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As projections of the number of AIDS orphans rise, some have called for an increase in institutional care for children. However this solution is not only expensive but also detrimental to the children. Institutionalizations stores up problems for society, which is ill equipped to cope with an influx of young adults who have not been socialized in the community in which they have to live. There are other alternatives available. One example is the approach developed by church groups in Zimbabwe, in which community members are recruited to visit orphans in their homes, where they live either with foster parents, grandparents or other relatives, or in child-headed households. The impact on the education sector A decline in school enrolment is one of the most visible effects of the epidemic. This in itself will have an effect on HIV prevention, as a good, basic education ranks among the most effective and cost-effective means of preventing HIV. There are numerous barriers to school attendance in Africa. Children may be removed from school to care for parents or family members, or they may themselves be living with HIV. Many are unable to afford school fees and other such expenses this is particularly a problem among children who have lost their parents to AIDS, who often struggle to generate income. A decline in school enrolment is one of the most visible effects of the epidemic. This in itself will have an effect on HIV prevention, as a good, basic education ranks among the most effective and cost-effective means of preventing HIV. The numerous barriers to school attendance they may be removed from school to care for parents or family members, or they may themselves be living with HIV. Many are unable 7
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to afford school fees and other such expenses this is particularly a problem among children who have lost their parents to AIDS, who often struggle to generate income. Prostitution rises because children and women decide to do it so as to earn a living and care for their sibling. The impact on teachers HIV and AIDS are having a devastating effect on the already inadequate supply of teachers in African countries; for example, a study in South Africa found that 21% of teachers aged 25-34 were living with HIV and they are likely to take periods of time off work. Those with sick families may also take time off to attend funerals or to care for sick or dying relatives, and further absenteeism may result from the psychological effects of the epidemic. When a teacher falls ill, students may be left untaught. The illness or death of teachers is especially devastating in rural areas where schools depend heavily on one or two teachers. The greatest proportion of staff that have been lost, according to the Tanzania Teachers Union, were experienced staff between the ages of 41 and 50. Impact on hospitals As the HIV prevalence of a country rises, the strain placed on its hospitals is likely to increase. In sub-Saharan Africa, people with HIV-related diseases e.g tuberculosis occupy more than half of all hospital beds Hospitals are struggling to cope, especially in poorer African countries where there are often too few beds available. This shortage results in people being admitted only in the later stages of illness, reducing their chances of recovery. Other 8
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sick people will face a lot of problems during admission because of lack of beds. Hospital workers are infected and affected among countries with the highest prevalence rates. Sickness often translates into absenteeism or death, leaving hospitals and clinics understaffed, and/or with workers who are not properly trained to handle the needs of patients with HIV/AIDS. Again, this is exacerbated by a large brain-drain out of countries hardest hit by the epidemic, which further reduces the number of trained workers able to effectively treat patients. Health care workers While AIDS is causing an increased demand for health services, large numbers of healthcare professionals are being directly affected by the epidemic. Botswana for example, lost 17% of its healthcare workforce due to AIDS between 1999 and 2005. A study in one region of Zambia found that 40% of midwives were HIV-positive. Healthcare workers are already scarce because of excessive workloads; poor pay and migration to richer countries are among the factors contributing to this shortage. Although the recent increase in the provision of antiretroviral drugs (which significantly delay the progression from HIV to AIDS) has brought hope to many in Africa, it has also put increased strain on healthcare workers. The impact on life expectancy In many countries of sub-Saharan Africa, AIDS is erasing decades of progress in extending life expectancy. In the worst affected countries, average life expectancy has fallen by twenty years because of the epidemic. 9
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Life

expectancy at birth in Swaziland is just 31 years - less than half of what it would be without AIDS. The impact that AIDS has had on average life expectancy is partly attributed to child mortality, as increasing numbers of babies are born with HIV infections acquired from their mothers. The biggest increase in deaths, however, has been among adults aged between 20 and 49 years. This group now accounts for 60% of all deaths in sub-Saharan Africa, compared to 20% between 1985 and 1990, when the epidemic was in its early stages. By affecting this age group so heavily have wipe out the young generation liking old people who are unable to work for a living, AIDS is hitting adults in their most economically productive years and removing the very people who could be responding to the crisis. The economic impact Through its impacts on the labour force, households and enterprises, AIDS has played a significant role in the reversal of human development in Africa. One aspect of this development reversal has been the damage that the epidemic has done to the economy, which, in turn, has made it more difficult for countries to respond to the crisis e.g agriculture sector by reducing labour supply through increased mortality and illness. Amongst those who are able to work, productivity is likely to decline as a result of HIV-related illness. Government income also declines, as tax revenues fall and governments are pressured to increase their spending to deal with the expanding HIV epidemic.

SUMMARY 10
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Impact on the Family HIV/AIDS affects the physical, emotional, moral, social, and economic well-being of the individual, family, community The HIV/AIDS epidemic is a serious threat to the health of all regardless of age, sex, social status, or race. The loss of human life and productivity due to this disease is a deterrent to socioeconomic development. HIV-related stigma and discrimination are important issues for HIV/AIDS-affected families. Discrimination is directed towards both People Living with Hiv/Aids and their family members, Expenses on medical care for sick family members must be borne entirely by the nuclear family, in addition to the medical costs e.g. drugs and traditional medical treatment, funeral expenses of family members are a heavy burden on the family budget. Poverty in the family so the only source of income to young girls for a living is prostitution which above all a sexually transmitted disease HIV/Aids, many family members has often more than one family member is affected and dies. The impact on old people To summarise, older people affected by HIV/AIDS need the following targeted support: Emotional support to help a child cope with the death of their parents; HIV/AIDS education To cope with their own grief at the death of their son, daughter or grandchild; and day-to-day support family member; 11
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to prevent isolation.

How HIV is transmitted and prevented recognizing symptoms of HIV in a

 How to care for a family member with HIV (including treating common infections); and Access to HIV/AIDS support groups and services. Economic support To meet households costs including food and healthcare; To provide education and clothing for grandchildren; For treatment and travel to clinics to care for sick children; and To compensate for loss of earnings or family support. Practical and legal support Support with parenting; Acceptance by the authorities as adoptive or foster parents; Access to information on nutrition and immunization; and Advocacy support, such as protecting the rights of widows and children to inherit land. Socio-economic impact. HIV/AIDS is disproportionately affecting rural women. In the districts studied, more households were found to be headed by AIDS widows than by AIDS Food production Household the epidemic adds to food insecurity in many areas, as agricultural work is neglected or abandoned due to household illness like Malawi where food shortages have had a devastating effect, it has been recognized that HIV and AIDS have diminished the countrys agricultural output (UNDESA, 2005).

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Widowers and Widows with dependent children became entrenched in poverty as a result of the socio-economic pressures related to HIV/AIDS. Widows lost access to land, labour, inputs, credit and support services. It stigmatization and health weaken their situation further, to the

extended that their main safety net was severed that they cannot work in their farms hence affect household produce and accumulate food and income decreases, the household falls into a downward spiral of increasing dependency ratios, poorer nutrition and health, increasing expenditure of resources (time and money) on health problems, more food shortages, decreasing household viability, and increasing reliance on support from extended family and the wider community. Impacts on Agricultural Sector and Food Security In recent years, studies have demonstrated the links between HIV/AIDS and diminishing food security at the household level. Being food secure means that there is an adequate supply of nutritious food, either domestically produced or imported, to which the population has access. This access is acquired through adequate incomes to purchase food, means to directly produce food, or both. For example, in Africa 80% of the population depends on small-scale, subsistence agriculture to generate income or to meet their basic food needs. Recent figures show that within the rural sector, seven million agricultural workers have died from AIDS in the last two decades. It is projected that another 16 million will die in the next twenty years (UNAIDS, 2003).

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Food security at the household level is increasingly unstable as more people in the rural sector become infected with HIV and AIDS. Poor health due to infection results in the diminishing ability to produce food or acquire income to purchase food. When people fall ill, they areas they can cultivate may shrink. They may also be forced to resort to cultivate crops that are less labor intensive (UNAIDS, 2004) (UNFPA, 2003). There are many ways to alleviate the effects of the disease in the family The community effort to initiate to come up with social support groups, saving associations, self help groups to help PLWHA and generally creating awareness to the society through social forums like churches, sporting activities among others on the effects of the pandemic deadly disease to family set ups. Faith based organizations have played a major role in putting up homes to provide habitation for orphaned children, providing Medicare to infected persons, spiritual support and counseling to affected families. The Government to provide financial support for provision of drugs and personalized Medicare to the Aids victims, infected pregnant mother is supported through the programmes to pretext the unborn baby from infection e.g AMPARTH (Kenya), NASCOP e.t.c

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GLOSSARY OF TERMS AND CONCEPTS Affected A person who is feeling the impact of HIV/AIDS through sickness or loss of relatives, friends or colleagues or a person whose life is changed in any way by HIV/AIDS due to the broader impact of the epidemic AIDS Acquired immune deficiency syndrome medical referred to as

opportunistic infections. HIV Human Immunodeficiency virus. A virus that weakens the bodys immune systems, causing AIDS A medical test to determine a persons sero-status of a persons well-being through medical, physical, psychosocial, spiritual and other means Comprehensive A range of services offered to HIV positive persons including, treatment, Care Counselling Infected Pandemic Prevention transmission Post Exposure 15
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HIV Screening Care Promotion

and clinical, physical, nutritional and psychosocial support A session where a person with difficulties is assisted to think through the problem(s) to find a possible solution A person who is living with the Virus that causes AIDS An epidemic occurring simultaneously over a wide area A programme designed to combat HIV infection and

and affecting many people

Prophylaxis presumed to have Prevalence of HIV population Evaluation Abstinence Bacteria Condom many cause diseases

Immediate treatment given to a person who is been exposed to HIV The number of people with HIV at a particular point as a percentage of the total

in time, often expressed

The assessment of the impact of a programme at a Avoiding sexual activity altogether Micro-organisms; some are helpful to body functions, but A rubber sheath worn on an erect penis during sexual pregnancy and sexually

particular point in time

intercourse to prevent transmitted diseases

Community health worker A trained person, often a volunteer, who works within a community to teach people about health practices, provides some simple treatments and refers sick people to clinics/medical centres for other necessary treatment Depression A psychological problem resulting from feelings of great sadness and hopelessness

Opportunistic Conditions Infections and diseases that take advantage of HIVweakened immune system Unscreened Blood Stigma Blood which has not been tested for HIV Negatively perceived characteristics used to set individuals apart from the normalized social order.

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ACRONYMS AND ABBREVIATIONS MKU AIDs ARVs HBHTC HIV PLWHA VCT STIs TB Mount Kenya University Acquired Immunodeficiency Syndrome Antiretroviral Home Based HIV Testing and Counseling Human Immunodeficiency Virus People Living with HIV/AIDs Voluntary Counseling and Testing Sexually Transmitted Infections Tuberculosis

NACADAA National Campaign AGAINST Drug Abuse Authority Home-based Services given at home to people who are ill. Services to people with AIDs focus on care general hygiene, nutrition, sexual behavior, support, treatment of AIDs- related conditions and physical therapy

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References UNAIDS (2010) UNAIDS report on the global AIDS epidemic The Impact of AIDS on Older People in Africa: Zimbabwe Case Study, Ageing and Life Course, Non-Communicable Disease Prevention and Health Promotion, WHO, Geneva, 2002. J. Knodel et al., Older People and AIDS: Quantitative Evidence of the Impact in Thailand, Social Science and Medicine, 52:9, 2001, pp. 1,3131,327. Floyd, S, et al (2003) the impact of HIV on household structure in rural Malawi. Paper presented at the conference on the Empirical evidence of the Demographic and social-economic impact of AIDs, Food and Agriculture Organization of the United Nations (2001) Rural Women Carry Family Burdens. Focus AIDs A Threat to Rural Africa Human Rights Watch (2005) Letting them fail: government neglect and the right to education for children affected by AIDs Report vol. 17 No. 13A National AID/STD Control Programme, Ministry of Health

Group 3 Discussion

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