Lucia Knight 1 , Victoria Hosegood 2 and Ian Timæus 3

1. Care and support by households and extended families in the era of HIV treatment: Responses to HIV and AIDS in rural South Africa Lucia Knight1, Victoria Hosegood2 and Ian Timæus3 1Human Science Research Council, South Africa 2University of Southampton, United Kingdom 3London School of Hygiene &Tropical Medicine, United Kingdom

2. Introduction • The obligations and norms strengthening the African family are perceived to have been eroded by social, economic and political factors1. • AIDS could compound the pressures on the family 2,3. • Despite this, there is limited investigation into the impact of AIDS on family functioning. Aims • To explore: • black South African families ability to respond to AIDS illness. • factors motivating the provision of support by family. • To asses: • the applicability of family obligation and reciprocity as concepts. • their contribution to social capital. • where these concepts don’t apply.

3. Methodology • 10 households from rural and peri-urban areas in Umkhanyakude, northern KwaZulu-Natal with AIDS illness or death were enrolled. • The household sample included: • 5 from a local HBC program, 3 from ‘Household Dynamics’ study, 1 through VA staff and 1 was an opportunistic contact. • Using in-depth interviews and participant observation ethnographic, retrospective and contemporary data were collected over 6 months. • Data were compiled into household case studies and analysed cross-sectionally using framework analysis. Results Family obligation I just help my family, I think it is right to help other people… (Gugu) • An obligation to, or reliance on, family was evident in all the households in this study. • The quality of the family relationship, influenced by contact, trust and feelings of closeness also played a role in family obligation.

4. Results cont’d Generalised reciprocity …they are so helpful because when I don’t have something they give it to me and what they don’t have I give to them…any kind [of help] even if it’s money, they had a funeral and we helped them…Even if we don’t ask they give…It helps us get out of trouble if we get what we need. (Precious) • Reciprocity is maintained through family bonds, trust and economic or material investment acting as social insurance. • It seems that, regardless of family obligation, a degree of reciprocity is expected of family if they are able. Complex and conflicted circumstances • Despite examples of family support some families failed to provide due to: • limited resources • obligations to other family, affecting their ability to behave, ‘like a member of the family’. • Family relationships are complex and did not always follow norms of obligation or reciprocity. Some households felt excluded from kinship networks.

5. Discussion • Family provided an important safety net to affected households and individuals. • Norms of family obligation and generalised reciprocity helped households access the support required and form the building blocks of social capital. • These norms had limits and inadequate resources. Excessive or conflicting obligations restricted support resulting in social exclusion. Conclusions and Recommendations • Our findings show that these families are largely resilient. • Given this resilience and social capital, the family needs adequate consideration in future HIV interventions. • Examples of social exclusion suggest that the resilience of the family should not be taken for granted, those vulnerable or at risk must be supported through community or government initiatives.

6. References 1. Nkosi, B., & Daniels, P. (2007). Family Strengths - South Africa. Marriage & Family Review, 41, 11 - 26. 2.Ankrah, E.M. (1993). The impact of HIV/AIDS on the family and other significant relationships: The African clan revisited. AIDS Care, 5, 5 - 22. 3. Seeley, J., Kajura, E., Bachengana, C., Okongo, M., Wagner, U., & Mulder, D. (1993). The extended family and support for people with AIDS in a rural population in south west Uganda: A safety net with holes? AIDS Care, 5, 117-122. 4.Sagner, A., & Mtati, R.Z. (2000). Politics of pension sharing in urban South Africa. Ageing & Society, 19, 393-416. 5.Siqwana-Ndulo, N. (1998). Rural African Family Structure in the Eastern Cape Province, South Africa. Journal of Comparative Family Studies, 29, 407-417. 6.Mason, J. (2002). Qualitative Researching. London: Sage. 7.Finch, J. (1987). Family Obligations and the Life Course. In A. Bryman, B. Bytheway, P. Allatt, & T. Keil (Eds.), Rethinking the Life Cycle. Basingstoke: The MacMillan Press Ltd. 8.Finch, J., & Mason, J. (2005). Negotiating Family Responsibilities. London: Routledge. 9.Sahlins, M. (1972). Stone Age Economics. Chicago: Aldine-Atherton. 10.Bourdieu, P. (1985). The forms of capital. In J.G. Richardson (Ed.), Handbook of Theory and Research for the Sociology of Education. New York: Greenwood. Acknowledgements • Zandile Gumedeand the staff of the Africa Centre for Health and Population Studies • Respondents from Umkhanyakude