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LOOKING AT POPULATION VULNERABILITY FROM THE PERSPECTIVE OF HIV/AIDS RESEARCH

LOOKING AT POPULATION VULNERABILITY FROM THE PERSPECTIVE OF HIV/AIDS RESEARCH. Tim Quinlan Research Director HEARD Health Economics and HIV/AIDS Research Division . DEFINITIONS (COMMON USEAGE IN HIV/AIDS RESEARCH). RISK - Probability of infect ion .

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LOOKING AT POPULATION VULNERABILITY FROM THE PERSPECTIVE OF HIV/AIDS RESEARCH

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  1. LOOKING AT POPULATION VULNERABILITY FROM THE PERSPECTIVE OF HIV/AIDS RESEARCH Tim Quinlan Research Director HEARD Health Economics and HIV/AIDS Research Division

  2. DEFINITIONS (COMMON USEAGE IN HIV/AIDS RESEARCH) RISK - Probability ofinfection. e.g. Biological : women more than men; Age : ‘youth’ (15-24 yrs old) Occupational categories: sex workers; truckers SUSCEPTIBILITY - infected Risk plus Context (living conditions, lifestyles and behaviour) Why some people have a higher chance of being infected than others (e.g. not all sex workers are equally at risk of being infected) VULNERABILITY -affected - how & why HIV/AIDS affects many people’s lives and livelihoods including those not infected; - why some are not able to cope; - why & how changes in lifestyle and behaviour (susceptibility indic.) Purpose: Identify conditions that contribute to the spread of HIV/AIDS; where to focus interventions.

  3. HIV prevalence rate by skill level for South Africa

  4. Total educator mortality by age group:KwaZulu-Natal 1998 - 2001

  5. A Spatial Framework for the Management & Support to Orphans and Vulnerable Children (OVC) in KwaZulu-Natal Su Erskine (HEARD) & Dan Wilson (EduAction) Funded by: Rockefeller Brothers

  6. Project background • Quantifiable data about OVC • Where are they located? • Who is providing the children with services? • Community & non-government organisations • Public sector services • Where are the gaps? • Creating a management tool • Visualising the spatial distribution of OVC • Assessing the service-demand relationship • Provide a rational basis for targeting additional support

  7. Potential Vulnerability FactorsPercentage of children (below age 15) who responded ‘No’ to the question ‘Is your mother alive?’ in the 2001 Census at MunicipalityLevel

  8. Potential Vulnerability FactorsPercentage households within each Municipality that have ‘insecure’ tenure status – (Rented Accommodation or Occupied rent-free)

  9. Define, identify & geolocate organisations working/ supporting OVC • Non-state service providers • Existing databases used as springboard • Building from contacts made • General knowledge, networking, newspapers etc • Technique known as geocoding used to position OVC projects

  10. Distribution of Feeding Schemes

  11. STRATEGIC PLANNING APPROACHES

  12. AMAJUBA CHILD HEALTH AND WELLBEING RESEARCH PROJECT Five year integrated project Aims: Document consequences of parental/caregiver death for welfare of orphans and other children in households that care for orphans Use the research information [to engage] with relevant Govt. Depts, NGOs & CBOs to construct a local level [district] integrated child welfare management plan

  13. METHOD AND METHODOLOGY FIELD TRIAL - 100-150 Orphans/ 350-400 non-Orphans; 9-15yrs old; - Prospective, incidence sampling - 6 bi-annual surveys - Demog., socio-economic status, psycho-social questions - Compare orphans/non-orphans in same & different households - School-based selection procedure - School performance assessment (?) 2)INTEGRATED RSRCH. & PLANNING FRAMEWORK - Social/Context assessment (benchmark) - Participatory Research (consultation, engagement with child welfare agencies) - Monitoring (change in context and content of child welfare through interaction of ACHWRP & welfare agencies)

  14. ACHWRP: Expanding & Refining vulnerability assessment Use existing ACHWRP to ‘piggy back’ sub projects: Nutrition/food security (simple tools, tested elsewhere) Child tracking/migration School Performance

  15. Gendered Consequences of caregiving of informal caregivers in South Africa By OLAGOKE AKINTOLA (MPH, Ph.D) (Health Economics and HIV/AIDS Research Division) University of KwaZulu-Natal, Durban, South Africa

  16. Introduction • Home-based care = national policy response in South Africa • Study focus on practice of HBC • Study aim: to understand gendered consequences of HBC on caregivers & implications for health care system.

  17. Gendered Burden of Care • Burden refers to the practical difficulties and mental pain experienced by caregivers • Some elderly women & many young girls served as secondary caregivers. • Reluctant to report stress due to socio-cultural values:giver stronger than receiver. • These women experienced PHYSICAL STRESS HH chores, walking in sun. Also at risk of infection with TB/HIV from caring without protective devices.

  18. STRESS • PSYCHOLOGICAL & EMOTIONAL STRESS eg. nightmares, insomnia, worry, anxiety, fears about imminent death, despondency from frequent deaths • SOCIAL STRESS -stigma, alienation from friends & social activities, outbursts of anger from patients. • ECONOMIC STRESS –most were Female household heads and breadwinners; decreased income from loss of jobs/job opportunities, transport to health facilities,of dead/funeral costs

  19. Key findings • Many families not able to provide HBC without undermining wellbeing of other family members - and volunteer caregivers. • Very strong resistance of men against involvement in caregiving • Women combine multiple roles as caregivers, heads of households, breadwinners • Volunteers are not financially better than the patients they care for. • Increasing number of volunteers are HIV positive themselves.

  20. Conclusions (Through comparative research in Uganda) KEY POINTS (for planning interventions): Replace ‘community-based’ ‘volunteer’ caregiving projects with ‘community-oriented’, professional caregiving system HBC not a cheap option for governments (it defers cost only)

  21. SOUTHERN AFRICAN VULNERABILITY INITIATIVE Attempt to develop ‘multi-stressor’ research framework How does climate change, trade, conflict, poverty physical enviro. degradation, trade, conflict, HIV. Etc. affect ‘human security’ in southern Africa Distinguish relative effects of climate change, etc. etc. Refine concepts (e.g coping; adaptation, resilience)

  22. SAVI WORK TO DATE 2002-2003:SAVI 1: research & findings workshop 2004: draft research framework paper Oct 2004: Planning workshop with researchers and NGOs dealing with vulnerability Sept-Dec 2004: ‘Negotiating Health in rapidly changing Urban environments’ (Canadian Geog MA student –research on vulnerability of women traders in Warwick Junction) Background project(Jan-June 2004): Comparison of enviro. conditions for women traders – Uganda & SA

  23. CONCLUSION Different projects – but developing programmtic focus on vulnerability Exploring different dimension of vulnerability in different sub-populations Aim to Get more precise definition of vulnerability concept (i.e. where when (when not) and, how to use it - Better data and analysis - Stronger foundation to inform planning of HIV/AIDS interventions

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