15 th May 2008 Janet Seeley, School of Development Studies, University of East Anglia

1. Lessons on defining the household from a study of socio-economic status and HIV and AIDS in rural Uganda 15th May 2008 Janet Seeley, School of Development Studies, University of East Anglia

2. Background • The MRC General Population Cohort (GPC) study was established in 1989 in 15 rural villages (expanded to 25 villages in 2000) in a sub-county of Masaka district in Uganda. • Its main objectives are: • to describe the dynamics of HIV infection within a rural population, • to identify the major risk factors for contracting HIV and to quantify the impact of mortality and fertility and • to study treatment seeking behaviour. .

3. Household Trajectory study background • In 1991-1992, the MRC/UVRI programme conducted an ethnographic study of household coping mechanisms based on the experience of 27 households selected from three of 15 villages that made up the GPC. • Over a period of one year interviewers paid monthly visits to the study households to record changes in different aspects of the household’s daily life such as composition, employment, health, food consumption and social networks.

4. Trajectory Re-study 2006-2007 • Twenty seven households (defined by members but usually meant the people living together on a compound and sharing meals) participated in the study in 1991/1992. • Members of 24 of those original households participated in the restudy. Information on two households which no longer exist because their household heads have died and their children have moved away was gathered from neighbours and relatives. One household refused to take part in the restudy.

5. Table 1: Households, socio-economic status and HIV and AIDS within the household 1991/2006 (all names have been changed)

6. Table 1 – cont’d

7. Only the original households of Pontiano, Namutebi and Violet have improved their position while the households of Hawa, Victoria, Betty, Lydia and Roda have become poorer. • Two of the new households, both men now in their 40s engaged in business and trade, were now more prosperous than their grandmother/father had been in 1991. • The reasons for the change, or in some cases, lack of change in socioeconomic becomes clearer when we take into account the existence of HIV and AIDS among the wider kin and friendship groups.

8. Table 2: Households, socio-economic status and HIV and AIDS in the household and wider family 1991/2006

9. Table 2 – cont’d

10. Pontiano KEY to kinship diagrams Male Female Household head Resident household member Formal marriage/sibling link Informal marriage Separation/divorce/death Denotes relationship of child or children to a couple

11. Hawa

12. Eva

13. Roda

14. Victoria Victoria

15. The data suggest… • A focus solely on the household unit cannot adequately explain the impact of HIV and AIDS on household socio-economic status. • While other family members may provide support to a household, they may also need support themselves and thereby drain resources from related households. • A look at the impact of HIV and AIDS on people’s wider families provides pointers to why those who may not have had an AIDS-related death in their own household may have failed to prosper.