Gendered vulnerability to AIDS and its research implications

According to the various studies, AIDS affects all facets of people’s livelihoods through illness and death and the subsequent care for orphaned children. Much of this literature uses rural households affected by HIV/AIDS as the unit of analysis and do not disaggregate data by hosting orphans, AIDS-related chronic illness and AIDS death. However, the AIDS epidemic has resulted in increased appearance of households headed by widows, elderly and orphans; households with orphaned children; households with chronically ill members; and households that recently suffered an adult death. These households are not a homogenous group but differ in their response capacities. Furthermore, the gender context in which AIDS-related impacts occur is of crucial importance but is often inadequately addressed. Also, many of the AIDS-impact studies are literature reviews or small-scale household studies conducted in a few communities over a short time interval. These studies often yield contradicting results and provide speculative inferences for the general population. Research on AIDS impacts is, in fact, complex and several methodological constraints are encountered when conducting micro-level investigations on AIDS and rural livelihood linkages. It is for these reasons that this research focuses on the gender, methodological, and ethical issues concerning AIDS impacts on rural livelihoods in sub-Saharan Africa. It aims at providing insights in how AIDS leads to vulnerability differentiation and what processes make rural households more or less vulnerable to AIDS impacts. This research also tries to provide insights in the resources female-headed household mobilised over time to respond to AIDS and the factors that enabled them in their response. Furthermore, this research examines the methodological and ethical concerns and implications of conducting micro-level AIDS-impact research. The study combines a literature review on AIDS impacts in sub-Saharan Africa, an analytical review of methodological and ethical aspects of AIDS-impact research based on literature and personal experience, and empirical data collection in the Northern Province, Zambia. For the empirical data collection, the adopted research design sequenced the use of qualitative and quantitative methodologies to complement each other. Furthermore, the research collected 12 case studies of female-headed households, which differ by marital status, age, educational attainment and wealth. This research concludes that vulnerability levels to HIV/AIDS impacts differ substantially and that understanding these differences is important as it exposes the causal conditions for people’s vulnerability and as such has important policy and programme implications. These must be sensitive to differentiation of households and challenge the inequalities that drive AIDS susceptibility and vulnerability. Also, the research concludes that female headship cannot be automatically used as an indicator for AIDS vulnerability as households headed by women are not a unitary category but differ by factors that enable them in their response. In order to develop supportive policies and responsive programming, a more complete and systematic evidence-base on HIV/AIDS, gender and rural livelihood linkages and the underlying causal factors is needed. Given the great variation in research design among impact studies that hinder comparison of empirical findings across countries and at a variety of scales, a common research framework is needed. Such a common research framework should comprise several issues. First, an integrated research design that sequences qualitative and quantitative research methods is required to capture the complexity of AIDS-impact. Second, a set of universal standardised indicators for measuring AIDS impact should be included as well as tools to measure these variables should be developed and standardised. Furthermore, standardised indicators should be developed for defining and identifying AIDS-affected households that make reference to the difference in impact between hosting of orphans, morbidity and mortality due to AIDS. Third, a common research framework for AIDS-impact should adopt the household as the core unit of analysis as this is the immediate context within which the provision of primary needs and care takes place, resources are mobilised to respond to AIDS, and continuing reformation takes place. Fourth, to capture the prolonged effects of AIDS on people’s livelihoods the research framework should call for resources to be combined to generate longitudinal data from cross-sectional studies by revisiting of study sites. Also, careful stratification of the sample and the use of a recall period to construct retrospective data from a single interview are required to offset the limitations inherent to cross-sectional surveys. Fifth, because the impact of AIDS is diverse and dependent on a wide range of factors, the research framework should include stratification of the sample population according to carefully selected criteria in order to understand the differential impacts of AIDS. Last, the research framework for AIDS impact should include guidelines for actual application of the existing ethical principles of respect for persons, beneficence and justice that were originally developed for biomedical research. In particular, guidelines should be developed for overcoming the ethical dilemmas faced when conducting AIDS-impact research and for determining the extent of ethical responsibility a researcher has in respect to informing respondents about their possible status, selecting AIDS-affected households with the support of key informants, the possibility of creating stigma to selected respondents, assisting respondents with testing and counselling, and dealing with malpractices that are observed as part of a research