AIDS mortality

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AIDS mortality household characteristics in
rural South Africa Implications for natural
resource use development

• Wayne Twine
• University of the Witwatersrand, South Africa
• Lori Hunter
• University of Colorado at Boulder, USA
• Funded by CICRED-PRIPODE

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Background Wits research in Bushbuckridge

• Wits Rural Facility established in 1989
• Base for sustained research in a rural
  former-homeland area
• SUNRAE research programme (1992)
• Ecological basis for sustainable rural
  development
• Agincourt Heath Population Unit (1992)
• Surveillance of health and population trends in a
  rural population of 12,000 households

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Agincourt health demographic surveillance
system (HDSS)

• Southern Bushbuckridge
• 21 rural villages
• Annual census in 12,000 households (population of
  70,000 people) since 1992

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Introduction to this study

• Two important population and environment trends
  in rural sub-Saharan Africa
• HIV/AIDS
• Environmental change
• Have important implications for rural livelihoods
• Relationship between impacts of HIV/AIDS and the
  environment is under studied.

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1) Natural resources

• Natural resources are central to rural
  livelihoods
• Domestic provisioning
• Generating income
• Resources include
• Fuelwood
• Edible wild fruit, vegetables, insects bushmeat
• Construction materials
• Wood for utensils and implements

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Table 1. Household utilisation of natural
resources in Bushbuckridge
Resources of households of households
Resources of households kg / household / year
Wild edible herbs 92 18
Fuelwood 92 3,395
Wild fruit 81 328
Insects 77 -
Poles for fences kraals 53 -
Reeds for weaving 54 -
Bushmeat 32 -
Poles for houses 20 -
Medicinal plants 49 -
Thatch grass 36 -
Hansen (1998), Shackleton Shackleton (2000)
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Table 2. Direct-use value of natural resources
Bushbuckridge region.
Resource Annual value per household Annual value per household Annual value per hectare Annual value per hectare
Rand Rand
Edible herbs 736.80 33.3 256.32 31.7
Fuelwood 465.35 21.0 182.89 22.6
Medicinal plants 383.49 17.3 149.37 18.4
Edible fruits 213.22 9.6 93.45 11.5
Construction wood 218.37 9.8 85.29 10.5
Thatch grass 51.15 2.3 20.96 2.6
Other 21.96 1.0 8.02 1.0
Carving wood 0 - 4.83 0.6
Reeds 11.03 0.5 3.66 0.5
Waving reeds 112.00 5.0 2.00 0.2
Twig hand brooms 4.56 0.2 1.87 0.2
Woodroses 0 - 1.27 0.2
Total 2,217.93 100.0 809.93 100.0
Shackleton Shackleton (2000)
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• Use of natural resources buffers households
  against some of the effects of poverty (part of
  rural safety net (Shackleton et al 2001))
• e.g. Bushbuckridge
• Over 80 of households have electricity
• BUT
• Over 90 still use fuelwood for cooking, mainly
  to save money
• Natural resources are under pressure in former
  homelands
• Environmental change has implications for rural
  livelihoods

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2) HIV/AIDS and prime-age adult mortality

• Sub-Saharan Africa is home to 70 of all
  HIV-infected people 2 mill new infections per
  year (UNAIDS 2004)
• Southern Africa is referred to as the epicenter
  of the AIDS pandemic (UN 2004)
• 21.5 prevalence in South Africa (UNAIDS 2004)

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• AIDS leading cause of death in 15-49 years age
  group worldwide (UNAIDS 2004)
• AIDS leading cause of death in 15-49 years age
  group in Agincourt DSS site, South Africa

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• Implications
• HIV/AIDS is severely impacting on economically
  productive age group
• HIV/AIDS is severely impacting on age group most
  active in collection harvesting of natural
  resources
• Loss of human capital has substantial
  implications for the household economy and
  livelihood strategies
• Prime-age adult mortality potentially affects
  livelihood strategies with regard to selection,
  use, collection and consumption of natural
  resources.

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THIS STUDY

• AIDS mortality household characteristics in
  rural South Africa Implications for natural
  resource use development
• SUNRAE Programme, Wits University
• AHPU, Wits University
• IBS, University of Colorado
• Funder Committee for International Cooperation
  in National Research in Demography (CICRED)

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• Research Questions
• Associations between household characteristics
  and household use of natural resources?
• 2) Associations between prime-age adult
  mortality and household use of key natural
  resources?
• 3) Implications for development in the context
  of rising AIDS mortality among poor rural
  communities?

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• Research design
• Conducted in the Agincourt HDSS site
• Three data sources
• Agincourt Health Population Unit HDSS sample
  selection household population data
• 2) Survey (n 248 stratified by mortality
  experience 124 prime-age adult mortality in last
  2 years, 124 no adult mortality in last 2 years)
• 3) Interviews (n 30 all mortality)

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• Survey questionnaire
• For fuelwood and water
• Availability, proximity
• Collection strategies
• Time allocation
• Level of use, types of use
• Interviews
• Impact of the loss of an adult member on general
  use natural resources in coping strategies

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Results

1. Quantitative results household characteristics,
   adult mortality household use of fuelwood
   water
2. Qualitative descriptions impacts of adult
   mortality on household resource use

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• Fuelwood
• Household characteristics
• Smaller households more likely to use
  electricity for cooking
• Smaller households male head less likely to
  harvest
• Higher sex ratio (malesfemales) use more
  fuelwood
• Older age structure use more fuelwood
• Poorer households use less wood (especially in
  summer)

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• Fuelwood
• Death of a prime-age adult
• 84 of households which had an adult death used
  large amounts of wood (average 750 kg) for
  catering at the funeral
• Households with an adult death more likely to
  use fuelwood instead of electricity, IF they were
  poor
• Households with an adult death more likely that
  male head harvested (declined with time since the
  death)

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• Water
• Household characteristics
• Smaller households male head more likely to
  collect
• Higher sex ratio (malesfemales) male head more
  likely to collect
• Poorer households spend much more time
  collecting water

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• Water
• Death of a prime-age adult
• Households with an adult death likelihood of
  male head collecting decreased with time since
  the death

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From interviews

• Shifts in household resource use strategies
  varied by role of the deceased in the household
  economy.
• Loss of resource collector
• Loss of wage earner
• Note Pseudonyms are
• used when quoting
• responses

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Loss of Resource Collector

• Impacts primarily on time allocation
• Children often bear increased burden

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• Following death of her sister, Tintswalo and her
  younger brother spent more time collecting
  resources. As a result, Tintswalo no longer had
  time for cleaning, hoeing the field, as well as
  going to church
• Georges household lost their primary resource
  collector, Georges wife. As he explains, she
  used to collect fuelwood in the bush . She was
  responsible for household duties like cleaning
  and other things. George now stays with his
  sisters daughter who performs those duties
  now.

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Loss of Wage Earner

• Affected household ability to buy food.

Tsakanis adult son would remember us every
month, buying groceries and a sack of maize
meal... She explained that since his passing
there is a serious gap now. Since the passing
of Elliots wife, who had a job, his household
stopped purchasing because you only do that when
you have moneysometimes we buy food but most
of the time we rely on the garden.
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• Collection often substituted for previously
  purchased goods Fuelwood, cultivated wild
  foods
• Opportunity cost

I used to buy some wood, but now I must do that
with my own hands The death of an income earner
brought a lot of changes to Ntombis
household. The first being changes on the diet
and the second thing is that we are no longer
able to buy fuelwood and water, so it requires us
to do that by our own hands.
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Livelihood benefits (especially nutrition)

• we have stopped purchasing food because you
  only do that when you have moneysometimes we buy
  food but most of the time we rely on the
  garden
• there is a big change now because we no longer
  have food, we just get assisted by the relatives
  and we depend more now in the field for
  collecting wild vegetables

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• Triza explained that since the passing of her
  husband who had sent remittances home, it was
  very hard because we had nothing to keep us
  survivingwe relied on guxe on a day-to-day
  basis because in the past we used to buy chicken,
  wors and fish.
• Locusts are now our
  beef

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To summarise

• Death of an adult household member impacted on
  household resource use strategies in complex
  ways.
• Allocation of household human resources
• Reliance on the natural environment for food and
  for energy for cooking, especially among poorer
  households
• Short-term increase in amount of wood used (at
  funeral)
• No significant effect on the long-term level of
  use (mass or volume) of fuelwood or water

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• Role of the deceased in the household economy was
  important
• Largest impacts were when the deceased had been
  the breadwinner
• Households were able to save money by collecting
  wood, water, wild foods and crops, which they had
  previously bought

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Policy implications

• Natural resource management
• HIV/AIDS ? population growth BUT ?in household
  use of resources
• Natural resources important buffers for
  households impacted by AIDS, particularly for
  poorer households
• Biomass energy will remain primary energy source
  in an era of HIV/AIDS
• Support needed for local management of natural
  resources

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• Rural development
• Rural energy address economic barriers to
  affordable electricity for cooking
• Food security support for low-input agriculture
  and use of wild foods
• Public health
• Declining resource stocks health consequences,
  especially for immuno-compromised household
  members e.g.
• Loss of nutritional benefits of wild foods
• Increased smoke inhalation from use of green
  wood

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Conclusion

• An integrated government response to the HIV/AIDS
  pandemic in rural communities will need to
  include policy and support for rural communities
  to use and manage their natural resources
  sustainably