COLUMBIA — The image of rural older women surrounded by young orphans has become a symbol of the effects of HIV/AIDS on sub-Saharan Africa. With more and more working-age people dying of the disease, poverty can strike households quickly and without mercy.
Charities, international organizations and governments have united to combat HIV/AIDS in Africa, pouring millions of dollars into education, prevention and treatment efforts. This year, the South African government appropriated more than $539 million to improve health care facilities.
The effects of the disease are devastating, especially to South African women, who are infected at a much higher rate than South African men, according to statistics compiled by the United Nations. AIDS-related deaths in 20- to 39-year-old women tripled between 1997 and 2004, and 1.2 million South African children have been orphaned by the disease.
As a result, in a country where one in four is unemployed and half the population lives in poverty, many rural households are being held together by older women who rely on government pensions to feed, clothe and shelter large extended families. Designed to provide financial support for one person, the pensions are often the only source of income for rural families spanning several generations — children, grandchildren and even great-grandchildren, according to research conducted in Agincourt, South Africa, by an MU professor and colleagues from the University of Colorado and the University of Witwatersrand in Johannesburg.
Enid Schatz, director of social science research at MU’s School of Health Professions, and her fellow researchers set out to determine whether an older woman who had had an AIDS death in her household suffered greater economic stress than those who did not. The results, published in August, showed that the burden of caring for adult children and grandchildren in rural South Africa is falling on many older women, not just those whose families have experienced a death from AIDS.
“We expected to find very different situations, but we found more commonality,” Schatz said. “You don’t have to have an AIDS death in your household to be affected.”
In addition to daily living expenses, older South African women often must help other families with funeral expenses or help take in children whose parents have died. In many cases, the older women must also support unemployed adult children.
Schatz interviewed 60 older women between the ages of 60 and 75 years old in 60 households. Of those, 38 women received a government pension, which at the time was equal to about $100 a month. Out of 30 older women, 28 received pensions and only a third lived in a household where an adult had died in the last two years from AIDS-related causes. Most of the women were caring for children who had lost a parent to AIDS or who had a single parent who had migrated to another part of the country to find work and had to leave children behind.
“There’s been a long history in southern Africa of fostering children,” Schatz said. “But I think the magnitude of it and the burden of it is increased because the parents aren’t coming home.”
South Africa offers grant money for social programs aimed at children, but Schatz and her colleagues found that women had trouble accessing the funds because they lacked knowledge about the programs or did not have the necessary documents for eligibility, such as birth certificates.
Although the government aid helped, the research found that it was not enough to support an extended family. The study reported that most of the women said their pensions ran out before the next check arrived, sometimes as much as two weeks before.
“I think AIDS is to some degree another crisis,” Schatz said. “And there are other crises, like, ‘How am I going to pay school fees for children who are left behind?’ ”
The United States Agency for International Development, a government-sponsored relief program, allocated $252 million in aid for South Africa. That aid, which has increased more than $100 million since 2006, funds programs that focus on economic growth, peace, security and the HIV/AIDS pandemic. President Bush’s Emergency Plan for AIDS Relief allocated more than $363 million in 2007 to the prevention, care and treatment of HIV/AIDS, an increase of about $168 million since 2006.
According to the PEPFAR Web site, only 20 percent of the money has been allocated for prevention, one-third of which is for abstinence-only education, eclipsing spending on condom distribution and on education aimed at reducing the chance of mother-to-child transmission of the virus.
Although she has not compiled research on policy, Schatz said aid money typically does not trickle down to the people she works with. Older women interviewed by the researchers said the best thing the South African government could do to ease their burden would be to increase their monthly pensions. Since the research’s publication in August, the pension has been increased by $25 a month.
According to the Global HIV Prevention Working Group, which is supported by the Kaiser Family and the Bill and Melinda Gates foundations, new HIV infections in sub-Saharan Africa will increase by 36 million by 2015.
Yusuf Kalyango, a native of Uganda who teaches international reporting at MU, said poverty, coupled with a lack of education, has fostered the spread of the disease, making it more difficult to control in the future. As Schatz’s research suggests, the burden will fall heavily on South Africa’s older women.
“Illiteracy, poverty and general ignorance will contribute to the spread of HIV,” Kalyango said. “Two things have to happen simultaneously, and that is economic empowerment and education. If citizens are not educated, they cannot be empowered.”