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Ministry of Agriculture and Food Security
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The impact of HIV/AIDS on livelihoods in Lesotho
Phase 1: Mafeteng
Livelihoods Recovery through Agriculture Programme (LRAP), Research Component
CARE Lesotho - South Africa
November 2003
By Mpolelo Mothibi (Independent Consultant)
Edited by Priscilla Magrath (CARE Consultant) and Palesa Ndabe (CARE LRAP Research and Information Coordinator)
Comments to: pndabe@care.org.ls
Posted with permission of Jo Abbott, Care. Further details on Care's LRAP project can be obtained from
Ms Abbott at joabbot@caresa.co.za
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Executive summary
This report describes the impact of HIV and AIDS on livelihoods in two villages found in Mafeteng district namely:
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Van Rooyen's gate (VR) a semi-urban border post west of Mafeteng town, under the principal chieftainship of Tebang.
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Ha Makhakhe (HM) a typical Basotho village situated east of Mafeteng town, under the principal chieftainship of Matelile.
The aim of this report is to present the findings, conclusions and recommendations of the research to policy makers and service providers with the intention of improving understanding of how HIV and AIDS affects household livelihoods strategies in Lesotho.
Following pilot interviews with four members of Positive Action in Maseru, in-depth interviews were carried out with 29 people in the two villages (17 in Van Rooyen and 12 in Ha Makhakhe). These included 9 purposively selected infected and affected people, 11 randomly selected control households (some of whom also turned out to be affected by HIV/AIDS) and 9 key informants.
Key Findings from the research
Pilot Interviews
Positive Action members who are open about their HIV status benefit from mutual support of other members, and improved health care but they experience stigma in their home villages and their livelihoods are insecure.
Van Rooyen's Gate and Ha Makhakhe Villages
Current livelihoods
Van Rooyen's gate used to depend on border trade and employment in South Africa. The economy is in decline as a result of retrenchment and food insecurity is widespread. Few own fields and gardens, though well kept, are uncultivated due to drought.
Ha Makhakhe is a more typical rural village, dependent on remittances from miners and agriculture. Sharecropping is common and water appears to be abundant. Food stocks are relatively high despite retrenchment.
Incidence, Awareness and Acknowledgement of HIV/AIDS
Incidence
There appears to be a high incidence of HIV&AIDS in both villages. Although quantitative data were not collected, high rates are suggested by the incidence of HIV/AIDS among the interviewees, including four out of 11 randomly selected households found to be affected, and by anecdotal evidence. For example, about two wheelbarrows per week are seen crossing the border at Van Rooyen, carrying the sick to their homes. Of these about two per month are returning to Van Rooyen. In both villages the frequency of funerals was mentioned; teachers commented on the high number of orphans in their schools, while community nurses regularly saw people with symptoms of AIDS. In Ha Makhakhe several houses are boarded up as the parents have died of AIDS and the children have been sent to live with relatives.
Acknowledgement and Awareness
Of the 15 interviewees who are infected or affected 6 did not acknowledge that they or their relatives had AIDS. Five out of these reside in Van Rooyen, suggesting that the level of acknowledgement is higher in Ha Makhakhe than in Van Rooyen. This was also the finding of a WFP report in 2003. For example, one affected elderly lady who has lost 8 of her children and 3 grand children between 1998 - May 2003 claims that these children died of chest pain and TB; her neighbour has also lost 7 of her children alternating with hers.
Denial protects the infected and affected from stigma but limits access to appropriate health care, and may encourage spread of the disease. Thus, stigma was higher in Ha Makhakhe, but medical care was better.
The main sources of information on HIV/AIDS in Van Rooyen were CARE SHARP, and to a limited extent the radio. In Ha Makhakhe the main sources were the District Aids Task Force, radio, schools and Mafeteng Hospital.
HIV/AIDS Education, Care and Support
Home based care support groups are active in both villages, but operate in different ways. The CARE SHARP support group in Van Rooyen is more pro-active in seeking out infected patients and in providing comprehensive care. In Ha Makhakhe the support group established by the District Aids Task Force visits those who come forward voluntarily, in practice mainly the elderly rather than HIV/AIDS sufferers. Two openly HIV positive interviewees avoid the support group due to fear of stigma.
The level of care and support is higher in Ha Makhakhe than in Van Rooyen even though the support group in Van Rooyen appears to be more active. The main reason appears to be that care from family members is more readily given in Ha Makhakhe, perhaps because the level of acknowledgement is higher, and also because social cohesion appears to be higher. The population of Ha Makhakhe also seem to make greater use of the medical supplies and counseling available from Mafeteng Hospital.
In both villages schools attempt to care for orphans and claim that they are not stigmatized. MOHSW contributes towards caring for orphans through payment of fees.
In both villages there appears to be a stark lack of coordination among village leaders, who are individually aware and concerned about HIV/AIDS but do not coordinate or work together. Individually some have an impact through their professional work. They say they would like to coordinate. Some have relevant training, including the community nurses and the priest in Ha Makhakhe, who is a trained counselor. This appears to represent a missed opportunity.
Impact of HIV/AIDS on Livelihoods
In Van Rooyen it is difficult to assess the impact of HIV/AIDS on agriculture since few households have been cultivating fields or gardens because of drought. Agriculture is not a main source of livelihoods as only 10% of households own land. Food insecurity is higher than in Ha Makhakhe and malnutrition appears to be accelerating deaths from AIDS. One interviewee had lost her business in vegetable marketing after paying funeral expenses.
In Ha Makhakhe where most households engage in agricultural production as a major livelihood strategy, most of those interviewed appeared to be maintaining agricultural production levels in spite of sickness, caring and deaths due to AIDS. Sharecropping arrangements are continued and family members provide additional labour where needed. However, the sample is too small to draw conclusions about the wider population. Two infected interviewees had left jobs in Maseru on becoming sick, and had returned to the village as dependents on relatives.
Recommendations
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Strengthening Home Based Care Support Groups: the CARE SHARP model of using peer educators and of actively seeking out AIDS patients for comprehensive care should be replicated beyond the two villages currently covered by the project in Mafeteng;
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Development of Village Aids Task Forces: it is recommended that village leaders and professionals come together to develop a community level strategy to address HIV/AIDS including education, prevention, care and support;
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Encouragement of infected and affected to acknowledge HIV/AIDS should be accompanied by efforts to eradicate stigma. For example, people should be encouraged to talk openly in funerals and social gatherings;
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Improved supply of gloves and advice to carers on preventing infection;
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Employment of Positive Action Members (or other people living openly with HIV/AIDS) in the care of infected and affected;
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Homestead gardening should be encouraged especially in Van Rooyen where the food security situation is serious and interest in gardening is apparent. The main constraint is the lack of water.
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Van Rooyen
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Ha Makhakhe
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Characteristics
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Peri-urban border post
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Typical rural village
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Problems
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Drought, food insecurity
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Livelihood strategies
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Pensions, piece jobs, beer brewing, prostitution, donations
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Agriculture, Mining in RSA, beer brewing
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HIV/AIDS incidence
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Apparently High
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Apparently High
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Acknowledgement of HIV/AIDS in the family
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Lower
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Higher
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Awareness of HIV/AIDS in the community
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Lower
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Higher
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Stigma
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Lower
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Higher
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Community support for HIV/AIDS patients
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Lower
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Higher
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Home Based Care Group
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Strong (SHARP)
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Weak (DATF)
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Medical care and counseling for HIV/AIDS patients
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Weak (lack of acknowledgement)
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Adequate (not ARVs)
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Impact of HIV/AIDS on Livelihoods
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Masked by drought and food insecurity
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Agricultural production apparently maintained
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