Gendered Imbalances in AIDS-Related Burden of Care: Lessons from Lesotho

Article excerpt

Abstract

This article reflects on the gendered burdens of AIDS-care within the family, and some of the difficulties in redressing them. It demonstrates the need for research-driven initiatives towards quantifying the gendered inequities in the burden of care, using Lesotho as case study. The article accentuates the gender aspects of AIDS burden of care, pointing to familiar problems: the difficulties of making women visible; prioritising their needs; and tackling the disadvantages and inequities which women systematically suffer. These problems underscore the importance of mainstreaming women in AIDS-related research in all ramifications. Such research will help to make women visible, highlight their needs, and bring into the frame of analysing shadowy realms of AIDS on households. While the findings of this study are essentially situated in the Lesotho context, their far-reaching implications for the Southern African region and indeed the African continent are adequately highlighted.

Keywords: Lesotho; HIV/AIDS; burden of care; women; gender equality; households.

Introduction

In the Kingdom of Lesotho (Lesotho), when a person falls sick with AIDS, the main site of care is the home, and the main providers of care are family members. Hypothetically, there are potential advantages from this arrangement. Being at home can be comforting for the sick person. Loved ones might be able to provide more tender attention than hospital staff. Caring for the sick at home is also commended as customaiy, and certainly repudiates the stigma often associated with HIV and AIDS (McDonnell, Brennan, Burnham and Tarantola, 1994; Ogden, Esim and Grown, 2006). But in Lesotho, perhaps the greatest virtue of care by relatives at home is necessity. Hospital beds are few, often inaccessible, and AIDS is already taxing hospital facilities in the major centres. The prevalence of HIV/AIDS is increasing, and the limited introduction of antiretroviral therapies from mid-2004 is not likely to significantly reduce AIDS-related morbidity or mortality in the foreseeable future, particularly among adults (UNAIDS, 2011). The diminished capacity of many countries' health sectors means having people with HIV cared for at home, or home based care, can be more appealing to governments than treating them at hospital. The growing need to support families and communities in what is called 'community-based care' is thus becoming a widely known phenomenon (Arno, 1986; Kalibala and Kaleeba, 1989; WHO, 2002; Mamaila, 2005). This article reflects specifically on the gendered burdens of AIDS-care within the family unit, and some of the potential difficulties in redressing them. As UNAIDS stated in its campaign document, HIV and AIDS have significantly increased the burden of care for many women. Poverty and poor public services have also combined with AIDS to turn the care burden for women into a crisis with far-reaching social, health and economic consequences'(UNAIDS 2004: 2). Furthermore, in Lesotho, AIDS increases the burden of care for women. While the observable consequences of this burden are many, the potential effects upon the health of women and girls alone deserve attention. Although mainstreaming gender and HIV/AIDS is necessaiy, this article contends that the gendered burden of AIDS-care highlights the prior importance of making women the focus of development, public health, poverty reduction policies and programmes in Lesotho.

Methods

For theoretical purposes, this study considers existing literature on AIDS-related burden of care. The discussion also makes use of the data published at intervals by the Government of Lesotho, governmental bodies, international development institutions and non-governmental organisations (NGOs) as well as scholarly works on relevant aspects of HIV/AIDS. It relies on first-hand observations as well as data gathered from semi-structured interviews administered in 240 households across 10 of the 13 districts in the Kingdom of Lesotho in the last quarter of 2011. …