Living and Care Arrangements of Non-urban Households in KwaZulu-Natal, South Africa, in the ...

213 Pages·2011·2.19 MB·English

Living and Care Arrangements
of Non-urban Households
in KwaZulu-Natal, South Africa,
in the Context of HIV and AIDS

Cornelia J. du Preez
Thesis committee

Thesis supervisor
Prof. Dr. A. Niehof
Professor of Sociology of Consumers and Households
Wageningen University

Thesis co-supervisor
Dr. G.J. Casimir, Assistant professor Sociology of Consumers and
Households, Wageningen University

Other members

Prof. Dr. M.A. Koelen, Wageningen University
Prof. Dr. G.C.M. Knijn, Utrecht University
Prof. Dr. S. Van der Geest, University of Amsterdam
Prof. Dr. Ir. J.W.M. van Dijk, Wageningen University

This research was conducted under the auspices of the Graduate School of Wageningen
School of Social Sciences (WASS).
Living and Care Arrangements
of Non-urban Households
in KwaZulu-Natal, South Africa,
in the Context of HIV and AIDS

Cornelia J. du Preez

Thesis
Submitted in fulfilment of the requirements
for the degree of doctor
at Wageningen University
by the authority of the Rector Magnificus
Prof. dr. M.J. Kropff
in the presence of the
Thesis Committee appointed by the Academic Board
to be defended in public
on Tuesday 31 May 2011
at 1.30 p.m. in the Aula
Cornelia J. du Preez
Living and Care Arrangements of Non-urban Households in Kwazulu-Natal, South Africa,
in the Context of HIV and AIDS

Thesis, Wageningen University, Wageningen, NL (2010)
With references, with summaries in Dutch and English

ISBN 978-90-8585-932-1
Acknowledgements

A long and challenging journey has come to an end. However, this journey and the
completion of my PhD would not have been possible without the support, encouragement
and inputs from several individuals. I would like to take the opportunity to thank all those
who contributed directly or indirectly to the successful completion of this journey.

I would like to thank the Netherlands Ministry of Foreign Affairs for their generous
funding of the African Women Leaders in Agriculture and Environment (AWLAE) project
and Anke Niehof, Lisa Price and others for their outstanding and professional management
of the project.

To my promotor Prof Dr Anke Niehof I am greatly indebted. She guided me
through a tough journey and encouraged me to believe in myself and in my study. I admire
her as an academic and study leader and I can only strive to provide my students with the
same excellent supervision I received from her throughout my study. My co-promotor Dr
Gerda Casimir made valuable inputs when I needed them most and was always available to
answer questions.

A very special word of thanks to Margaret van Wissen who worked under
tremendous pressure and sacrificed personal time to get the thesis print ready. Thank you
also to Hedy Munro, always available on short notice, for all the logistical arrangements.
Thank you also to all the former and current members of the Sociology of Consumers and
Households and Health and Society Chair Groups for their friendship and support.

I have to thank all those who participated in the research, including the community-
based health workers, households and many other key informants and individuals in the
research area. Thank you for answering endless questions and for allowing me into your
homes and sharing your lives with me.

It was a wonderful experience studying and living with the AWLAE ladies in
Wageningen. I enjoyed sharing this enriching experience with you and I hope that the
friendships we forged will endure the test of time and that our paths will cross frequently. I
am grateful to all the other PhD students with whom I shared time in the department for
their friendship and their contributions to the successful completion of my study. I have to
mention Marian Koster with whom I shared an office for several months and who was a
great office mate and sounding board.

I do not know where to begin to thank my current and former University of
Zululand colleagues. My sincerest gratitude to former colleagues Sazile Mtshali and
Josephine Kiamba who believed I was the right person for the scholarship and who
sacrificed time and energy supporting me throughout the study. I would also like to thank
other former and current colleagues in the Department of Consumer Sciences who had to
cover for me when I worked on my PhD in the Netherlands and at home. Thank you to all
of you who had to take over my teaching and administrative responsibilities. I also
appreciate your frequent words of encouragement. My thanks to the University Zululand
for granting me some time to devote to my studies.

Thank you to all my Dutch friends who provided me with a home away from home.
I have known many of you before I embarked on this journey and I will always treasure our
friendship. I have to mention a few of you by name. Josine from the student chaplaincy in
i
Wageningen, you are a friend to many and make each feel special. Jeltje and Tjebbe, thank
you for allowing me to take care of your beautiful home and the lovely meals I had with
you. Floriska, thank you for the meals we shared and for not only inviting me to your home,
but also to that of your parents. Stella, you have been a great neighbour and wonderful
friend and I enjoyed the Sundays we spent together at the movies or at your home. Kees,
we have been friends since we studied together towards our masters and we embarked on
this PhD journey at about the same time, I appreciate your friendship and our academic
discussions.

To all my dear friends in Empangeni and in other parts of South Africa, thank you
for your continuous interest in my study and for your frequent words of encouragement.
You were really there for me through thick and thin and I am grateful that all of you
survived my PhD. I have to mention one friend and colleague, Helene, who has been there
for me during the good times and the bad times. You were always prepared to listen and
you always had words of encouragement to keep me going through those difficult times and
I appreciate your friendship.

To my loving parents, Andries and Martha du Preez, I do believe that I am blessed
with the best parents any child can wish for. The person I am today is mainly attributed to
you and the way you raised me, you instilled in me faith and values that keep me grounded.
You told me that the journey would not be easy, but I knew I could always count on your
love, prayers, support and encouragement to see me through. To my dearest brother Braam
and his family, you always assured me that you are keeping me in your prayers and that you
are confident that I will successfully complete the journey. Thank you for keeping me
upright and for reminding me that there is light at the end of the tunnel. I thank all the
family members across South Africa who always showed an interest in my study and
wellbeing.

This has been a remarkable journey and an experience of a lifetime. Not only did I
grow and develop as an academic, I have also grown as a person and I am truly thankful for
the opportunity.

ii
Table of contents

Acknowledgements i 
List of tables vii
List of figures ix
List of acronyms x

Chapter 1 Introduction 1 
1.1  The evolvement of HIV and AIDS in South Africa 1 
1.2  Rationale 2 
1.3  Research problem and questions 4 
1.4  Outline of the thesis 4

Chapter 2 Conceptual and theoretical framework 7 
2.1  Household 7 
2.2  Livelihood 12 
2.3  Gender 19 
2.4  Care 19 
2.5  Conceptual framework and operationalisation 21

Chapter 3 Research design and methodology 25 
3.1  Research design 25 
3.2  Unit of analysis 26 
3.3  Research procedure 27 
3.4  Data collection 28 
3.4.1 Key informant interviews 29 
3.4.2 Descriptive survey 30 
3.4.3 Case studies 32 
3.4.4 Focus group discussions 35 
3.4.5 Secondary data 36 
3.5  Data management and analysis 37 
3.6  Validity and reliability 38 
3.7  Challenges and ethical considerations 38

Chapter 4 Study area and context 41 
4.1  South Africa 41 
4.2  KwaZulu-Natal Province 42 
4.3  The uThungulu district and Mbonambi local municipality 43 
4.4  Social development 44 
4.5  Health 46 
4.6  The policy environment 48

Chapter 5 Profiling and classification of households 51 
5.1  Demographic, socio-economic and health characteristics of individuals 51 
5.1.1 Sex and age 51 
5.1.2 Marital status 53 
5.1.3 Education 54 
5.1.4 Employment 56 
5.1.5 State and private grants 58 
5.1.6 Health 60 
5.2  Household characteristics 63 
iii
5.2.1 Household religion 63 
5.2.2 Household heads 63 
5.2.3 Household size and composition 65 
5.2.4 Income and assets 68 
5.2.5 Housing, access to land and agricultural activity 73 
5.2.6 Services and infrastructure 745 
5.3  Individual and household impacts of HIV/AIDS and/or TB 77 
5.3.1 Morbidity, mortality and orphans 77 
5.3.2 Classification and comparison of households 81 
5.4  Discussion 83

Chapter 6 Household living arrangements and livelihoods 85 
6.1  Cluster 1: households neither afflicted nor affected by HIV/AIDS 87 
6.1.1 Case 1: Thuli 87 
6.1.2 Case 2: Cebani 88 
6.1.3 Case 3: Sandile 90 
6.1.4 Case 4: Gugu 91 
6.1.5 Case 5: Sfiso 92 
6.2  Cluster 2: households afflicted by HIV/AIDS 94 
6.2.1 Case 6: Lina 96 
6.2.2 Case 7: Bongi 97 
6.2.3 Case 8: Dudu 98 
6.2.4 Case 9: Thulani 99 
6.2.5 Case 10: Phume 101 
6.3  Cluster 3: households affected by HIV/AIDS and/or TB 101 
6.3.1 Case 11: Juliet 103 
6.3.2 Case 12: Irene 105 
6.3.3 Case 13: Themba 105 
6.3.4 Case 14: Constance 107 
6.4  Cluster 4: households afflicted and affected by HIV/AIDS and/or TB 108 
6.4.1 Case 15: Emanuel 110 
6.4.2 Case 16: Mandla 111 
6.4.3 Case 17: Busi 112 
6.4.4 Case 18: Alexina 114 
6.4.5 Case 19: Velaphi 115 
6.5  Discussion and conclusions 117

Chapter 7 Arrangement and provision of care 123 
7.1  Phases of care 124 
7.2  Care and social capital 125 
7.3  Micro-macro linkages 126 
7.4  Provision and utilisation of care 127 
7.4.1 Public and private hospitals and clinics 127 
7.4.2 Non-governmental organisations 129 
7.4.3 Community- and home-based care 130 
7.5  Evidence relating to the four phases of care 133 
7.6  Integrity of the care process 137 
7.7  Discussion and conclusions 144

Chapter 8 Conclusions and general discussion 147 
8.1  Summary and conclusions 147 
8.1.1 Profile of individuals and households 147 
iv
8.1.2 Household classification in the context of HIV and AIDS 151 
8.1.3 Impacts HIV and AIDS on household living arrangements
and livelihoods 152 
8.1.4 Arrangement of care 154 
8.2  Theoretical and methodological considerations 156 
8.2.1 Theoretical considerations 156 
8.2.2 Methodological considerations 158 
8.3  Recommendations 159 
8.3.1 Recommendations for policies and interventions 159 
8.3.2 Recommendations for further research 160

References 161

Appendix 171

Summary 187

Samenvatting 191

About the author 195

Training and Supervision Plan 197

AWLAE 199 
v
vi