AIDS-related morbidity and mortality are expected to have a large economic impact in rural Malawi, because they reduce the time that adults can spend on production for subsistence and on income-generating activities. However, households may compensate for production losses by reallocating tasks among household members. The data demands for measuring these effects are high, limiting the amount of empirical evidence. In this paper, we utilize a unique combination of qualitative and quantitative data, including biomarkers for HIV, collected by the 2004 Malawi Diffusion and Ideational Change Project, to analyze the association between AIDS-related morbidity and mortality, and time allocation decisions in rural Malawian households. We find that AIDS-related morbidity and mortality have important economic effects on women’s time, whereas men’s time is unresponsive to the same shocks. Most notably, AIDS is shown to induce diversification of income sources, with women (but not men) reallocating their time, generally from work-intensive (typically farming and heavy chores) to cash-generating tasks (such as casual labor).
Using reflective letter-writing as a method of generating data, a group of four researchers embarked on a collaborative autoethnographic inquiry into the emotional dimensions of researching social aspects of HIV & AIDS. In this article, we use the medium of a narrative dialogue to represent and re-examine our reflective letter-writing method. The dialogue draws attention to key features of reflective letter-writing as a collaborative autoethnographic research method and, in so doing, highlights and explores the nature, potential significance, and challenges of this method. Our discussion points to the value of a collaborative process of reflective letter-writing as a way for researchers to access and portray emotional aspects of their research experience, to deepen their engagement with these emotional dimensions, and to gain insight into their own and others' lived research experiences.
Task shifting from trained clinicians to community health workers (CHWs) is a central, primary health care strategy advocated by global health policy planners in resource-poor settings where trained health professionals are scarce. The evidence base for the efficacy of these programs, however, is limited—in particular, research that identifies their potential unintended consequences. Based on sustained ethnographic study of CHWs working for AIDS projects in South Africa at the height of the country’s AIDS epidemic, this article identifies how structural and local factors produced unintended consequences for CHW programs. These consequences were (a) CHWs moonlighting for multiple organizations, (b) CHWs freelancing in communities without regulation, and (c) adverse patient outcomes resulting from uncoordinated care. These consequences stemmed from structural elements of a bureaucratically weak health system and from local grassroots dynamics that jeopardized long-term CHW program sustainability and eroded national health goals.
Professionalism is an ideal defined as the norms or values that orient the work of an occupation. In practice, research derived from country settings in the Global North shows how the ideal of professionalism competes with market and bureaucratic priorities. Less is known about how professionalism is nurtured or subjugated to market and bureaucratic institutions in postcolonial contexts in the Global South. This paper takes up the study of factors that promote or constrain professionalism in one postcolonial setting by contrasting South African social worker professionalism during and after apartheid. In the wake of calls for international research that is historically-grounded and sensitive to local context, data drawn from archival research and ethnographic fieldwork finds that social workers are prevented from asserting their professional values as a unified profession due to enduring race divisions in the profession. Another legacy of apartheid is the profession's dependency on the state for funding social worker salaries, which constrains social workers ability to assert professional values independent of the state's agenda. Finally, the organizational context employing social workers creates uneven opportunities for social workers to assert their professional values through policy advocacy.
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