Contextualising AIDS and human development: Long-term illness and death among adults in labouring low-caste groups in India

Abstract

This study compared evidence from two low caste labouring communities in India: a relatively modernized urban group and a rural group in a backward region. It explored their levels of ill health, their capacities to respond to adult illness and the support they received. In each region, a baseline survey of approximately 1,000 households provided background quantitative evidence with qualitative evidence was collected from about 55 families. HIV infection and AIDS deaths were found to occur in the 'less poor' segments of the study group in both regions. In keeping with the official data, they formed a small proportion of the overall mortality and morbidity in this group. Stigma and discrimination were found to be low but fear of stigma was high, generated by the medical response to AIDS and used opportunistically for personal gains. The study provides insights into the structural determinants of health and coping mechanisms in these communities. The best conditions for a healthy life were found in the group that had a rooted community setting, collective political power, migrant economic support and improved working conditions--the less poor rural group. While improved economic status was associated with better health status, this relationship was stronger when combined with the presence of improved working conditions, with social cohesion at family and community levels and with political power as indicated by levels of organized collective representation and identity formation in workplace, local- and state-level politics. However, the traditional forms of social cohesion are under stress and new forms, moderated by commercial relations, are proving inadequate to meet major household shocks, like adult mortality.

Learning from diverse contexts: Equity and inclusion in the responses to AIDS

“…Coping responses such as the sale of household assets, including land and cattle, eating into savings and borrowing from various sources, reported in background literature across a range of communities, were also found in the studies described in this supplement (Desmond et al, 2002;Kanyamurwa & Ampek, 2007;Priya & Sathyamala, 2007). These responses often took place against a background of existing disadvantage in assets, endowments and access to state and private sector resources, such as for women farmers in Uganda, threatening survival or deepening poverty, despite efforts to use remaining resources to the maximum.…”

“…The studies give many examples of these asymmetries: the sexual and physical violence against women in situations of political instability, informal settlements and poverty undermines their autonomy at the most profound level. In contrast, open dialogue between individuals and their parents and partners and shared decision making between partners were found to have a positive effect on autonomy, particularly of young people (Amuyunzu et al, 2007;Chacham et al, 2007, Priya & Sathyamala, 2007. Access to training, job opportunities, employment and decent work are shown to strengthen people's autonomy and resources to respond to risk environments.…”

“…In Kenya, women in KENWA contrasted the solidarity support from of their support groups with the moral messages of some churches on shame associated with AIDS raising stigma (Amuyunzu et al, 2007). In India, messages on AIDS communicated from medical and counselling services that did not 'match' with community self perceptions were reported to raise stigma, while community members also noted the opportunistic use of medical conditions to pursue other vested interests, usually economic (Priya & Sathyamala, 2007).…”

“…The studies point to the significance of this for women, who may respond to income and employment insecurity through practices that increase risk, such as migration or sale of sex or alcohol. The quality of work is not irrelevant in this, as the experiences in Congo and India suggest that some jobs may themselves raise risk, particularly if they carry high risk, disrupt social stability or involve migration away from sources of stability (Amuyunzu et al, 2007;Bongou Bazika, 2007;Chacham et al, 2007;Priya & Sathyamala, 2007).…”

“…At community level, Foster (2007) describes a range of short and long term forms of support, such as burial societies and savings clubs that are based on proactive savings, but that may themselves be challenged by household and community poverty. Community based organisations and religious and faith based groups and associations provided treatment and care, credit and welfare support, including for school fees, food security and other longer term needs (Amuyunzu et al, 2007;Foster, 2007;Kanyamurwa & Ampek, 2007;Priya & Sathyamala, 2007).…”