Livelihood Trajectories and HIV and AIDS in South West Uganda - a longitudinal study of rural households

The main objective of this project is to assess the impact of HIV-infection on households over a 15 year period (1991-2006) in a rural setting in Uganda. The research will take place in Masaka District, the study area of the Medical Research Council Research Programme on AIDS in Uganda (MRPA). The MRPA is a multidisciplinary research programme established in 1988. In 1991-92 the MRPA undertook an ethnographic study of 27 households in the General Population Cohort (GPC) (which had been set up in 1989 covering the population of 15 villages). The findings of the 1991-92 study suggested a combination of socio-economic indicators to predict household vulnerability to future crises such as illness and death of an adult member due to AIDS-related infections. In this new study we will revisit, as far as possible, members of the original 27 households over a period of one year. In addition, two new components are included to broaden the study. The first examines the impact of HIV infection on households from a health economics perspective with a particular focus on the lives of affected children. The second examines the wider impact of HIV infection on the household life-cycle from a life-course perspective with secondary analysis of annual GPC census and survey information collected continuously since 1989. Replication of the ethnographic study of household coping in the 1991-92 study is designed to provide a close, contextualised understanding of responses to HIV/AIDS among a small number of households that would not be possible through more targeted methodological approaches such as single in-depth interviews or survey questionnaires. Revisiting the same households covered in the original study will allow us to evaluate the indicators of vulnerability and learn from both successes and failures of indicators to predict subsequent household trajectories over 15 years. There is a growing literature on the consequences of HIV/AIDS on households that suggests household structure and intra-household relations are as important as socio-economic factors in enabling families to adapt to changes brought by the epidemic but this has not been tested through in-depth longitudinal research. The first new component involves both quantitative and qualitative data collection to compare the influence of parental HIV-infection on household resource allocations, particularly those that affect children (education, health care, fostering etc.). The ability to trace individuals and households through long-term retrospective GPC data gives unique analytical leverage to this design. In addition to its usefulness in tracing households and children over time, the presence of annual demographic and HIV surveillance data from the GPC over 15/16 years provides an invaluable resource for understanding the impact of infection on ultimate household trajectories. The second new component involves a thorough secondary analysis of GPC census and adult medical survey data from baseline (1989/90) through to 2004/5 to describe real household trajectories in response to HIV infection over time. This data set can also be used to test hypotheses emerging from the new data collected, thus enhancing the generalisability of findings from the overall study. The results of this study have the potential to play an important role in the formulation and implementation of sensitive and effective policies and programmes to address the needs of poor people, AIDS orphans, families that raise AIDS orphans, and other children affected by HIV/AIDS. The emphasis on longitudinal or life course trajectories aims to enhance our understanding of the value of this approach in the context of chronic disease and care-giving. It is hoped this study will make an independent contribution to theories of family sociology in sub-Saharan Africa.