Men's involvement in the South African family: Engendering change in the AIDS era

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Abstract

The literature on the South African family and its response to the HIV/AIDS epidemic is rife with accounts of men that reflect a deficit model of male involvement. Few acknowledge the historical, economic and social complexities of male involvement in family life. As the South African family undergoes demographic, social and economic transformation there is a need to describe the range of roles played by all household members, including men. This paper examines data collected over two and a half years from a small sample of households affected by HIV/AIDS in rural KwaZulu Natal, South Africa. Non-participant observations were made during outreach visits by research staff to twenty households caring for at least one adult with disease symptoms indicative of TB or AIDS. We find that men are positively involved with their families and households in a wide range of ways. They care for patients and children, financially support immediate and extended family members and are present at home, thereby enabling women to work or support other households. As the qualitative data demonstrate, however, such activities are often not acknowledged. The dominant perception of both female respondents and research assistants continues to be that men are not caring for their families because they are irresponsible and profligate. We consider reasons why this disjuncture exists and how more men might be encouraged to fulfil such roles and activities as their families and households suffer the social and economic impacts of HIV/AIDS.

Introduction

Men…have the potential, through involved and affectionate care, to make a major contribution to children's relief. It is therefore remarkable that so few programmes aiming to improve children's health and well-being, the functionality of families, or community life target, or even include, men, let alone fathers. As advocates and activists on behalf of children we are locked into our own stereotypes, seeing men as problematical, irresponsible, neglectful, abusive and irremediable. This has to change.

(Richter, Manegold, Pather, & Mason, 2004).

Over the last decade, families and households in rural South Africa have faced the social and economic impacts of a severe HIV epidemic in addition to increases in adult mortality. Yet despite the fact that all members of households are affected in some way by the experience of HIV/AIDS, debates about the ability of extended families to cope have largely assumed that women are the only (or primary) caregivers and have focused on their experience and needs. Family structures and the gender roles within them are depicted as homogeneous and static, with little attention paid to the existence of diverse and continually evolving household and care-giving patterns.

In this paper we explicitly explore the roles and activities of men in households affected by HIV/AIDS, and discuss how these are perceived by the wider community. We seek to broaden understanding of how vulnerable groups are responding to the challenge of HIV in their daily lives and to re-frame models for care and support to better reflect the fact that men, like women, are essentially gendered beings. As such, male identity and behaviour are neither universal nor immutable, but rather social constructs generated in a particular context (Carrigan, Connell, & Lee, 1985; Connell, 1994; Cornwall & Lindisfarne, 1994; Morrell & Richter, 2004). Including men more proactively in research on the typology of families and their response to HIV, therefore, has the potential to inform the development of new programmatic approaches that might feasibly engage men's concerns and needs, and more effectively include men as actors in community coping strategies.

Families and households in rural South Africa have been shaped by contemporary and historical social, cultural and economic processes. These, in turn, affect men's identity, roles and activities in domestic and public spheres. Specifically, the legacy of apartheid and labour migration have had a major influence on the patterns of family formation and household dynamics, including a sustained decline in marriage rates. Households in former rural Bantustan ‘homelands’, such as the one in which this study was conducted, are characterised by high adult migration, with 25% of all household members being non-resident in the area. Men have dominated labour migration in the past and nearly half of all men aged 25–29 years are non-resident. However, women are also highly mobile and nearly 40% of women in the same age group are non-resident (Hosegood & Timaeus, 2001). Much has been written about the resulting fluidity of rural households, inter-household transfers of people and financial support, and the “stretching” of families and households between different places (Murray, 1981; Spiegel (1986), Spiegel (1987); Spiegel, Watson, & Wilkinson, 1996; Van der Waal, 1996).

Although in the past labour migration offered young men an important opportunity to accumulate bride wealth (lobola) in order that they could marry, secure land and form an independent household, today, economic changes have led to large declines in opportunities for the unskilled and semi-skilled workforce. In 2001, 22% of people aged 15–65 years in the study area reported that they were unemployed and actively seeking work (Case & Ardington, 2004). Many young men are now unable to pay lobola, marry and establish separate households, further accelerating the decline in marriage observed in KwaZulu Natal since the 1970s and 1980s (Preston-Whyte (1978), Preston-Whyte (1993)). In the context of high labour migration, extended kin, particularly parental siblings and grandparents, are often involved in caring for children (Van der Waal, 1996). The prevailing perception is that carers or foster parents are predominantly female, often aunts and grandmothers. Only recently have researchers started to explore the role of fathers in providing care and support in the absence of the child's mother, or the role of other men, such as uncles and grandfathers, in contributing to children's well-being (Morrell, Posel, & Devey, 2003; Townsend, 1997).

Discourse surrounding the subject of men and families in South Africa has been dominated by studies of domestic violence. Indeed, the prevailing image of the South African male is that of the violator and abuser, and this is mirrored in studies that show a high rate of violence against women (Jewkes, Levin, Mbananga, & Bradshaw, 2002; Jewkes, Penn-Kekana, Levin, Ratsaka, & Schreiber, 2001; Kim & Motsei, 2002; Wood & Jewkes, 1997). In research published by Dunkle et al. (2004), 55.5% of women attending antenatal clinics in Soweto reported physical/sexual violence from a partner. Around 8% have experienced sexual assault as adults by non-partners.

Men also experience a high rate of violence themselves: injuries account for 25% of male deaths in South Africa, with 51% of these due to homicide. In women the figures are much lower, at 10.2% and 30%, respectively (Bradshaw, Schneider, Dorrington, Bourne, & Laubscher, 2002). Furthermore, unemployment rates of 28.2% in 2003 (Statistics South Africa, 2004) have placed men in something of a “crisis” in relation to their identity, leading to the expression of disempowerment through violence (Hunter, 2004; Morrell, 1998).

Campbell's (1992) work examines how the historical construction of African masculinities and the resulting ‘crisis’ has impacted on the ability of men to be positively involved within the household. She discusses how low wages and mass unemployment make it increasingly difficult for men to live up to the socially defined role of father as breadwinner. The resulting frustration is likely to further drive men away from familial responsibilities and engagement (Engle, 1997; Foumbi & Lovich, 1997; Smit, 2002).

Simultaneous with its social and economic upheavals, South Africa has experienced one of the world's most rapidly progressing HIV epidemics, which also influences family and household structures. National antenatal HIV prevalence rates rose from 0.8% in 1990 to 24.5% in 2000 (Karim & Karim, 1999; South Africa Department of Health, 2001). KwaZulu Natal is the province of South Africa with the highest HIV prevalence rate among antenatal clinic attendees. Demographic data from the area where our study was conducted show the high prevalence of HIV and its impact on mortality. In 1998, an antenatal survey found that 41% [95% confidence interval (CI), 34.7–47.9] of pregnant women were HIV infected (Wilkinson, Connolly, & Rotchford, 1999). By 2000, AIDS was the leading cause of death in KwaZulu Natal, accounting for 73% of female and 61% of male deaths at ages 15–44 years (Hosegood, Vanneste, & Timæus, 2004). In 2000, 4% of all households experienced the death of an adult (15 years and older) from AIDS; 5% of children under 15 years were maternal orphans and 12% were paternal orphans (Hosegood & Ford, 2003).

This study was conducted in northern KwaZulu Natal, South Africa. The area includes land under the Zulu tribal authority, formerly known as a homeland under the Apartheid era Group Areas Act, and two townships under municipal authority, one formerly for Black residents, one for White. Infrastructure development and population density across the area are heterogeneous, ranging from fully serviced town houses to isolated rural homesteads without water, electricity or sanitation. Part of the area is included in a demographic surveillance system that routinely records information about births, deaths, migrations as well as health and economic data (Hosegood et al., 2004). The population in the surveillance area is highly mobile. Twenty-nine percent of all household members are non-resident but return periodically and maintain social relationships with households (Hosegood, McGrath, Herbst, & Timæus, 2004). Although it is a rural area, few households are engaged in subsistence agriculture, with most dependent on waged income and state grants. As mentioned previously, rates of both unemployment (22% of people aged 15–65 in 2001) and HIV (41% of pregnant women in 1998) in the area are high (Case & Ardington, 2004; Wilkinson et al., 1999).

Section snippets

Methods

This paper presents analysis of field notes collected between 2002 and 2004 as part of a study examining the experiences of households coping with HIV/AIDS. The study collected ethnographic data through non-participant observation during outreach visits by research staff to 20 households caring for at least one adult with disease symptoms indicative of TB or AIDS. Households were identified by volunteers in a local home-based care programme; by nurses from the demographic surveillance system

Findings

Analysis of the field notes reveals a significant difference between how men's activities are talked about and what some men were observed to be doing for their own or other households. Female respondents and field assistants participated in a strongly gendered discourse reflecting an apparently shared set of beliefs: men should be economic providers for their children and the household, yet most men fail because they are irresponsible and promiscuous. The prevailing social norms did not

Discussion

This study finds that men are involved in a diverse range of activities within immediate and extended families coping with the numerous impacts of HIV/AIDS.

We observed men being proactively involved in the lives of their parents and siblings, their own children and those of a partner or sibling, and in their extended family. We found many men providing financial and emotional support to children who were not their biological children. Some men had assumed a social fatherhood relationship with a

Acknowledgements

The authors are grateful to the households, volunteers and government staff who shared their experiences and time with us.

We also acknowledge the committed work and insights of Sindile Moitse and Sayinile Zungu in contributing to this study. Eleanor Preston-Whyte was a driving force behind this research and her intellectual input into the study and mentorship have been invaluable. This work was supported by The Welcome Trust, UK through grants to the Africa Centre for Health and Population

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