Poverty reduction strategies in a public health pespective. Social grants, HIV/AIDS and the role out of HAART in South Africa

Despite high levels of unemployment South Africa?s welfare system is premised on full employment. HIV prevalence is highest among majority black African population, which also has the highest rate of unemployment (especially women) and the lowest per capi ta income. Low levels of schooling, few specific skills and lack of employment opportunities make them especially vulnerable to changes in health status. In order to keep a maximum of support and income, a variety of strategies and trade offs are applica ble.This has an important bearing on the kinds of policies and interventions that are most likely to cushion the epidemic?s impact. Unemployed women who have their health restored by HAART may find themselves in a difficult labour-market position. They c ould thus face a terrible choice: not to take HAART and keep the disability grant: or take HAART, live longer but without an income. The proposed study would allow us to investigate this potentially very serious problem, and will add to a relatively scarc e amount of knowledge on how basic social services in very poor settings affect women?s decision making regarding health, nutrition, infant feeding, fertility and work.The research is organised in three main components: (1) a follow-up of an on-going surv ey of HIV-infected people (majority women=where we will investigate health-seeking behaviour, social support, adherence to HAART, experience of stigma, as well as awareness and knowledge of social grants, (2) a qualitative in-depth study of HIV-infected m others designed to obtain information on ideas of social grants, BIG, roll-out of HAART, health, nutrition and strategies that are applied to maximize income and (3) qualitative explorative focus group discussions with key stakeholders on topics related to prevention and mitigation with regard to relevant social policies and programmes for HIV-infected people.