The impact of hiv/aids regarding informal social security: issues and perspectives from a south african context

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CI Tshoose*
1 Introduction
It is common cause that, since the dawn of human civilisation, no other epidemic has inflicted so much misery and suffering on humankind than the HIV/AIDS pandemic. According to the UNAIDS,1 more than 22.4 million people were living with HIV/AIDS in Africa. Of these, an estimated 1.9 million were newly infected in 2008. Young women remain one of the most vulnerable groups and are twice as likely to be infected as young men.
An estimated 5.7 million people were living with HIV/AIDS in South Africa in 2009, which is more than in any other country in the world.2 It is believed that in 2008, over 250 000 South Africans died of AIDS.3 National prevalence is around 11 per cent, with some age groups being particularly affected. Almost a third of women aged 25 to 29 and over a quarter of men aged 30 to 34 are living with HIV/AIDS.4 According to the Department of Health National HIV and Syphilis Sero-prevalence survey, 10.9 per cent of all South Africans over the age of two were living with HIV/AIDS in 2008. The estimated HIV/AIDS prevalence amongst those aged 15 to 49 was 16.9 per cent in 2008. The scourge of HIV/AIDS amongst pregnant women stood at 28 per cent in 2007.5
South Africa has the largest number of HIV/AIDS infections in the world.6 Apart from the decimation of the most productive segments of the population, the HIV/AIDS pandemic continues to undermine the institutions and human capital development strategies on which future health, security and progress depend. Moreover, the devastation of HIV/AIDS-related deaths is reflected in the social problem of AIDS orphanages and the increasing number of households headed by children in South Africa.
It is against this background that the article discusses the narrow coverage of the non-contributory social security system, which effectively excludes people living with HIV/AIDS and their families, in particular, destitute families. Following this, the article examines the role played by households in mitigating the adverse effects of HIV/AIDS. These households are often left to assume the primary role of taking care of members who are infected by the epidemic. Their vulnerability is linked in many instances to lack of income, poverty, unemployment, access to basic necessities of life, and social assistance. Similarly, these households rely heavily on the informal social security as a safety net. It is in this light that the article argues that HIV/AIDS will rapidly erode the households' coping strategies for survival should it be left uncontrolled.
In addition, the medical model currently used to determine eligibility for access to disability grants is inefficient because it results in large numbers of people being marginalised from benefiting under the system of social security. Accordingly, the article advocates for reforms to the system with a view to achieving a better and integrated system wherein concrete measures aimed at preventing further human suffering should be adopted, as a matter of urgency. The article concludes that, whilst recent policy developments are to be welcomed, more remains to be done in order to provide a more comprehensive social security system for the excluded and marginalised people who are living with HIV/AIDS.
2 Understanding the concept of "social security"
2.1 The concept of social security defined
Determining the ambit of the concept of social security is extremely important not only for the purpose of understanding the constitutional right of access to social security, but also for the purpose of obtaining a broader understanding of what the social security system in the South African context entails. The traditional Western-orientated concept of social security may also not be able to capture the characteristics of the African context sufficiently.7
It accepted that social security is not a fixed concept.8 To define "social security" with regard to the content of the intended scheme may leave insufficient room for the development of social security and to provide for new answers to any new social problems that may arise. Within the South African context, the concept of "social security" is viewed as an umbrella concept, encapsulating, amongst other aspects, the notion of social assistance, social insurance, and a wide variety of private and public measures that provide cash or in kind benefits or both, in the event of an individual's earning power permanently ceasing or being interrupted.9
The glossary in the White Paper for Social Welfare10 defines social security as:
the policies, which ensure that all people have adequate economic and social protection during unemployment, ill health, maternity, child rearing, disability and old age, etc, by means of contributory and non-contributory schemes providing for their basic needs.11
From a constitutional rights perspective, it is clear that there is a close interrelationship between the concept of social security and several other related concepts that constitute the basis of specific fundamental rights, such as the right to have access to land,12 to housing,13 to health-care services and to sufficient food and water.14 In a nutshell, social security denotes programmes that ensure that people have a safety net in those cases in which their earning capacity ceases to exist. In South Africa, social security is founded on social assistance, social insurance, private savings, social relief and social allowance.
2.2 Informal social security issues and challenges
Informal social security refers to self-organised family, community or informal sector coping mechanisms.15 Informal social security represents a way of life within traditional Black "African" communities and it incorporates values that promote togetherness and a sense of belonging.16 Within communities, informal social security is usually distinguished by informal social arrangements that can be divided into traditional support systems and self-organised systems. Generally, self-organised informal social security comprises a particular group of people within the community, including families and neighbours. Examples of self-organised informal social security include stokvels, burial societies and rotation money schemes.17 The African traditional support system is based on the principles of solidarity and reciprocity. Under the traditional support system, the family serves as the line of defence to members who are unable to provide for themselves. The support provided may be in the form of cash or in kind. These informal safety nets have proven to play a significant role in mitigating the impact of HIV/AIDS at family and community levels.
The role played by the family as a safety net is the most effective community response to the HIV/AIDS crisis in South Africa, as affected households in need of food send their children to live with relatives. In most instances, relatives are then responsible for meeting the children's basic needs and other requirements.18 The problems experienced by extended families in taking care of the children relate to lack of knowledge about the available social grants. In other cases, children become caregivers themselves or even heads of households.19 In many cases, such children become increasingly vulnerable to malnutrition, ill health, abuse and exploitation.20 In cases in which older people are caregivers of young children, they are sometimes unaware of the availability of grants, such as the Child Support Grant, the Care Dependency Grant for Disabled Children and the Foster Care Grant.21
It is clear that whilst the informal social security system cannot be dismissed as ineffective, its effect nonetheless diminishes as the impact of HIV/AIDS intensifies. The rising number of child-headed households clearly indicates the extent to which informal safety nets have become stretched. When parents die or are too weak to do anything owing to HIV/AIDS, the trend in most poor families is that relatives take care of the orphans.22 Grandparents, with their meagre social assistance grants, play an important role in looking after their grandchildren.23 In the event that there are no relatives, the eldest child often assumes the role of caregiver for his or her parents (should they still be alive), as well as his/her younger siblings.24
2.2.1 Changes in extended family systems
A primary issue arising from the impact of HIV/AIDS on households is the ability and willingness of extended family members to assist in the care of remaining family members, especially children who have been orphaned. As mentioned, a prevailing assumption in many national HIV/AIDS policies is that "traditional" family structures can and will cope with the pressures caused by the epidemic. However, results from a number of field studies conducted on the subject cast doubt on this assumption. In light of social and economic changes stretching back well into the colonial era, what is often referred to as the "extended" family has evolved into numerous forms across South Africa, bringing in turn numerous variations in coping with the impact of HIV/AIDS.
Family members who have settled for two, three or more decades in rural areas may have weak links with their wider family living in other areas of the country. In such cases, social networks may take precedence over family membership. Families who have little contact with their extended families have a greater likelihood of orphans being abandoned should the current caregiver die. While it is not an either/or situation (that is either extended families are coping or they are not), it does appear that HIV/AIDS is placing new pressures on many families, who are finding it increasingly difficult to cope.
The trend in other cases is that relatives with jobs are expected to play a larger role in direct support of extended family members (such as fostering a child) or indirect support (providing money for medical expenses or school fees). It is usual in South Africa to find salaried workers supporting two, three or more extended family members with their earnings.
3 Analysing the concept of disability
There is no general statutory definition for the concept of "disability" and much depends on the context within which it is used.25 The International Labour Office (ILO) concludes that a distinction may be drawn between three concepts of disability,26 namely:
(a) physical disability, which refers to the total or partial loss of any part of the body, or any physical or mental faculty, irrespective of the economic or occupational consequences of that loss;

(b) occupational disability, which refers to the loss of earning capacity resulting from the inability to follow an occupation previously exercised by the person concerned; and

(c) general disability, which refers to the loss of earning capacity resulting from the inability to take up any of the possibilities open to the person concerned in the general labour market, including those possibilities that might involve a change in occupation and possibly some sacrifice of professional or social status.27
What follows from this definition is that disability is dependent upon the theoretical construct that one uses to understand the term. Disability can be viewed from a medical perspective, which looks purely at the physical or mental impairment and views the degree of severity as the extent to which certain activities of daily living cannot be undertaken.28
This raises numerous practical and administrative problems. Currently within the South African social assistance system, disability is measured and defined entirely by the medical profession.29 Its interpretation determines a person's qualification to receive a grant. Hence, South Africa appears to have opted to integrate HIV/AIDS into existing safety nets, rather than create new ones.
The South African social assistance system is sometimes vague and characterised by inconsistent definitions. This is evident from the definition of "disability" as discussed above.30 A person suffering from HIV/AIDS cannot be classified as handicapped. By definition, a handicapped person is defined as including a blind person, a permanently disabled person, a person with an artificial limb and a person suffering from a mental illness.31 The only status that might include a person suffering from HIV/AIDS is permanently disabled.
4 Disability grant in practice: Issues and perspectives
The Black Sash points out that social grants have many advantages for impoverished and vulnerable South Africans. They are used to purchase essential food and clothing, improving nutrition and basic human welfare. Households that receive grants are less likely to have malnourished or stunted children, and are better able to access essential state services, such as health clinics and schools. In this way, social grants enable recipients to enter into systems of social reciprocity and mutual support, which continue to characterise many impoverished South African communities. They enable recipients to care for their households, underwriting their continued entitlement to support and protection within these networks, and thereby empowering marginalised household members, such as the ill and disabled.32
Despite the extensive reach of South Africa's social grants system, there are certain barriers that prevent very poor and vulnerable people from obtaining the disability grant. These include lack of identification documents, inability to afford transport to government offices, illiteracy, and ignorance as to what they are entitled to and the procedures they are required to follow.33
There are many documented problems with the disability grant administration. These include, in particular, inconsistent practices between provinces, inadequate understanding of the criteria for disability grants (as discussed above) and temporary disability grants, failure to inform people of their rights (such as the right to an appeal following grant refusal), incorrect placement of people on temporary instead of permanent grants and vice versa, delays in processing applications, failure to inform applicants of receipt of a grant, and arbitrary removal of beneficiaries from the grant system.34
Inefficient administrative systems make the process of applying for and receiving a grant too onerous for disabled people. Some of these administrative issues have an unequal gendered impact in cases in which women's security is involved or in which women's childcare responsibilities and other such needs are not recognised.35 The costs (financial, physical and emotional) of attempting to access the grant system and remain on it are high for all grant applicants and beneficiaries. Gathering documents, travelling to government offices and pay points, and negotiating bureaucratic formalities are some of the tasks that place a strain on them. In addition, the high cost of disability means that many disabled people have expenses and difficulties in addition to those of able-bodied people, such as assistive devices, remuneration of caregivers and additional transport costs.
5 Socio-economic realities facing social security in South Africa
The most significant factor distinguishing South Africa from other countries is its experience of colonialism and Apartheid.36 The latter was an era characterised by political relations of domination, and an economic system that excluded and marginalised the majority of the African population from participating in the opportunities offered.37 In prescribing the impact of Apartheid, the proponents of Apartheid ensured that such policies of deliberate impoverishment distinguished the experience and dynamics of poverty in South Africa. As such, the implementation of Apartheid legislation resulted in persistent poverty and extreme inequality.38
The first inclusive democratic elections in 1994 marked a peaceful transition from Apartheid to democracy. This introduced an era of racial and gender equality, multi-party democracy and freedom of movement. The democratic government intended to ensure that the backlog of social needs would be addressed by introducing programmes aimed at socio-economic reform. These programmes included, inter alia, the Reconstruction and Development Programme (RDP); Growth, Employment and Redistribution (GEAR); and Accelerated and Shared Growth Initiative for South Africa (AsgiSA).39
5.1 Unemployment and employment
The unemployment rate in South Africa is ever growing and proving to be the worst enemy of social protection. As more people join the ranks of the unemployed, so the continued financial viability of many formal social security schemes, such as the Unemployment Insurance Fund, the continued existence of informal schemes (for example burial societies and stokvels) and other informal transfer arrangements (for example kinship-based transfers) become uncertain, in dealing with the impact of HIV/AIDS.40 As these schemes focus only on the risk associated with the virus, they fail to address issues pertaining to the integration of people living with HIV/AIDS into the labour market, in order for them to be able to continue to derive an income and support themselves.
The rate of unemployment in South Africa is very high and the reasons for this are two-fold.41 Firstly, economic growth has been too low to absorb the ever-increasing number of young men and women entering the labour market owing to demographic growth and rising participation rates. Secondly, the policies and actions of government, organised labour and business have together resulted in a growth path that has been skewed in favour of joblessness, in that employment has fallen despite economic growth. Crucially, the growth path has entailed rising productivity and rising wages for an ever-decreasing pool of workers, with concomitant shrinkage in unskilled employment opportunities, especially.42
It is within this context that South Africa is often referred to as a country of two nations – one for the rich and the other for the poor. The main reason for this is that living standards in South Africa are closely correlated with race. According to Africa Focus,43 poverty is concentrated amongst Black people. Approximately 61 per cent of black people and 38 per cent of people from a mixed-race (or so-called "Coloureds") are poor, compared with five per cent of Indians and one per cent of white people.44
Using a broad definition (which includes those who are willing to work but are not looking for work), the unemployment rate is estimated at 40 per cent.45 According to Statistics South Africa, the unemployment rate in 2009 was estimated at 24 per cent.46 In 2010, the unemployment rate remained virtually unchanged at 24 per cent, whilst the participation rate stood at 54.8 per cent and the labour absorption rate at 41.5 per cent.47 This clearly indicates the high rate of social backlog that South Africa faces.
5.2 Poverty and inequalities

There is no accepted official definition of "poverty" in South Africa, and a range of commentators outline the complex interaction of methodological and ideological factors in disagreements about the nature and scale of poverty.48 Regarding the various definitions and methodologies, it is accepted that between 45 per cent and 55 per cent of the South African population are poor, and between 20 per cent and 25 per cent live in extreme poverty.49 In South Africa, there is a glaring racial disparity in income poverty. While three quarters of African children lived in poor households in 2007, only 5 per cent of White children lived below the poverty line. Poverty rates for Coloured and Indian children were 43 per cent and 14 per cent, respectively.50
The Report of the Committee of Inquiry into a Comprehensive System of Social Security51 for South Africa discovered that 45 per cent of the population lives on less than US$2 per day. As measured by the World Bank, 25 per cent of African children are physically stunted (that is, short for their age), 10 per cent of Africans are malnourished (that is, underweight for their age), and 60 per cent of the poor receive no social security transfers.
In measuring poverty in South African households, some studies use the US$1 and US$2 a day methodology.52 In public discourse, the US$1 a day level has gained a great deal of prominence. While acceptance of that level helps to popularise notions and maintain the intensity of public debate, it is not necessarily an accurate indicator.
It is clear that many South Africans live below the breadline. Similarly, in many developing countries, poverty is more rife in rural areas than in urban areas.53 This is mainly because rural areas are generally isolated from urban areas in which there are industries or job opportunities. In addition, people who are unemployed, illiterate and marginalised by the formal social security system are, in most instances, concentrated in rural areas.54 The extent of poverty is illustrated by more than 40 per cent of South Africans living in poverty, with the poorest 15 per cent in a desperate struggle to survive.55 There is a body of evidence that highlights the role of social assistance in South Africa in poverty alleviation. Social assistance is an important source of income for household security and household food security. Further, social transfers or social assistance help to mitigate chronic poverty in so far as part of welfare transfers are invested in "income-generating activities, education, social network and the acquisition of productive assets".56
Poverty plays an important role in the large-scale transmission of malaria and tuberculosis, which are opportunistic infections that in the HIV/AIDS era have become even more important concerns for health authorities. Poverty and disease combine in a vicious cycle in which disease and malnutrition result in poor health, which in turn culminates in low production, low income, low taxation and lack of health facilities. Poor health also feeds into poverty because of diminished household savings and increased debt, lowered learning ability and diminished quality of life.57
Poverty acts to further entrench poor health because of increased personal and environmental risks, increased malnutrition, lack of access to knowledge and information, and a diminished ability to access care. Sexual and reproductive health plays an important role in explaining the persistence of poverty. Lack of knowledge and awareness, which results in low-income earning people not investing in education, contribute to a lack of family planning. The resulting overpopulation and large families exacerbate land shortages, which in turn feed into low production, low productivity and low income, thus closing the vicious cycle.58
Similarly, access to basic services, such as housing, water, land and electricity, remains a problem for many South Africans.59 The programmes that ensure people have access to these basic services are often not well co-ordinated and sufficiently comprehensive.60 In general, sources of income for households in South Africa differ substantially. The poorest households tend to rely heavily on sources such as pensions and social grants, whilst the other households tend to rely on wage income and other sources for income-generation.61
This is an important consideration for social policy, bearing in mind that many low wage earners in urban areas and families affected by the HIV/AIDS pandemic have to maintain their poorer relatives. In doing so, these families are thus effectively assuming some of the social responsibilities that should ideally be taken up by the state.62
This has resulted in many poor households being more vulnerable to the "shocks" of unemployment and ill health, and poorly placed to take advantage of the new opportunities opening in the labour market. Hence, South African society might be viewed in terms of a game of "snakes and ladders".63 The "ladders" are the jobs that people find, whilst the "snakes" are retrenchment, morbidity and mortality of household members. There are many snakes and ladders, but they are not distributed randomly. There are few ladders at the bottom end of society. Lacking social and human capital, and being more vulnerable to HIV/AIDS-related illness, households at the bottom face few ladders and thus few opportunities for upward mobility. The further up the board one proceeds, the more ladders there are, which favours the already advantaged.64

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