RESPONSIBILITIES OF THE BOARD OF DIRECTORS

the Study Sites, and the Broader South African Context

INTRODUCTION

The preceding chapters have considered the relationship between HIV and AIDS and household food security (Chapter 3), as well as the relationship between HIV and AIDS, and what been referred to in this thesis, as diverse food acquisition strategies. These diverse food acquisition strategies included the use of cultivated foods (Chapter 4), wild foods (Chapter 5) and foods acquired through social transfers (Chapter 6) in order to buffer dietary intake. This emphasis on diverse food acquisition strategies was prompted by the theoretical discourse of HIV and AIDS, which suggests that households in the context of HIV and AIDS are tend to diversity (or possibly curtail) their food acquisition strategies in order to cope with HIV and AIDS shocks.

It is evident from the preceding chapters that the relationship between HIV and AIDS, food security, and food acquisition strategies can vary widely between sites. This inter-site variability is one of the most interesting aspects of this study, given the need for studies that explore how HIV and AIDS responses can vary at the village, or community level

(Mutangadura et al. 1999; White and Robinson 2000; Gillespie et al. 2001; Barnett and Whiteside 2002; Bell et al. 2006). Hitherto, site-disaggregated analyses have been conducted within each results section, but the thematic nature of the chapters makes it difficult to envision a composite view of how the food security and acquisition strategies in each site are structured. The current chapter provides such an overview, through synthesizing key findings from the preceding chapters into a composite perspective for each site.

In addition to providing a composite view for each site, this chapter addresses the overall relevance of the study findings within the broader South African context. In the preceding chapters, a number of significant relationships between HIV and AIDS, food security and food acquisition strategies have been highlighted. Following this, it is important to consider the relevance of these relationships within the overall context of the dominant food

acquisition strategies in the study sites, and in South Africa as a whole. In other words, how significant are these (modifications in) household food acquisition strategies when they are considered in the context of the dominant drivers and food security and acquisition in the study sites? Through addressing this question, the relevance of the study within the context of South African food security policy and practice can be assessed. Specifically,

recommendations can be formulated in terms of the anticipated impact of HIV and AIDS on household food security responses, the significance of this impact in terms of overall household, community and national-level food security, and the relevance of these findings for food security monitoring and interventions in South Africa. These issues are considered in the final section of this chapter.

A COMPOSITE VIEW OF FOOD SECUIRTY RESPONSES IN EACH SITE

KwaDlangezwa

KwaDlangezwa was the most urbanised of all sites, forming an expansive, semi-rural sprawl appended to the nearby industrial centres. Households were easily formed and readily broken up in KwaDlangezwa. Perhaps because of this, length of residence was an important factor in determining the level of household social capital (Table 6.1). KwaDlangezwa also

demonstrated the widest variation in wealth and income-status between households, with households ranging from a relatively political and social elite, to households whose status could be described as near-destitute. Overall, the health-status of residents was also not good in KwaDlangezwa, and the site had the highest levels of chronic illness (Figure 2.9).

KwaDlangezwa also had the highest experience of food insecurity (CSI) of all the sites. It is further notable that KwaDlangezwa was the only site which showed a strong (statistically significant) relationship between household income and HDDS (Figure 3.3), whereas the CSI was not statistically significant with household income at the site level (Figure 3.4).

There was no significant relationship between household income and HIV and AIDS status in KwaDlangezwa. Given this, it is perhaps not surprising that HDDS was not significantly lower in households with HIV and AIDS proxies, as the HDDS in KwaDlangezwa was primarily associated with household income (Figure 3.3). However, the CSI (which was

independent of household income in KwaDlangezwa, Figure 3.4) was significantly higher in KwaDlangezwa households with worsening chronic illness (Figure 3.8) and recent mortality (Figure 3.11). Notably, while households with recent mortality did not have on average lower incomes than households without mortality (Table 3.4), regressions that controlled for the presence of mortality in the relationship between CSI and household income (Figure 3.15) showed that income may have anameliorative effect on the degree of food security

experienced in mortality-afflicted households. Thus, although households with mortality are on average more food insecure, as income increases, they tended to cope better.

In contrast, households which reported orphans without a grant appeared more vulnerable to experience of food insecurity even in the presence of a higher household income (Figure 3.14). The qualitative evidence supported the view that orphan-fostering (particularly paternal orphan) households were a particularly vulnerable group in KwaDlangezwa. There was, however, statistically significant evidence that households with paternal orphans have higher levels of social capital, specifically in terms of being able to borrow money from neighbours (Chapter 6, p.160). For these households, there was evidence from the qualitative data that these households actively built or maintained their levels of social capital (Box 6.1). But this maintenance process was not necessary to simply acquire food transfers, but also cash, access to housing, land and socio-psychological support.

Finally, households with chronic illness in KwaDlangezwa appeared particularly prone to heightened CSI scores. A worsening chronic illness condition over 12-months very strongly demonstrated this trend. Close analysis of the coping strategies employed in KwaDlangezwa suggest that these households are restricting food quantity, rather than food diversity (HDDS). Most of the association of chronic illness with CSI was attributable to the CSI items relating to restriction of portion sizes and borrowing food from neighbours (Chapter 6, p.163). Analysis of the number of donated foods in the household diet also showed that in KwaDlangezwa, households with chronic illness are also more likely to have food from neighbours (Table 6.6 and 6.7). There was also evidence that households with chronic illness in KwaDlangezwa were investing more heavily in cultivation, as these households had a higher proportion of foods from cultivated sources (5.1 % ± 1.4 % versus 2.6 % ± 1.7 %). This effect was apparently independent of household income, but was mediated by whether the household was receiving treatment for the chronic illness or not (Chapter 4, Model 4).

Nkandla

Whereas KwaDlangezwa was characterized by heterogeneity in household demographic, food security and wealth status, Nkandla was marked for its conspicuous homogeneity in

household wealth and dwelling status. Most dwellings were physically very similar,

settlements were dominated by closely-knit kinship groups, and the region was also relatively geographically isolated. Diets were of very poor diversity in Nkandla: there was a very low range of food-groups consumed, and a small degree of variation between households. Perhaps because of this, even very small changes in HDDS level indicated an improvement in the experience of food security of the household: of all the sites, HDDS and CSI showed the strongest correlation in Nkandla (Figure 3.6). However, it should also be noted that the study year in question fell during a time of severe rain scarcity (see Chapter 2, site descriptions), which may have negatively affected the food security status of the Nkandla community. This is one of the limitations of this study, as the ability of this study to describe food security responses under ‗normal‘ conditions is limited.

Perhaps because of the absence of conspicuous wealth-status markers between households, it was the level of social capital in the household that had the strongest statistical association with the household‘s experience of food security in Nkandla (Table 6.2). Whereas household income and wealth-status were at best only weakly correlated with household food security, simple linear regressions showed that total household social capital score explained almost 25% of the variability in the household CSI scores (Chapter 6). Site-disaggregated analysis of the CSI components suggested that high CSI scores in Nkandla were associated with

strategies related to portion restriction, and running out of food (that is, food quantity restriction). From this it might be inferred that households with high social capital were not necessarily eating a higher diversity of foods (HDDS), but tend to be more food secure in terms of eating adequate portions and not running out of food. This heightened food security was not, however, apparently associated with higher levels of donated foods at the household- level, although overall the total percentage of HDDS derived from donated food groups was highest in Nkandla 5.6 % (± 0.9 %) compared to 3.3 % (± 0.8 %) in KwaDlangezwa and 3.6 % (± 1.1%) in Mt. Frere.

For the most part, the quantitative survey indicators were unable to capture what high levels of social capital were defined by in Nkandla. High social capital levels were not associated