In this study we are concerned with understanding the impact of basic municipal services on the treatment, care and support of people sick with HIV-related illnesses. In particular, we enquire into the ‘marketization’ of basic services and the implications this might have in the lives of those caring for people living with AIDS. Marketization refers to policies and practices that present municipal services as economic goods or commodities, not as entitlements. Marketization does not exclude life-line water supply. What it means is that any amount of water used over this minimum ‘life-line’ amount are charged at market-related rates, i.e. on a cost recovery basis. The study was conducted in an Eastern Cape town, and is based on interviews and home visits to 30 households where one or more family members is being cared for with HIV-related illnesses. The research focuses on the use of electricity, water, sanitation and refuse removal facilities in caring for those sick with AIDS. General household living conditions are also considered in understanding the challenges of AIDS care. Our findings were that most families have only occasional access to limited supplies of electricity and municipal water allowances – far less than is required for washing and caring for the sick. Most households have access to water from a yard tap only, and no run-off to dispose of waste water from washing. They also have limited access to electricity and need to burn wood and paraffin for heating and cooking in homes without ventilation. The difficulties of caring for the sick without basic facilities are made worse by the crowded conditions in homes. The study shows that AIDS care increases the demand for electricity and water. The sanitation situation is dire, both in terms of disposal of waste water and toilet facilities, and poses a serious health risk to HIV positive people and their families. There seems little chance that HIV-affected families will ever be able to meet their basic health needs without some form of further help in a situation where water is cut off and restricted after non-payment and free basic electricity is only accessible on successful application for concessions. Such applications are in most cases unsuccessful because if families receive grants they are often not eligible for concessions. Significant inefficiencies and lack of clarity about allowances are further obstacles to service access. There is a clear need to raise the concerns highlighted in this study to the forefront of AIDS care advocacy.
MSP Occasional Paper No.14