About five million people are infected with HIV in South Africa. AIDS is killing approximately 600 people a day. The HIV/AIDS epidemic is without doubt one of the biggest challenges for South Africa's reconstruction and development after the apartheid. A Basic Income Grant (BIG), a social grant of R100 a month for every South African (i.e., for example, R600 per month for a household consisting of six members), will greatly assist people living with HIV/AIDS and their families, including orphans and vulnerable children.

HIV/AIDS and Poverty: A Vicious Circle

There is a strong correlation between HIV prevalence and poverty.

Poverty increases people's vulnerability to HIV/AIDS by increasing their likely exposure to unsafe sexual practices. Migrant workers, most of whom are from poor households, are often at greater risk because they cannot live with their families. Some children see sex work as the only possible means of survival. Poor women and children living in overcrowded households are in greater danger of being sexually assaulted. Poverty can prevent women from gaining information about or access to means of protection, and it can further reduce women's ability to negotiate about condom use with sexual partners.

In turn, HIV infection compounds poverty. Studies have shown that households affected by HIV/AIDS are significantly poorer than non-affected households. A case study in the Free State shows adult equivalent per capita income in affected households represents only between 50% and 60% of the level of income in non-affected households. ⁽¹⁾ In another study, two thirds of AIDS-affected households reported a fall in income. This drop of income was exacerbated by the fact that most of the households studied were already poor: 44% of surveyed households were surviving on less than R1000 a month.⁽²⁾

Household income can fall if household members lose their jobs due to illness or if they have to give up jobs to take care of the sick. Diminished income is often coupled with increased expenditure, particularly on medical care and funerals, further impoverishing the affected households. As a result, less money is spent on food, which leads to higher rates of malnutrition and increases the danger of contracting opportunistic infections. Children are often taken out of school to assist in caring for the sick or to earn supplemental household income; this cuts their education short, reduces their future employability, and increases their vulnerability to the HIV/AIDS in future.

Policy interventions to address the HIV/AIDS crisis must break the vicious circle of HIV/AIDS and poverty through effective poverty reduction initiatives, just as they must also prevent new infection and provide appropriate treatment and care for people living with HIV/AIDS.

As early as 1994, the government recognised how poverty, inequality, migrant labour and gender subordination all contribute to higher HIV transmission in poor communities (National AIDS Plan). The government's HIV/AIDS/STD Strategic Plan in 2000 again stated a commitment to addressing poverty and other socio-economic factors.

Current Social Security Provision for Households affected by HIV/AIDS

Social grants, especially the Old Age pension (R700 a month), significantly reduce poverty in the recipient households. Currently there are 3.6 million individuals receiving social grants, of which 1.9 million are receiving Old Age pension. However, 11.8 million of the poorest 23.8 million South Africans - including many people living with HIV/AIDS - still live in households that receive no social grants. Despite of the huge needs of the individuals and households affected by HIV/AIDS, the current social security provision is far from sufficient.

Disability Grant

Adults (18 years or older) living with HIV/AIDS are eligible for the Disability Grant (R700 a month) only in the advanced stages of the disease, when their CD4 cell count falls below 50. However, there is sufficient evidence to recommend earlier intervention in relation to medical treatment and nutritional needs. Moreover, even those who are eligible often have difficulty in accessing the grant due to the complicated application procedure.

Grants for Children

Currently there are an estimated 300,000 AIDS orphans in South Africa. By 2015, their numbers are likely to swell to almost 2 million.

Under the current social security system, however, there is no social assistance specifically intended for orphans. The Foster Care Grant (R500 a month) can be accessed by a child's carers if they are legally foster parents. However, the legal process to become foster parents is extremely lengthy and cumbersome. Thus, those caring for AIDS orphans who are members of their extended family are not often able to access the grant.

The scope of the Care Dependency Grant (R700 a month) for disabled children (up to 18 years old) is also limited, as it is only for those "who due to their severe mental and/or physical disability, need full-time care". Children with moderate disability or chronic illness (including HIV/AIDS) are excluded. Some HIV positive children receive the Care Dependency Grant when they reach the later disabling stages of the illness. However, in most cases the assistance comes too late as young children with HIV often die quickly if they are not supported with correct nutrition and health care.

The Child Support Grant (CSG, R160 a month) for children under the age of 9 years is so far the most accessible grant for children. Although take up rates have been low, the government and NGOs are undertaking a national campaign to register more children. The recently announced gradual extension of the CSG up to 14 years old is certainly good news, but falls short of the recommendation by the Taylor Committee that CSG be immediately extended to all children up to 18 years old (i.e., without a means-test). (Please refer Fact Sheet #3 for more detailed discussions regarding the CSG.)

The BIG is the answer

There is an obvious need to reform existing grants to provide more appropriately for people living with HIV/AIDS and other special needs. It is also important that all persons eligible for existing grants be registered. Although it is possible to imagine a targeted intervention, this would not be sufficient to address poverty in general. A much more comprehensive and effective approach would be to introduce a universal, non-means-tested Basic Income Grant to prevent people from falling into destitution even if they do not have access to other grants.

A BIG would ensure that households have a small, but regular income with which to buy nutritious food. This is especially important to maintain the health of people living with HIV/AIDS. It will also reduce the need for children to drop out of school, and diminish the burden on households that take care of AIDS orphans. A BIG can help to break the vicious cycle of HIV/AIDS and poverty and reverse the trend of the HIV/AIDS crisis in South Africa.

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Register for social grants by contacting your nearest Welfare Office or call 0800 601 011 (toll free number for Department of Social Development). If you need any assistance, contact the Black Sash Advice Office in your area.

You can contact the BIG Coalition at (021) 461-7804

¹ Booysen, F le R, "HIV/AIDS and Poverty: Evidence from a Household Impact Study conducted in the Free State province, South Africa," paper presented at DPRU Conference, Johannesburg, 22-24 October 2002.

² Hitting Home - How Households Cope with the Impact of the HIV/AIDS Epidemic: A Survey of Households Affected by HIV/AIDS in South Africa, The Henry J. Kaiser Family Foundation, October 2002.