Department of Anthropology, Emory University, 1557 Dickey Drive, Atlanta, GA 30322, USA.
Health Policy Plan. 2011 Jan;26(1):43-52. doi: 10.1093/heapol/czq017. Epub 2010 May 3.
Low-income volunteers constitute a major part of AIDS care workforces in sub-Saharan Africa, yet little research has been conducted to determine how poverty and insecurity among volunteers impact their wellbeing and the sustainability of the AIDS treatment programmes they support. This paper presents longitudinal ethnographic and epidemiological research documenting how the 2008 food crisis in Addis Ababa affected AIDS care volunteers' care relationships and motivations. Ethnographic results highlight the distress and demotivation that rising food costs created for caregivers by contributing to their own and their care recipients' experiences of food insecurity and HIV-related stigmatization. Epidemiological results underscore a high prevalence of food insecurity (approximately 80%) even prior to the peak of food prices. Rising food prices over the 3 years prior to 2008, underemployment and household per capita incomes averaging less than US$1/day, likely contributed to the very high prevalence of food insecurity reported by caregivers in our sample. We also show that new volunteers recruited in early 2008 by one of the non-governmental organizations (NGOs) involved in this study were more likely to be dependants within their households, and that these participants reported lower rates of food insecurity and higher household income. While this shift in volunteer recruitment may help sustain volunteer care programmes in the face of widespread poverty and underemployment, food insecurity was still highly prevalent (58-71%) among this sub-group. Given the inability of the local NGOs that organize volunteers to address the challenge of food insecurity for programme sustainability, our results raise important policy questions regarding compensation for volunteers' valuable labour and poverty reduction through public health sector job creation.
在撒哈拉以南非洲，低收入志愿者是艾滋病护理工作队伍的重要组成部分，但几乎没有研究来确定志愿者的贫困和不安全感如何影响他们的福祉以及他们所支持的艾滋病治疗计划的可持续性。本文介绍了纵向民族志和流行病学研究，记录了 2008 年亚的斯亚贝巴的粮食危机如何影响艾滋病护理志愿者的护理关系和动机。民族志研究结果突出表明，不断上涨的食品成本导致护理人员自身和护理对象经历粮食不安全和与艾滋病毒相关的污名化，从而给他们带来了痛苦和动力丧失。流行病学研究结果强调，即使在食品价格达到峰值之前，粮食不安全的情况也很普遍（约 80%）。在 2008 年之前的 3 年中，食品价格不断上涨，就业不足，家庭人均收入平均每天不到 1 美元，这可能导致我们样本中的护理人员报告的粮食不安全现象非常普遍。我们还表明，参与这项研究的非政府组织之一在 2008 年初招募的新志愿者更有可能是其家庭中的受抚养人，而这些参与者报告的粮食不安全程度较低，家庭收入较高。虽然这种志愿者招募的转变可能有助于在普遍贫困和就业不足的情况下维持志愿者护理计划，但粮食不安全在这个亚组中仍然非常普遍（58-71%）。考虑到组织志愿者的当地非政府组织无法解决粮食不安全问题以确保计划的可持续性，我们的研究结果提出了关于为志愿者的宝贵劳动提供补偿和通过公共卫生部门创造就业机会来减少贫困的重要政策问题。
