What Works for Women and Girls

actually have a surviving parent” (Irwin et al., 2009: 12, based on Belsey, 2008; Sherr, 2008;Richter, 2008). For example, an assessment of 12 out of 39 community groups that currentlysupport 3,975 OVC, 200 PLWA and 1,375 HIV-affected households in Uganda in 2005 found afunctioning extended family system playing a significant role in the care and support of PLHAand OVC in all communities (Balaba et al., 2008). Supporting family systems is thereforeessential.This chapter covers interventions that work in caring for and supporting women and girlsin general, both with respect to their own needs in illness and the burden of caring for otherswho are ill. It also covers the care and support of orphans and vulnerable children, especiallythe particular vulnerabilities and needs of orphaned girls.12A. Care and Support: Women and GirlsBy all estimates, most care and support is provided in the home and women provide twothirdsor more of that care and support (Ogden et al., 2006; Homan et al., 2005; Akintola,2006; United Nations, 2008b; Nyangara et al., 2009). Ina study in China, a woman noted, “When I didn’t feel well,“Who cares for the carers, andwhy is it taken for granted thatwomen provide, and will continueto provide, care and support tofamily members and loved ones,with no sense of the cost andvalue of this work to society andthe economy in general?”(Berman 2002,cited in Ogden et al., 2006)no one would take care of me…I often felt depressed when Ifinished doing those chores for him, but I couldn’t tell himhow I felt” (Zhou, 2008: 1120).Care and Support Programs Often Relyon Women’s Unpaid LaborWhile ordinary care for families tends to be consideredwomen’s domain in most countries, care and supportprograms have been built on the assumption that thesupply of women’s labor is unconstrained and flexible andthat women’s labor will be adjusted in response to crisesor illness (Elson, 1999, cited in Ogden et al., 2006). Dueto this pervasive view of gender roles, “home-based care is often perceived as a ‘cost-effectiveresponse’ to the epidemic, yet in reality it is exploitation of women’s unpaid labour…” (Esplen,2007: 20). Thus, care often relies on “women, young girls, and elderly grandmothers who are‘default volunteers’…” (Sepulveda et al., 2007: 193). Between 2000 and 2001, 254 interviews ofcaregivers in Botswana found that 66% of female caregivers were single mothers who providedthe bulk of caregiving for their sick children with little or no contribution from fathers, with21% of HIV caregivers losing pay in order to provide care (Rajaraman et al., 2006).A distinction can be made between linked and unlinked care, although the two are oftenused interchangeably in relation to HCBC to refer to both clinical and non-clinical careprovided by lay, volunteer or professional providers who are linked to programs and non-clin-342 CHAPTER 12 CARE AND SUPPORT