Household Composition among Elders in Sub-Saharan Africa in the Context of HIV/AIDS.

Cross-sectional and repeated surveys from household components of Demographic and Health Surveys in sub-Saharan Africa were examined to determine whether household composition indicators for older adults (N = 52, 573), involving offspring and grandchildren, correlated with national levels of AIDS mortality. One in 4 was living with a grandchild whose own parents were absent. Absence was a result of residence elsewhere and parents being deceased. Older adults in countries with a high accumulation of AIDS mortality were more likely to live in a skip-generation household and with a double-orphaned grandchild and less likely to live in a 3-generation household. Change in living arrangements toward skip generation and a double orphaned household was experienced in countries with high accumulation of AIDS mortality. Key Words: African families, aging, AIDS, cross-national, intergenerational relations, living arrangements. Harsh living conditions, including poverty, a severe AIDS epidemic, and high rates of communicable and infectious causes of mortality such as malaria and tuberculosis, characterize much of sub-Saharan Africa. Because of limited research on elders, defined currently as those 60 and older, the impact of these conditions on household composition of older people is unclear. Yet, household composition of elders is considered by many an indicator of their well-being, in large part because of physical, material, and social support that can be garnered through co-residence (Aboderin, 2006; Adamchak, Wilson, Nyanguru, & Hampson, 1991; Albert & Cattell, 1994; Cattell, 1990; Cliggett, 200 1 ; Cowgill, 1 986; Devisch, Makoni, & Stroeken, 2002; Schatz, 2007; United Nations, 2005). Past research has indicated that the skip-generation household, in which older grandparents live with grandchildren whose own parents are absent, is common in the region and may be considered a normative part of family life (Madhavan & Schatz, 2007; Zimmer & Dayton, 2005). One reason for a skip-generation household is migration for work among younger adults who leave own children behind to be fostered by grandparents (Isiugo-Abanihe, 2002). Therefore, it is common to find households that consist of one or more elders and one or more grandchildren, with the grandchildren's own parents living elsewhere. But, a widening of the HIV/AIDS epidemic may be increasing proportions of skip- generation households and leaving older adults with obligations of raising grandchildren. The current study examines this and other household compositions that relate to older adults living with own offspring and grandchildren across countries with heterogeneity in levels of AIDS mortality. Although causality is difficult to assert, observing associations can implicate the epidemic and provide a base from which to examine the impact of HIV/ AIDS on the living conditions of older adults in the region. The first sign of an HIV/AIDS epidemic, defined as a rapidly expanding and widely prevalent infection, was detected in the 1970s in middle Africa (Lamptey, Johnson, & Khan, 2006; UNAIDS/WHO, 2003). The virus began to spread west and to eastern parts of the continent in the 1980s. By the early 1990s prevalence rates were highest in middle and eastern countries such as Uganda, Tanzania, and Zambia. By that time, the epidemic had also begun a virulent move into southern reaches of the continent, and by the late 1990s prevalence rates (defined as the percent aged 15 to 49 with the HIV virus) had increased to over 20% in some southern countries. Today, the epidemic is by far most severe in the south. Being transmitted mostly through sexual activity, the virus has always been concentrated in the young to middle adult aged population, who are of the age where they would have both their own offspring and living grandparents. There is also about a one in three chance of a child contracting the virus in utero. Today, 30 to 40 million people worldwide are living with HIV, about 30 million have died of AIDS, and there are about 5 million new infections per year, but by far the hardest hit region is sub-Saharan Africa, which experiences two thirds of new infections globally and the bulk of AIDS deaths (Lamptey et al. …