A poor and HIV-positive South African may well hear advice about "living positively" with HIV, but this is guidance that many find impossible to follow.
"I received advice about eating a healthy diet, taking immune boosters and vitamins, but I never knew where I would get the money for all this," said an HIV-positive woman from South Africa's poorest province, the Eastern Cape, who preferred not to give her name.
The woman, who survives on the equivalent of a few dollars a day, grew increasingly frustrated until she joined a Savings and Credit Group formed by SaveAct. This South African non-profit organization has pioneered the linking of its financial services for the poor with community groups assisting people affected and infected by HIV/Aids. With the highest number of HIV infections of any country in the world, more than 5.6 million of South Africa's 50 million people are estimated to be HIV-positive.
"Being a savings-led, rather than a credit-based model, there's a lot more emphasis in SaveAct on other services, like providing financial education on how to save," said SaveAct board member Timothy Hobden, an international expert in rural low income financial services who recently advised the governments of Mozambique and Uganda. "There are also social aspects, like working with HIV/Aids organizations."
A researcher from the UK recently investigated the role of these savings and credit groups in increasing coping strategies for poor rural households affected by HIV/Aids. Annie Rose Barber of the University of Bath said the organizations best positioned to help SaveAct implement its savings program are community-based HIV/Aids support groups and home-based care bodies. HIV infection levels in the Eastern Cape are estimated at 19-26 percent. Aids and associated infections such as tuberculosis are contributing to falling levels of life expectancy among women, who make up 88 percent of the savings and credit groups surveyed.
"The staff of these groups had met and worked together with SaveAct's staff, so it was seen as an opportunity to build on the group spirit that was already there," said Barber, who spent three months earlier this year in the Alfred Nzo and Joe Gqabi districts of the Eastern Cape's Matatiele and Elundini local municipalities.
This province has the highest rate of extreme poverty in South Africa, with 74 percent of its people living below the poverty line. The area where Barber conducted her research has the highest poverty rate in the province, estimated at 82 percent, with most households surviving on monthly government child grants of less than U.S.$40.
No More Stigma
One of most intriguing aspects of the partnership between the community Aids groups and the nine savings groups that Barber investigated is the openness among members about their HIV status. Her report showed 83 percent of participants to be openly HIV-positive. She attributed this change directly to their membership in the groups.
"It's because people now have knowledge about what HIV is and how you are infected or affected by it," explained a SaveAct field officer in KwaZulu Natal province, Fisani Zondi. "Before people saw HIV as something that made you a sinner, but now everybody is open because we all understand what HIV/Aids is, so there is less of this stigmatization."
"For the majority of people, once they're in an HIV/Aids support group, disclosure is one of things they deal with," said the SaveAct coordinator for the Eastern Cape office, Nolufefe Nonjeke-Dlanjwa. She and the field officers pointed out many concrete rewards for HIV-positive people to disclose their status when their support groups enter partnerships with SaveAct.
"They become financially stable," said Eastern Cape field officer Samella Mdlangathi. "They feel like, 'I'm positive but life goes on, and now I'm able to manage my finances, to buy food and medicine'."
Cecilia Klaas, a member of an Eastern Cape savings group said SaveAct had changed her life. She has no husband and looks after orphans in her home. "I've been able to pay for their school fees and uniforms. I even see a change in the quality of food we are now eating. Things have really changed," she said.
Barber's South African case study was commissioned by Universitas Forum, which aims to publish material in its Rome-based journal on innovative development strategies for empowering women, and FinMark, a Johannesburg-based trust focused on financial markets for the poor set up by the UK Department for International Development (DfID).
The study documented the effects of the savings and credit groups on communities affected by HIV/Aids by testing for what economists call "consumption smoothing". This is the ability of people on limited means to stabilize their consumption patterns so as to avoid having to suddenly cut back on basic necessities.
Barber's research found an even pattern of spending throughout the year among the groups, even through periods of unexpected financial hardship. She also noted that most groups contribute a small monthly amount to an Emergency Social Fund, so they are ready to assist members with non-repayable grants in times of crisis.
"My research showed that people living with HIV/Aids are a good target for these kinds of interventions, that they use the money they save and borrow productively," said Barber. She found that 38 percent of those she interviewed cited "improved health" as the most important benefit of SaveAct membership, with 90 percent reporting improved diet and nutrition since joining savings groups. Two participants were able to show evidence from clinic tests that their CD4 cell counts had risen. CD4 cells are a type of white blood cell that fights infection and higher numbers indicates a stronger immune system.
No More Loan Sharks
Barber's report, 'Transforming lives: Can Savings and Credit Group membership work for people affected by HIV/AIDS?' shows a sharp contrast between group members' past and present financial practices. Five years ago nearly 20 percent borrowed emergency funds, mainly for funerals, inevitably turning to unregulated moneylenders. Such loan sharks are known in the Nguni languages of South Africa as "mashonisas" and charge interest rates of 60 percent per month and higher. Since joining SaveAct groups, nearly all members turn to their groups for credit, at interest rates of only 5-10 percent.
Barber identified the principal policy implication of her report as a recognition of the role of savings and credit groups in helping people affected by HIV/Aids to cope. Her study shows them to be as successful in saving as any others.
Barber's report found an indication of SaveAct's success in the increasing demand for its services, with 98 percent of all members in households affected by HIV/Aids recommending the program to relatives, friend and neighbours.
"Demand in the target area is currently too high for SaveAct to meet, so plans to expand and spread the project to new areas are underway," concluded the report. "With this target group being largely typical of rural populations affected by HIV/Aids in South Africa, it is likely that the same impact can be achieved on a much larger scale and there is thus great scope for project replication in other areas."
SaveAct's Eastern Cape coordinator confirms this finding, as she and her field officers are no longer spending much effort around mobilization.
"Word of mouth is doing it for us," said Nonjeke-Dlanjwa proudly. "We have a long list of people who want to join savings groups, now that they realize it can be of benefit to them."