Examining social determinants of food insecurity, common mental disorders, and motivations among AIDS care volunteers in urban Ethiopia during the 2008 food crisis Open Access

Maes, Kenneth Charles (2010)

Permanent URL: https://etd.library.emory.edu/concern/etds/ws859g36t?locale=en


By mixing ethnographic and community-based epidemiological methods, this
dissertation aims to illuminate the challenges facing AIDS care volunteers in urban
Ethiopia, a setting characterized by low income, high rates of food insecurity, and
ongoing scale-up of highly-active antiretroviral therapy programs. Shortages of health
workers - widely recognized as the greatest threat to global health - are addressed
throughout sub-Saharan Africa by using community volunteers. Whether it is unjust
and/or unsustainable to rely on volunteerism in such settings has become a major concern
for a widening group of social scientists and global health practitioners. This dissertation
demonstrates that acute-on-chronic food insecurity during the 2008 global food crisis
impacted psychosocial health and motivations to continue volunteering among AIDS care
volunteers serving local non-governmental organizations in Addis Ababa, Ethiopia. This
dissertation also proposes a theory of how volunteers' pro-social motivations are shaped
and sustained by local norms of reciprocity and empathy, as well as by global group
rituals organized by the institutions that rely on volunteer labor in rolling out
antiretroviral therapies in settings of chronic food insecurity.
Participant observation was conducted in neighborhoods adjacent to a large public
hospital in southwest Addis Ababa, including attendance at volunteer trainings, caregiver
and care recipient homes, volunteers' reporting and planning meetings, and volunteer
recognition ceremonies, over 20 months between May 2007 and January 2009. A
sample of 13 volunteer caregivers was recruited to complete a series of semi-
structured interviews. In addition, a random sample of 110 volunteers from
two local NGOs was surveyed 3 times over 11 months in 2008. Surveys included
measures of food insecurity and common mental disorders, care relationships, and
motivations for being an AIDS care volunteer. Text analyses, regression analyses, and
cultural consensus analyses were triangulated to test hypotheses and interpret results.
Results indicate that volunteers faced unrelenting poverty, but also built
positive, empathic relationships with others in their communities. They also expected
divine rewards as Orthodox Christians caring for marginalized people. Nevertheless, this
dissertation concludes that "volunteerism" is an optimistic and loaded term that over-
simplifies the motivations of low-income individuals and potentially masks a system of
unsustainable labor exploitation within AIDS treatment and other development-focused

Table of Contents


Chapter 1 (Introduction)

Examining health care volunteerism in a food-insecure world -- Page 1

Chapter 2

Food insecurity among volunteer AIDS caregivers: Highly prevalent but buffered from the 2008 food crisis -- Page 36

Chapter 3

Food insecurity and mental health: Surprising trends during the 2008 food crisis -- Page 62

Chapter 4

Volunteer home-based AIDS care: Sustainability in the face of chronic food insecurity -- Page 87

Chapter 5

"My stress is because I am not working." HIV serostatus, food insecurity, and psychosocial health -- Page 111

Chapter 6

"We will continue volunteering, but how can we live with this life condition?" Displacing the myth of the selfless community health
volunteer -- Page 142

Chapter 7

The ritual basis of sustainability: Motivating the "untapped volunteer spirit" in HIV/AIDS treatment programs in urban Ethiopia -- Page 195

Chapter 8 (Conclusion)

What future for global health volunteer labor in sub-Saharan Africa? -- Page 235

References Cited -- Page 245

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