Slightly more than 20 years ago, the first cases of AIDS (acquired immunodeficiency syndrome) were identified. Since then, scientists not only have identified the human immunodeficiency virus (HIV) that causes AIDS, but also now understand many of the stages in transmission. Naturally, an infection that is transmitted in a predominantly heterosexual manner and that destroys the health and finally the lives of people of prime producing age exerts a considerable socioeconomic impact.
Neither a vaccine nor a cheap, assured, and effective treatment for HIV/AIDS exists. The pandemic continues to grow and to affect millions of people worldwide, particularly the poor in the southern hemisphere, where 95 percent of cases are concentrated. With most illness and death occurring in the 15-50 age group, the disease deprives countries, communities, and households of their strongest, most productive people.
Today, approximately 36 million individuals are living with HIV/AIDS. Assuming that each HIV/AIDS case directly influences the lives of four other individuals, a total of more than 150 million people are being affected by the disease. Sub-Saharan Africa is the region most affected by HIV/AIDS, now that area-s leading cause of adult morbidity and mortality (see table). Most, if not all, of the 25 million people in Sub-Saharan Africa who are living with HIV/AIDS will have died by the year 2020, in addition to the 13.7 million Africans already claimed by the epidemic.
HIV/AIDS also is spreading dramatically in Asia. India leads the world in absolute numbers of HIV infections, estimated at 3 to 5 million. China, too, has a growing HIV/AIDS problem, with approximately 0.5 million AIDS cases and, according to private estimates by Chinese specialists, up to 10 million HIV infections. Asia will overtake Sub-Saharan Africa in absolute numbers before 2010; by 2020 Asia will be the HIV/AIDS epicenter.
HIV/AIDS is a huge health problem with profound social and economic implications, including its effect on the ability of households to acquire enough nutritious food for members to lead active, healthy lives. HIV/AIDS has created or contributed to exorbitant health care costs, labor shortages, declining asset base, breakdown of social bonds, and downgraded crops and loss of livestock. All of these effects contribute to food insecurity.
Households are said to be food-secure when the following four elements are in balance with each other: food availability, equal access to food, stability of food supplies, and quality of food. For rural households, the equitable availability of stable quantities of nutritious food depends on food production (using mainly family labor, land, and other resources), food purchase (using household income), assets that can be quickly turned into food or cash as necessary, and social claims on others through custom and societal structures such as family and community networks.
HIV/AIDS morbidity and mortality affect food security by reducing households- ability to produce and buy food, by depleting assets, and by reducing the insurance value of social networks as the household calls in favors. Morbidity affects agricultural productivity by affecting labor availability, forcing households to reallocate labor from agriculture to patient care. AIDS mortality permanently removes adult labor from the household. This combination of adult morbidity and mortality and the associated reallocation and withdrawal of labor has led to a number of adverse changes:
Downgraded crops and loss of livestock. Households affected by HIV/AIDS often replace valuable and nutritious crops that are labor-intensive with root crops, which are fast-maturing but less profitable. Household members consume this mainly starchy food, but cannot easily purchase nutritious food because of lower farm income. Chronic food insecurity and high levels of malnutrition among children, especially orphans, are the likely results of these changing crop patterns. Livestock may be sold to generate cash for patient care or as compensation for a labor shortage, may be taken away from survivors, or may be slaughtered for consumption during funerals-or animals may die because of poor management. When households lose livestock, they also lose fertilizing manure, milk for the family, and -ambulatory- savings.
Loss of farm management resources and skills. Subsistence agriculture requires the interaction of human, financial, and physical resources, and all adult household members contribute to this interaction in some way. But HIV/AIDS breaks the chain of knowledge transfer and labor sharing between generations. As a result, survivors-notably orphans and the elderly, who cannot manage the family farm due to lack of knowledge, experience, and physical strength-often remain or become malnourished.
Inability to earn income. By killing young adults, the key earners of nonfarm income, HIV/AIDS dramatically reduces households- earning power and, therefore, their ability to buy food and related goods and services. Illness and funerals force households to spend most of their cash on care, treatment, and other expenses, with adverse consequences for food availability. Labor shortages force households to forgo cash crops in favor of fast-maturing food crops, curtailing the ability of afflicted households to generate cash. Evidence from eastern and southern Africa shows that households affected by HIV/ AIDS not only are eating fewer meals and consuming poorer foods, but also are investing less in the health of surviving members, losing even more labor to frequent morbidity.
Loss of assets. Food security hinges on household assets, which create a buffer between poor production on the one hand and consumption and exchange needs on the other. In times of need, assets such as livestock, land, trees, and even furniture can be readily converted into cash to buy food. Households accumulate assets as an insurance strategy, but HIV/AIDS forces households to dispose of their assets. They are left not only impoverished, but also vulnerable in the long term.
Disruption of social networks. By killing productive adults who are key family providers, HIV/AIDS shatters the social networks that provide households with community help and support. Survivors are left with few relatives upon whom to depend, and strong evidence shows that gender and age are critical determinants of social exclusion in the face of HIV/ AIDS. Widows and their households face critical shortages of food and income, primarily due to disinheritance, lack of sufficient assets, lack of labor supply, and exclusion from wider kinship networks. Orphans, widows, and the elderly find it particularly difficult to depend on other relatives for survival.
Increasing dependency. Households headed by survivors, notably widows, orphans, and the elderly, are more highly dependent on outside sources of support, further compromising their access to food. Moreover, the centuries-old external support structures that guaranteed the interhousehold transfer of food to cushion the needy are collapsing because of HIV morbidity and mortality.
Few poverty and distributional policies and programs-particularly in Africa, but also in Asia and Latin America-are unaffected by HIV/AIDS. Households that lose labor are less able to earn cash, with implications for income-generating projects. Less purchasing power reduces the standards of long- and short-term dependent care within those households. Any efforts at mitigating the rural impact of HIV/AIDS, however, must be multisectoral and must take account of local circumstances.
Efforts should be made to identify the most vulnerable farming systems and to ensure the food security of the most vulnerable households. Farming systems and households that remain viable should be supported to prevent individuals from resorting to activities that deplete natural resources (such as bush encroachment).
Research and extension programs should contain an HIV/ AIDS education component and should encourage rural people to consider how they would respond to the impact of HIV/AIDS. In some communities, farmers- panels could be established so that those who have coped or are coping with the disease can talk with people from hitherto lightly affected communities.
Development, dissemination, and scaling up of labor-economizing methods of cultivation, food preparation, water supply, and livestock-raising should be encouraged. Agricultural education should be targeted to orphans and out-of-school youth, and land tenure arrangements must safeguard the interests of widowed women and orphaned children.
In general, policies and programs must go beyond HIV prevention and AIDS care to the long-term issues of livelihood maintenance and food security.
For further reading see T. Barnett and P. Blaikie, AIDS in Africa: Its Present and Future Impact (London: Belhaven Press, and New York: Guilford Press, 1992); T. Barnett with M. Haslwimmer, The Impact of HIV/AIDS on Farming Systems in Eastern Africa (Rome: FAO, 1995); and G. Rugalema, -Adult Mortality as Entitlement Failure: AIDS and the crisis of Rural Livelihoods in a Tanzanian Village,- PhD thesis, Institute of Social Studies, The Hague, The Netherlands, 1999.
HIV/AIDS by Region, December 2000
| Region | Epidemic Started | Adults and Children Living with HIV/AIDS | Adults and Children Newly Infected with HIV | Adult Prevalence Rate (%) | Percent of HIV-Positive Adults who are Women |
|---|---|---|---|---|---|
| Sub-Saharan Africa | Late 1970s - early 1980s | 25,300,000 | 3,800,000 | 8.8 | 55 |
| North Africa and Middle East | Late 1980s | 400,000 | 80,000 | 0.2 | 40 |
| South and Southeast Asia | Late 1980s | 5,800,000 | 780,000 | 0.56 | 35 |
| East Asia and Pacific | Late 1980s | 640,000 | 130,000 | 0.07 | 13 |
| Latin America | Late 1970s - early 1980s | 1,400,000 | 150,000 | 0.5 | 25 |
| Caribbean | Late 1970s - early 1980s | 390,000 | 60,000 | 2.3 | 35 |
| Eastern Europe and Central Asia | Early 1990s | 700,000 | 250,000 | 0.35 | 25 |
| Western Europe | Late 1970s - early 1980s | 540,000 | 30,000 | 0.24 | 25 |
| North America | Late 1970s - early 1980s | 920,000 | 45,000 | 0.6 | 20 |
| Australia and New Zealand | Late 1970s - early 1980s | 15,000 | 500 | 0.13 | 10 |
| Total | 36,100,000 | 5,300,000 | 1.1 | 47 | |
| Source: www.unaids.org Note: Adulthood is 15 B 49 years of age. |
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Anthony Barnett (A.Barnett@uea.ac.uk) is professor of development studies at the School of Development Studies, University of East Anglia, UK; Gabriel Rugalema (Gabriel.Rugalema@tao.tct.wau.nl) is a research fellow in the Group on Technology and Agrarian Development, Wageningen Agricultural University, The Netherlands.