Study Paper No. 6
THE IMPLICATIONS OF HIV/AIDS FOR RURAL DEVELOPMENT POLICY AND PROGRAMMING:¹ Focus on Sub-Saharan Africa

1. Introduction: Purpose and scope

This discussion paper will examine the implications of the HIV epidemic for rural development policy and programming in sub-Saharan countries with mature epidemics (including Botswana, Kenya, Malawi, Tanzania, Uganda, Zambia, Zimbabwe), but also more generally in countries affected by HIV. For the purposes of this paper, rural development is defined as an integrated and interdependent system of productive and other components aiming to increase agricultural productivity and food security.

The paper is intended to serve two purposes:

1. To analyse the inter-relationships between rural development and HIV/AIDS and to identify the broad policy and programme development challenges which the epidemic poses for rural institutions.

2. To develop a conceptual framework for the identification of the main policy and programming issues for rural development raised by the HIV epidemic. The primary objective of the framework is to provide explicit guidance for the design and conduct of a set of case studies to be carried out in Eastern and Southern Africa on the implications of HIV for policy and programme development. The case studies, which will be subsequently undertaken by FAO with UNDP funding, will use a participatory rural appraisal (PRA) process to generate policy and programme responses to HIV in each of the four countries. Upon completion, the findings and proposed policy and programme responses will be presented in national workshops.

The discussion paper will address the following key questions:

- Why do formal and informal, public and private, rural institutions need to respond to HIV/AIDS?
- What are the key issues that rural institutions need to address in their response to HIV/AIDS?
- How can the forthcoming case studies generate policy and programme responses to the epidemic?

Two points need to be made at the outset: firstly, the paper is not meant to be empirically comprehensive and focuses only on selected areas of rural development; and secondly, as the impact of HIV/AIDS on agriculture and agrarian systems (subsistence and commercial agriculture) has already been analysed to some extent², this paper also deals with other aspects of rural development.

2. The interface between the rural institutional environment and HIV

2.1 The rural dimension of HIV

The cumulative population in sub-Saharan Africa affected by the HIV epidemic (inclusive of children and elderly dependents) is currently estimated at about 150 million (21 million currently living with HIV plus 9 million who have already died from AIDS, times a factor of 5 to take account of dependents). This effectively means that more than one-third of sub-Saharan Africans are directly affected by the epidemic.³

Given the rural composition of many African countries south of the Sahara⁴, the majority of those 150 million directly affected by the epidemic are likely to live in rural areas. And yet, HIV/AIDS is primarily perceived as and dealt with as an "urban" problem. Rural areas are considered to be far removed from the epicentre of the epidemic, as they tend to have lower HIV prevalence rates than urban areas. In actual fact, however, the number of people living with HIV may, in absolute numbers, predominate in rural areas. For instance, in Kenya, in absolute numbers, close to 600,000 rural adults and 300,000 urban adults were living with HIV in 1994, despite the fact that the rural HIV prevalence rate of 5-6% was only half the urban rate of 13-14%.⁵

Moreover, in some countries, like Swaziland, South Africa⁶, Zimbabwe and Botswana, there is little difference in HIV infection rates between rural and urban areas.

The rural dimension of HIV needs to be addressed for several reasons:

• Even though urban HIV prevalence rates among certain population sub-groups may be declining in some countries (i.e. urban adolescents in Uganda), HIV prevalence rates continue to rise in rural areas of most countries, through migration, trade, refugee movements, strengthened rural-urban linkages, etc. However, HIV infection rates in rural areas are hard to measure and more prone to under-reporting or misdiagnosis, as a result of poor health infrastructure, restricted access to health facilities and inadequate surveillance mechanisms. For this reason, rural HIV remains, to some extent, silent and invisibleCin other words, an unknown entity for policy-makers and planners with potentially far-reaching implications for the rural economy.
• Institutional infrastructure and support is less developed in rural areas. There are fewer institutions operating in and delivering HIV/AIDS information, education and communication programmes (IEC), providing testing and counseling for HIV, and making condoms accessible in rural than in urban areas. Such services are both less accessible in remote communities and less tailored to the local realities (illiteracy, cultural practices, socio-cultural and gender differentiation, etc.). Thus, assumptions that knowledge of HIV/AIDS is in the range of 90% among the populations of several countries (Kenya, Uganda, Tanzania) is unlikely to be accurate insofar as rural men and women are concerned. More importantly, IEC, counseling and condoms alone are unlikely to have an impact in poor, remote areas where survival is the overriding concern and young men and women may have little incentive to change their lifestyles and adopt "safe" behaviours. Responses to HIV in rural areas have largely been based on assumptions made from experience drawn from urban environments. Moreover, "risk behaviour" has not, for the most part, been defined from the perspective of local population sub-groups and thus our understanding of why risk behaviour is practiced and how it is justified by those concerned is limited.
• The cost of HIV/AIDS is largely borne by rural communities, given that many HIV infected urban dwellers return to their village of origin when they fall ill. Rural households (and particularly women) provide most of the care for AIDS patients. In addition, food costs, medical care costs and funeral expenses are borne by rural families. However, this is rarely factored in nation-wide development policies and programmes (which are often urban-biased), or in rural development policies and programmes.
• In some countries, such as Botswana, economic development is contributing to the spread of HIV in rural areas by strengthening rural-urban linkages. Urbanisation, improved transport and relatively high incomes are enhancing mobility while socio-cultural factors are prompting an increasing number of "rurban" people to maintain strong footholds in rural areas and commute between urban and rural areas on a regular basis.⁷
• In macro-economic terms, countries most affected by HIV are also those most heavily reliant on agriculture, and particularly on agricultural exports for foreign exchange needed to pay for raw materials and essential imports for development. Thus, the impact of HIV/AIDS on rural communities and on rural economies in general (and not just agriculture) is of critical significance to such countries. However, as it is not always visible or measurable with macro-economic indicators (such as GDP or per capita income), it is often all too easily dismissed as a minor factor in development policies and programmes, particularly insofar as rural development is concerned.

2.2 Rural susceptibility and vulnerability to HIV/AIDS

To date, analysis of the epidemic in rural sub-Saharan Africa has, for the most part, focused on the socio-economic impact of the epidemic on agricultural production systems and on rural communities. However, the near exclusive emphasis on impact has inadvertently concealed the inter-relationships between the socio-cultural and socio-economic conditions in rural environments as well as susceptibility and vulnerability to HIV and AIDS.

Susceptibility refers to "the likelihood of a society to experience the epidemic."⁸ Social susceptibility is determined by relative wealth or poverty (this defines choice or the absence of choice: wealth gives people [mainly men] the chance to have many sexual partners, poverty forces or encourages them [mainly women] into sexual liaisons as a survival strategy), relative potential for effective mobilisation of political resources and influence, gender relations, livelihood strategies and culture.⁹

Vulnerability refers to a risk environment in which biological, socio-cultural, economic and political factors make it likely that a society or groups of that society will be rendered particularly susceptible to HIV infection and to the likelihood of experiencing the impact of the epidemic. Biological factors include age and gender (younger people are more susceptible to HIV infection than older people, women are biologically more prone to HIV infection than men). Economic and political factors contributing to vulnerability to HIV/AIDS include poverty, fragmented social and family structures, gender inequality, unemployment, drug use, tacit acceptance of multi-partner sexual relationships, etc.¹⁰

Two types of rural areas are particularly vulnerable to HIV: those situated along truck routes and those that are sources of migrant labour to urban areas.¹¹ The spread of HIV along trade routes (a factor likely to be of significance in the spread of the epidemic to agricultural surplus regions) is well established. Traditional subsistence regions are perceived to be less vulnerable to HIV. However, the fact that many subsistence agricultural regions are also sources of migrant labour in the agricultural lean season may make them vulnerable to HIV. In many countries, youths migrate from regions with low agricultural potential to urban centers in search of income opportunities. When they do not find work, many return to their place of origin after two or three years of exposure to increased risk of HIV, and some may thus transmit the virus to their families or sexual partners in their villages.¹²

Rural dwellers, including male and female subsistence farmers, fishermen, nomadic pastoralists, seasonal migrant workers, women heading households, etc. are susceptible and vulnerable to the epidemic in different ways. For example:

• Women heading households with seasonal migrant husbands are vulnerable to HIV infection as their spouses may have other sexual partners at their place of work. In fact, as some female-headed households tend to be poorer than other rural households (with less access to productive resources and to social/support services), the effects of HIV/AIDS on such families may be severe.
• Nomadic pastoralists are at increased risk of contracting HIV due to their mobility, marginalisation, cultural traditions and limited access to support services (health, education, etc.). For instance, in Rakai, Uganda, the Bahima people, who are predominantly pastoralists, have recently forged close relationships with settled farmers and have traditions, such as the levirate, which are known to increase exposure to HIV infection. In Tanzania, changes in lifestyle among the pastoralists of the Usangu plains in Mbeya rural district are contributing to the spread of the epidemic. In the past, the nomadic Masai were a relatively insular society. Recently, however, they have been mixing freely with other ethnic groups while searching for pastures for their livestock throughout the country.¹³
• Widows (who are also likely to be infected with HIV) may have no legal rights to land and property (due to customary inheritance laws or the difficulties of enforcing existing remedial legislation) after their husbands' death. Impoverishment may force them to send some of their children away, engage in occasional sex for money or earn a living as commercial sex workers.¹⁴
• Artisanal fishing communities are at increased risk of contracting HIV due to the socio-economic dynamics of their trade, including mobility, prolonged periods of separation from their families and disposable incomes. Susceptibility and vulnerability also extends to their casual or semi-casual sexual partners and to their wives at home.¹⁵

2.3 Why do rural institutions need to address HIV/AIDS?

In aggregate terms, the HIV epidemic will have an effect on rural development on three levels:

1. It will impoverish directly affected households and communities.
2. It will erode the capacity of rural institutions through losses in human resources
3. It will disrupt the smooth operation of rural institutions by severing key linkages in the organisational and/or production chain.

Before analysing the impact of the HIV epidemic on rural institutions and their work, it may be useful to briefly outline the rural institutional environment.

There are two types of rural institutions: formal and informal (traditional).

Formal rural institutions, include:

• Government Ministries (Ministry of Agriculture and/or Rural Development, Ministries of Health, Education, Public Works, etc.)
• Parastatals
• International organisations engaged in rural development
• Registered community-based organisations (CBOs), (such as church groups, cooperatives, youth groups, etc.)
• Non-governmental organisations (NGOs)
• The private sector

Formal institutions can be broken down to public, private and semi-public. Public institutions refer mostly to government, private institutions refer to the private sector and semi-private institutions refer to parastatals. International organisations and CBOs can be both private and public, while NGOs are often referred to as the "third sector". Given the recent trend toward privatisation, decentralisation and economic liberalisation, the private sector is increasingly assuming a leading role in rural development (i.e. in the provision of health and agricultural extension services, water schemes, etc.) and, as such, should also feature prominently in the response to HIV/AIDS.

Informal rural institutions, include:

• The extended family system
• The kinship system
• Non-registered CBOs (women's groups, mutual assistance associations, traditional savings groups, etc.)
• Cooperative production and marketing arrangements
• Traditional political structures

The relationships between rural institutions and HIV/AIDS are bi-directional:

a) the HIV epidemic may have an effect on formal rural institutions (and their policies and programmes) and on informal institutions (customary practices and traditions) ; and
b) the policies and programmes of rural institutions may have an effect on the spread and impact of the epidemic.

2.3.1 The inter-relationships between formal rural institutions and HIV

The contribution of certain policies and programmes to the spread of HIV will vary according to the stage and pattern of the epidemic. The more advanced the HIV epidemic in a country or region is, the more likely it is that rural development programmes will experience its impact either directly or indirectly.

The inter-relationships between formal rural institutions and HIV/AIDS can be broken down into five categories:¹⁶

1. Professional and support staff (including drivers, secretaries, watchmen, etc.) may be confronted with HIV/AIDS personally or their families and communities may be affected.

2. Technical personnel may confront the impact of the epidemic in their professional capacity. For example, agricultural extension workers may face technical problems related to increased target group morbidity and mortality, such as the adverse effects of the epidemic on the farm household economy, which extend beyond their agronomic capacity (deteriorating agricultural practices, changes in cropping patterns, etc.).

3. The clients or target groups of rural institutions may be susceptible and vulnerable to HIV or may be affected by its impact. Given the magnitude of the epidemic, the depth of impoverishment of affected families and the rise in the number of parentless children, these issues are likely to become of direct concern to rural institutions.

4. The objectives, strategies and activities/services of rural development programmes may be compromised by the impact of HIV/AIDS. Reduced productivity and capacity at target group and institutional levels are likely to undermine performance and set back the progress of rural development efforts in countries severely affected by the epidemic. They may also jeopardise capacity-building and the viability and sustainability of rural development efforts in the long run. For instance, government fisheries programme staff in Malawi are concerned about the growing turnover among fishing crews resulting from increased mortality, which is undermining training efforts.¹⁷

5. Personnel and management issues related to the impact of the epidemic may add a considerable burden on rural institutions (see Box 1). For example, formal rural institutions may suffer from an increased loss of skilled and/or managerial staff and of absenteeism. The loss of skilled staff is costly and problematic, as replacements have to be identified, hired and trained at additional cost, and prolonged delays may be experienced in programme activities. The shortage of skilled labour may affect the provision of essential support and social services and the operation and performance of commercial rural development enterprises. In Uganda, two technical cooperation projects recently could not hand over activities to the government as two highly trained counterparts had died at a critical time in the project cycle. Since no replacements were on hand, the contracts of international staff had to be renewed.¹⁸

These five categories of inter-relationships between HIV and formal rural institutions should not be considered in isolation from one another or else the analysis is likely to be static and limited in terms of its usefulness. Similarly, the breakdown of the costs of HIV/AIDS for development programmes into different categories as listed in Box 1 should not be considered individually. To arrive at a dynamic analysis of these inter-relationships, the aggregate and changing impact of the effects of HIV/AIDS over time and the linkages between these categories and costs must be taken into account.

Rural development programmes may indirectly contribute to the spread of the HIV/AIDS epidemic. It is possible, for instance, that a seemingly straightforward programme objective, such as increasing the economic potential of a particular area, can, if pursued in isolation from the socio-cultural and socio-economic environment and informal institutional setting, end up contributing to the spread of HIV. Factors that come into play include the following:

• displacing farmers and stimulating labour migration through, for instance, the construction of large scale infrastructure ( roads, irrigation schemes, etc.);
• inadvertently encouraging migration, for example, by increasing the economic potential of a particular area;
• increasing disposable incomes of male workers, part of which may then be spent on alcohol, casual sex, drugs, etc.; and
• exacerbating gender disparities (i.e. by inadvertently displacing women farmers through the promotion of cash crops, the construction of large scale infrastructure [see the example of the Volta River Dam project in Ghana in section 3.5], etc.)¹⁹

2.3.2 The inter-relationships between informal rural institutions and HIV

In Africa, informal rural institutions have traditionally acted as social safety net mechanisms in the absence of national health and social security systems. For instance, when a husband dies, the extended family and kinship systems protect widows and their children from poverty and marginalisation through the practice of wife inheritance.²⁰ Widow inheritance, which is widely practiced in eastern and southern Africa, has acquired a sinister dimension with the advent of HIV/AIDS in two ways:

• It is threatening the extended family as a social and economic unit with disintegration as HIV spreads from one wife to another and to their children.²¹ The disintegration of the extended family takes place as a result of a combination of some of the factors listed below:

a) the loss of the patriarchal head of family (which often implies loss of land and property rights for the widow and surviving children);

b) the loss of labour, income and services;

c) the disposal of assets and disposable cash for medical treatment, funeral expenses, etc.²² and

d) the marginalisation, stigma and discrimination that people living with HIV/AIDS (PLWAs) or their spouses and offspring are often faced with, even within their own families.

• It is making the extended family a conduit for the spread of HIV as a result of traditional practices such as wife inheritance, polygamy, sexual cleansing rites, etc. For instance, the fact that western Kenya has the highest rate of HIV and AIDS in the country is attributed in part to wife inheritance, which has allowed the disease to grow exponentially, according to Omodi Magunga who directs the Kenyan government's AIDS efforts.²³

Pervasive as it has been, however, HIV/AIDS has not discouraged the tradition of widow inheritance. One of the reasons is that men often seek to take over land from the widows by inheriting them. Widows on the verge of impoverishment have continued to rely on inheritors to take care of them and their families.²⁴ Another reason for the continuation of traditional practices despite the dangers posed by the epidemic is socio-cultural.²⁵ The social fabric of African societies has been woven over the centuries around such traditions. These have survived in part because they have served a vital function. It is unrealistic to expect people to change their attitudes and lifestyles overnight, given the potentially far-reaching implications of such changes (gender and power relations within families may shift, land ownership and inheritance patterns may be altered, etc).

In effect, HIV/AIDS is transforming the extended family and kinship systems that formerly provided a critical welfare function in society into self-destructive, unsustainable institutions,²⁶ undermining their very raison d'être. Other recent socio-economic developments, such as migration and the breakdown of family life, increased mobility, the high incidence of divorce, etc. have been undermining informal rural institutions over time. However, HIV/AIDS has been catalytic in creating a crisis of unprecedented proportions among informal rural institutions with implications not only for the spread of HIV but also for the viability of rural institutions and of traditional social safety mechanisms.

Another critical function that the extended family system used to play before the advent of HIV/AIDS is that it provided support for the elderly. Today, AIDS is eroding this safety net as grandparents can no longer expect to be supported by their children in their old age. Instead, the elderly often have to shift roles from dependents to main providers, having to support not only themselves but also a number of dependent grandchildren, often in conditions of poverty.

The extended family and kinship systems have also traditionally fulfilled the critical role of child fosterage. In many households, this has created considerable pressures on extended families which may be unable to cope with the added burden of caring for and supporting one or several additional children. The implications for the foster children are far-reaching: some are withdrawn from school, others run away, yet others end up as street children in urban centers.²⁷ While there have been reports of decreased willingness on the part of extended families to foster orphans, and, thus, of the emergence of child-headed households,²⁸ more data is needed to identify the characteristics, needs and coping mechanisms of child-headed households as well as the prevalence of this new phenomenon.

Conversely, it is important to underscore the positive role that the extended family and kinship systems can still play for households affected by adult morbidity and mortality. For instance, in some areas severely affected by HIV/AIDS, rural community interdependence has been strengthened as a result of the epidemic (in Rakai district of Uganda). To cope with the loss of adult labour, income and services, rural communities have set up informal cooperative production and marketing arrangements, which are reported to be efficient and effective. In addition, there is evidence that new informal rural institutions have been created in areas heavily affected by HIV/AIDS to help households cope with adult mortality, besides the traditional savings and mutual assistance associations. In particular, women in some villages in Tanzania have set up associations specifically to help families affected by AIDS mortality.²⁹

The following questions with regard to the interface between formal and informal institutions arise from the above analysis:

• How can the imperiled extended family and kinship systems be reconstructed and strengthened so that they are able to continue to perform their vital function of providing support for those in need (including HIV/AIDS-affected families) without further spreading HIV?³⁰
• How can traditional political structures be mobilised to facilitate and support such changes? Local political organisations are important in the context of HIV/AIDS given that they are powerful agents of change (or conservatism) and of authority.
• How can formal agricultural institutions, in collaboration with formal institutions from other sectors (health, education, welfare, etc.) effectively support informal rural institutions (women's groups, community groups, etc.) to assist with food production, income-generation and poverty alleviation activities?
• How can the potential of cooperative production and marketing arrangements be tapped?
• How do the extended family and kinship systems in heavily affected areas respond to AIDS impact? How do they assist affected families (cash/kind/ services) and for how long after the death of an adult?
• How can the needs of rural children and youth (knowledge, skills, socialisation, etc.) as young productive adults be addressed to ensure that they will be able to contribute to the development process?

2.4 Aligning rural development policies and programmes with the response to HIV

Rural development policies and programmes aim to make a significant contribution towards overcoming poverty on a sustainable basis, enhancing food self-sufficiency and security and improving the living standards and conditions of rural men and women. In Africa, the challenges facing rural development institutions are enormous: by the year 2025, Africa's rural population is expected to rise to just under 700 million from about 480 million in 1995³¹. The majority of rural people, who make up about 70% of the continent's population, are poor.

Rural people's access to basic human needs, such as health care, education, potable water and sanitation is limited, while malnutrition, low life expectancy and high infant mortality are more severe in rural as opposed to urban areas. These are among the very reasons that render rural men and women susceptible and vulnerable to diseases, including HIV/AIDS: poor health and limited access to health care means that rural people with sexually transmitted diseases (STDs), for instance, are unable to get treatment, thus increasing the risk of HIV transmission; limited access to education means that young (sexually active) men and women have little information on STD/HIV prevention; and so on.

Two major world fora have specifically addressed rural development priorities and strategies since the 1960s: The World Conference on Agrarian Reform and Rural Development (WCARRD) in 1979 and the World Food Summit in 1996. Other major world conferences which have touched upon rural development include the 1992 UN Conference on Environment and Development; the 1995 World Summit for Social Development; the 1995 Fourth World Conference on Women; and the 1994 International Conference on Population and Development.

WCARRD focused on poverty alleviation and underscored that participation by rural people in the institutions that govern their lives is a basic human right. If rural development is to realize its potential, it was argued, disadvantaged rural people had to be actively involved in designing policies and programmes and in controlling rural institutions. WCARRD's rural poverty alleviation objectives and strategies focused on the following priorities:

• access to land, water and natural resources;
• people's participation;
• the integration of women in rural development;
• access to inputs, markets and services;
• the development of non-farm rural enterprises; and
• education, training and extension.³²

Since WCARRD, most countries in sub-Saharan Africa have suffered serious economic setbacks, forcing many to cut back on rural development programmes and give priority to growth and structural adjustment rather than participation and equity. Such policies have hit the poor especially hard, as social and support services have been drastically cut across the continent. In addition, bilateral and multilateral aid to agriculture declined from US$10 billion to US$7.2 billion worldwide between 1982 and 1992.³³

During this same period, however, progress was made in the elaboration of alternative approaches to rural development which are participatory, gender-responsive and multi-sectoral. Emphasis has been shifting away from production-, employment- or poverty-oriented approaches toward more integrated strategies. A consensus is also emerging that poverty is not a linear continuum measured merely in terms of income (wages/salaries) or consumption. Deprivation and well-being are recognised as multi-dimensional and, as such, not limited to financial definitions.³⁴ In fact, deprivation includes socio-cultural factors, such as discrimination and social exclusion, which are directly relevant to HIV/AIDS.

These new approaches were reflected in the Rome Declaration and Plan of Action of the World Food Summit of 1996. In particular, the Nineteenth FAO Regional Conference for Africa³⁵, held in preparation of the World Food Summit, reaffirmed that given the extensive nature of food insecurity on the continent and the severe resource constraints, it is necessary to complement actions aimed directly at increasing food production with efforts at more broad-based sustainable and participatory rural development. The following key objectives were proposed for African rural development in the 21st century:

• To expand the effective participation of farmers and producers in the agricultural and rural development process.
• To improve self-reliant rural food security by increasing rural incomes.
• To promote and facilitate broad-based and more self-reliant rural development, including improvements in infrastructure, better marketing arrangements, access to improved technologies and supporting services and inputs, and more secure land tenure arrangements.³⁶

All three objectives are closely linked to HIV and are central to confronting the epidemic: without the participation of men and women in demand-driven rural development policies and programmes, it is unlikely that the spread of the epidemic will be arrested and its impact mitigated. Thus, enhancing sustainable human development and social participation are not only prerequisites for the revitalisation of the rural economy, but also for effective responses to HIV/AIDS (see Box 2).

The World Food Summit established a strong link between poverty and food insecurity and set among its objectives the implementation of rural development policies that focus on strengthening rural institutions and on providing poor and vulnerable households with greater access to productive resources and assets (see Box 3).³⁷ The following actions were recommended at national level for Africa:

• Reorient the allocation of resources for health, education and social services to redress the relative neglect of rural areas.
• Promote broad participation in the formulation and implementation of food security-related programmes and actions, through decentralization, transparency and resources for strengthening the abilities of civil society as well as in the development of local community organizations and activities.
• Strengthen policies and programmes to achieve the equal participation of women in all aspects of social life, particularly those contributing to the achievement of food security, and improve their access to all resources required to this end.
• Reorient and design rural development policy and programmes to support women's health, education and financial needs as primary agricultural producers.³⁸

In effect, these recommendations for action provide a springboard from which to mainstream HIV in rural development policies and programmes. As FAO's Focal Point for AIDS recently argued, "the potential[ly] indirect but very important role that rural development policies and programmes can play in arresting the spread of HIV and mitigating the impact of AIDS by alleviating rural poverty, empowering rural women, encouraging changes in migratory movements, etc. should not be underestimated." ³⁹

This is largely because the causes and consequences of the HIV epidemic are closely associated with wider challenges to development, such as poverty, food and livelihood insecurity, gender inequality, etc. According to UNDP's HIV and Development Programme, "setting in process those activities essential to the achievement of sustainable human development will simultaneously put in place those conditions which will slow HIV transmission, and also strengthen the capacity of social and economic systems to cope with the impact of the epidemic."⁴⁰

Notes:

1. Paper prepared for the Harare Conference: "Responding to HIV/AIDS: Technology Development Needs of African Smallholder Agriculture," 8-12 June 1998.

2. For an analysis of the impact of HIV/AIDS on agricultural production systems in Eastern Africa see FAO, What has AIDS to do with Agriculture, Rome, 1994; Tony Barnett, "The Effects of HIV/AIDS on Agricultural Production Systems and Rural Livelihoods in Eastern Africa (Uganda, Zambia, Tanzania): A Summary Analysis," FAO, 1994 and the Zambia, Uganda and Tanzania country reports on which the above summary is based. For an analysis of the impact of the epidemic on agricultural production systems in Western Africa see Andrée Black-Michaud, "Impact du VIH/SIDA sur les systèmes de production agricole et l'environnement rural au Burkina Faso et en Côte d'Ivoire," FAO, 1997. For an analysis of the impact of the epidemic on rural communities see Daphne Topouzis & Guenter Hemrich, The Socio-Economic Impact of HIV/AIDS on Rural Families in Uganda, UNDP Discussion Paper No. 2, 1996; G. Hemrich, HIV/AIDS as a Cross-Sectoral Issue for Technical Cooperation: Focus on Agriculture and Rural Development, GTZ, May 1997. See also "FAO and the Socio-Economic Impact of HIV/AIDS on Agriculture," 1997 (paper summarising FAO initiatives on HIV/AIDS to date).

3. Desmond Cohen, "Poverty and HIV/AIDS in sub-Saharan Africa," draft paper, UNDP, April 1998, p. 1.

4.For example, Malawi is 94% rural, Uganda is 90% rural and so on.

5. J. Mann et al., AIDS in the World, London 1992, p.78

6. An important determinant of the differential levels of HIV infection is the amount of movement and linkages between urban and rural areas. See Lieve Fransen and Alan Whiteside, "HIV and Rural Development: An Action Plan," Considering HIV/AIDS in Development Assistance: A Toolkit, The European Community, 1997.

7. A significant proportion of recent urban migrants are "rurban," i.e. not real urban citizens, "but rural people who move to urban areas only to carry over their village mode of life to the new setting. The distinction rural-urban becomes somewhat blurred and represents more a concentration of people than people of fundamentally different characteristics." Jacques du Guerny, "A Population Notebook: Points for Discussion," Ceres, No. 155, September-October 1995, p. 22.

8. Tony Barnett and Alan Whiteside, "Social and Economic Factors Crucial in Defining the Spread and Effect of HIV," AIDS Analysis, Vol. 2, No. 4, July 1996.

9. Alan Whiteside, "The HIV/AIDS Epidemic: Background, Implications and Concepts," paper presented at the workshop on "Including HIV/AIDS in Development Aid," Brussels, June 1996, p. 9.

10. GTZ Annual Report 1995, Population, Health and Nutrition Division, 1996, p. 40.

11. C.M. Becker, AThe Demo-Economic Impact of the AIDS Pandemic in sub-Saharan Africa,A 1990, cited in Lynn Brown, The Potential Impact of AIDS on Population and Economic Growth Rates, Food, Agriculture and the Environment Discussion Paper, International Food Policy Research Institute, 1996.

12. G.Hemrich, HIV/AIDS as a Cross-Sectoral Issue for Technical Cooperation, op. cit., p.12.

13. FAO, The Effects of HIV/AIDS on Farming Systems in Eastern Africa, 1996, pp. 72-73. Little is known about the effects of HIV on the livelihood system of nomadic pastoralists. FAO has recommended that this become a priority area in future research on the impact of HIV/AIDS.

14. Sheila Tlou, "Women & AIDS in Southern Africa," Southern African Development Community/European Union, Proceedings and Background Papers on Regional Action, Conference on HIV/AIDS, Malawi, December 1996, p. 9. There is evidence, however, from Bukoba, Tanzania (where there is no tradition of levirate), that this practice may be changing. Widows are no longer sent back to their natal households nor do their in-laws take away the husband's possessions. However, they receive no support from the extended family or kinship systems. It remains to be seen whether they will be pushed out of the land (given that they are legal minors), once their children reach adulthood and establish families of their own. Personal communication, Gabriel Rugalema, ISS, 2 May 1998.

15. G. Hemrich, HIV/AIDS as a Cross-Sectoral Issue for Technical Cooperation, op.cit., pp. 24-25.

16. This analysis is based on a framework developed by Guenter Hemrich in HIV/AIDS as a Cross-Sectoral Issue for Technical Cooperation, op. cit., p. 31.

17. Ibid., p. 25.

18. Ibid., p. 38.

19. Ibid., pp. 36-37.

20. A widow traditionally did not remarry but was taken over as her brother-in-law's responsibility. If the brother-in-law could not care for her, then a cousin or a respected outsider would. The inheritor ensured that the widow and her children were fed, clothed, sheltered and educated, and protected within the community. But, a brother-in-law or close relative could only take a widow if he already had a family. His first wife would accept the arrangement because tradition looked down on his having sexual relations with his inherited one. The system worked well until recently when the inheritors began to shun that taboo and have sex with the widows. See Stephen Buckley, "Wife Inheritance Spurs AIDS Rise in Kenya," Washington Post Foreign Service, November 8, 1997.

21. "An inheritor has his own family. He infects his first wife and the widow he has inherited. Then he dies, and two other men inherit the women he leaves behind. Those men die. And then their widows are inherited," in ibid.

22. Personal communication, Emmanuel Chengu, FAO Rural Institutions Analysis Officer, 9 April 1998.

23. Omodi Magunga, cited in Buckley, op. cit.

24. Buckley, op. cit.

25. "It's a terrible cycle," Magunga argues. "You will tell [a family] that the husband died of AIDS, and the woman is probably very sick, but they say someone must [inherit] the wife. They say tradition must be followed," in ibid.

26.Personal communication, Emmanuel Chengu, FAO, 9 April 1998.

27. D. Topouzis, The Socio-Economic Impact of HIV/AIDS in Rural Families in Uganda: An Emphasis on Youth, op. cit..

28. Personal communication, Gabriel Rugalema, ISS, 2 May 1998.

29. The World Bank, Confronting AIDS: Public Priorities in a Global Epidemic, Oxford University Press, 1997, p. 219.

30. Personal communication, Emmanuel Chengu, FAO, 9 April 1998.

31.United Nations, World Urbanisation Prospects: the 1994 Revision, Annex Table A3, p. 23.

32. For a detailed analysis of the findings and recommendations of WCARRD, see FAO, Rural Poverty Alleviation: Policies and Trends, Economic and Social Development Paper, No. 113, 1993.

33.TeleFood, FAO, August 1997.

34. Robert Chambers and Gordon Conway, "Sustainable Rural Livelihoods: Practical Concepts for the 21st Century," IDS Discussion Paper, No. 296, February 1992, p. 4.

35. See Nineteenth FAO Regional Conference for Africa, World Food Summit: Food Security Situation and Issues in the Africa Region, Ouagadougou, Burkina Faso, 16-20 April 1996, paragraph 69.

36. Ibid, paragraph 70.

37. Rome Declaration on World Food Security and World Food Summit Plan of Action, Rome, 1996.

38. Nineteenth FAO Regional Conference for Africa, World Food Summit: Food Security Situation and Issues in the Africa Region, op.cit., paragraph 75.

39. Interview with Jacques du Guerny, FAO Focal Point on AIDS, Rome, October 1997.

40. Desmond Cohen, "The HIV Epidemic and Sustainable Human Development," Paper prepared for the 4th International Congress on AIDS in Asia and the Pacific, October 1997, pp. 5-7.