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

5. Conclusions

1. Given the rural composition of most countries south of the Sahara, the majority of the 150 million sub-Saharan Africans affected by the HIV epidemic live in rural areas. The magnitude of the HIV epidemic, which now affects about one-third of the population of the region, the disproportionate burden it places on rural communities and on the rural economy, and the inadequacy of services and responses in rural areas point to the urgent need for rural institutions to address the policy and programming issues raised by the epidemic.

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

- the HIV epidemic may have an effect on formal rural institutions (policies and programmes) and on informal institutions (customary practices and traditions) ; and
- rural institutions may have a positive or negative effect on the spread and impact of HIV/AIDS.

3. In aggregate terms, the epidemic will have an effect on rural development in general, and on formal rural development institutions in particular, on three levels:

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

4. Rural development is a dynamic, integrated and interdependent system of productive and other components, operating through a network of inter-related sub-sectors, institutions and rural households with linkages at every level of activity. The efficiency and effectiveness of each sub-sector, institution and household, depends, to a large extent, on the capacity in other parts of the system. If this capacity is eroded through HIV, the system's ability to function is diminished. Thus if one component of the system is affected by HIV, it is likely that other areas will also be affected. In other words, the impact of HIV is not only cross-sectoral, but, more importantly, systemic.

5. HIV/AIDS is acutely affecting informal rural institutions, which provide a vital social safety net in African societies, and particularly the extended family and kinship systems. For example, wife inheritance is threatening the extended family and kinship systems and becoming a conduit in the transmission of HIV. A key issue to be addressed is how the imperiled extended family and kinship systems can be reconstructed and strengthened so that they are able to continue to perform some of their important functions of providing support to those in need without further spreading HIV.

6. A multi-sectoral response to the epidemic needs to take into account the linkages between formal/informal rural institutions and HIV. To this effect, there is a need for a shift in analysis from the impact of the epidemic to the interface between formal/informal rural institutions and HIV/AIDS.

7. The following key points, which cut across the conceptual framework on the implications of HIV/AIDS for rural development policy and programming, are integral to any analysis of the inter-relationships between rural development and HIV/AIDS and to the generation of policy and programming responses to the epidemic:

a) 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. In effect, HIV/AIDS exacerbates existing problems of rural development through its catalytic effects and systemic impact.

b) In areas heavily affected by HIV/AIDS, the catalytic effects and systemic impact of the epidemic on rural development may:

i. amplify existing problems to such an extent as to trigger structural changes (i.e. in adult and infant mortality); and/or
ii.create new problems and challenges for rural development (child-headed households, the breakdown of informal rural institutions and thus of certain vital social safety net mechanisms).

c) Given that most problems arising from the epidemic are not specific to HIV/AIDS, policy and programme responses need not be HIV/AIDS-specific but must address the root causes and consequences of the wider challenges to rural development. In other words, a developmental rather than an AIDS-specific focus is critical to tackling the multi-sectoral complexity of the epidemic and its systemic impact and to ensuring the sustainability of both HIV/AIDS responses and rural development efforts.

d) The policy environment plays a key role in defining the parameters of susceptibility/vulnerability to HIV/AIDS and of the impact of the epidemic.

e) Gender, age and marital/family status play as decisive a role in determining susceptibility/vulnerability to HIV/AIDS and the potential impact of the epidemic as economic and cultural conditions. For this reason, the interplay between these factors needs to be considered at each stage of policy and programme development.

f) The policy and strategy recommendations put forth by the World Conference on Agrarian Reform and Rural Development and by the World Food Summit provide a springboard from which to mainstream HIV/AIDS in rural development policies and programmes. In particular, WCARRD's focus on poverty alleviation and participation by rural people in the institutions that govern their lives as a basic human right, and the World Food Summit emphasis on food security and sustainable human development are not only prerequisites for the revitalisation of the rural economy, but also for effective responses to HIV/AIDS.

g) Rural development policies and programmes in support of poverty alleviation, food and livelihood security, the empowerment of rural women, etc. are, in effect, also HIV prevention and AIDS mitigation measures and vice versa.

h) While rural development programmes can be integrated with HIV/AIDS prevention and mitigation programmes, HIV/AIDS-specific policies and programmes have an important complementary role to play.

8. The proposed conceptual framework on the implications of HIV/AIDS for rural development policy and programming highlights the following issues:

Poverty alleviation: The dynamic inter-relationships between HIV and poverty are poorly understood and under-researched. In fact, information on household coping strategies, the inter-generational effects of HIV, and the long-term impact on children and the elderly is largely inadequate to generate policy and programme responses. Issues that need to be addressed include: a) whether affected households are able to recover from the shocks of adult morbidity and mortality; b) if so, what are the characteristics of these households differentiated by gender, age and family status; and c) if not, what the effects of impoverishment are for the younger generation, and particularly for young women.

Food/livelihood security: Food, nutrition and livelihood security may be seriously undermined by HIV/AIDS. The dynamics of labour mobility/migration and food security/sustainable livelihoods are critical dimensions of susceptibility to HIV and of the impact of the epidemic. Labour-intensive food production strategies, upon which food security policies and programmes are often based may, in some instances, need to be reviewed, given labour shortages arising from HIV/AIDS as well as drought, migration and other factors. Closely linked to the issue of labour shortages is that of livelihood insecurity. Labour shortages reduce opportunities for labour diversification within households, which is critical for livelihood security. More research is needed on food and livelihood security coping mechanisms of informal rural institutions, using nutrition as an entry point.

Empowerment of rural women: Poverty and gender inequality facilitate the spread of HIV. Rural women's access to formal rural institutions, such as health and education, is essential for HIV prevention, while access to technology, inputs, credit, etc. is likely to mitigate the impact of AIDS by enhancing women's employment opportunities, income and status. Rural development policies and programmes aimed at improving rural men and women's access to sustainable livelihoods and to better living conditions (such as access to clean water, income opportunities, and household labour-saving technologies) can have a significant impact on the epidemic. The interface between formal and informal rural institutions and HIV/AIDS is important, if potentially life-threatening practices, such as wife inheritance, sexual cleansing rites, etc. are to be modified or else discouraged.

Labour: A key point in the analysis of the impact of HIV on labour is that this is not homogeneous but heterogeneous. The policy and programming implications of HIV/AIDS for labour and employment primarily relate to: human rights; production and productivity issues; employment and labour market issues, and specifically: the role of the workplace in HIV prevention; lost skills and experience; the substitutability of labour; losses in production and rising payroll costs. Home ownership, the promotion of family lifestyle, the elimination of discrimination in the workplace and the provision of primary health care are increasingly being recognised as cost-effective strategies to contain the epidemic.

Infrastructure: The construction and maintenance of rural infrastructure (roads, dams, etc.) often involve the influx of migrant labourers who live and work in conditions that facilitate the spread of HIV. Thus, infrastructure policies and programmes have to build-in mechanisms that reduce the spread of HIV during construction but also after completion of the projects. The strengthening of infrastructure that discourages HIV transmission (health dispensaries, schools, youth centers) is an important element in complementary HIV prevention and mitigation strategies. The effects of HIV/AIDS on housing and thus on living conditions in rural areas is becoming increasingly problematic either through loss of gender-differentiated skills within households or through the loss of income for repair materials.

9. Participatory, gender-sensitive and multi-sectoral rural development policies and programmes should form the basis of responses to HIV/AIDS. There is a need to develop capacity-building strategies to improve the planning capabilities of government departments, NGOs, CBOs and other rural institutions and help them cope with the loss in human resources and other effects of the epidemic.

10. Rural institutional strengthening/capacity-building activities that may also assist the case studies to generate policy and programme responses may include:

a) Rural development sector/sub-sector susceptibility/vulnerability assessment (why and how is a sector/sub-sector vulnerable to HIV/AIDS? which population/employee groups are most susceptible/ vulnerable? How do certain labour conditions facilitate HIV transmission? etc.)

b) Human resource needs/capacity assessment of key public and private rural development institutions, to evaluate the degree to which their policies and programmes are aligned with the effects of the epidemic, and the implications of human resource losses.

c) Participatory training for rural institutions and their clients/target groups in: bottom-up, cross-sectoral, gender-sensitive planning; the implications of HIV/AIDS for rural development; and mechanisms that move field-based information about the bi-directional relationships between HIV and rural development up the planning ladder in order to influence how planners and policy-makers think and how they plan responses and set policies.

d) Policy/programme review (national and district level rural development policies and plans, etc to take into account the dynamics and impact of the epidemic; to enhance multi-sectoral collaboration among rural development programmes such as poverty alleviation, food security, etc.; to integrate rural development programmes with HIV/AIDS prevention and mitigation programmes.)

e) Creating a mandate on HIV/AIDS and generating political commitment at the highest level for HIV/AIDS to facilitate the operationalisation of multi-sectoral responses to the epidemic beyond the health sector.

f) Setting up a Management Information System on HIV/AIDS in rural areas to generate information and HIV sentinel surveillance data for rural areas, evaluate the magnitude of the epidemic, and monitor on-going activities and their costs.