Interview with Jacques du Guerny
Jacques du Guerny is Chief of the FAO Population Programme Service (SDWP), FAO Focal Point for AIDS and 1996 Chairman of the Inter-Agency Advisory Group (IAAG) to UNAIDS, of which FAO is a member.
International aid agencies seem to be moving beyond looking at HIV/AIDS as a purely medical issue and are focusing more on its effects on rural development. How important is this shift?
For a number of years there has been a clear understanding that HIV/AIDS is a pandemic, made of multiple epidemics, each with its own characteristics. One of the reasons for the establishment of the joint UN programme UNAIDS was precisely the recognition that the epidemics went beyond the medical aspects and required a comprehensive approach involving medicine, human rights, culture, socio-economic dimensions, etc.
However, up to now, the effects of AIDS on rural populations and rural development have received very limited attention. The reasons for this include the fact that the epidemics have been more urban based and have consequently received more attention, that information on rural areas is more difficult to collect and, also, research has focused on sexual behaviour, which is essential, but at the same time has neglected the crucial area of the implications of population movements. What is starting to emerge is the potential indirect but very important role that agricultural policies and programmes, by alleviating rural poverty, empowering rural women, encouraging changes in migratory movements, etc., can play in mitigating the effects of HIV/AIDS in rural communities.
Early FAO studies were carried out in East Africa in the late 1980s and others have now been conducted in West Africa. The future course of the pandemic in Asia remains a major unknown, but the pandemic's centre of gravity could very well shift from Africa to Asia.
Information on the impact of AIDS on rural areas in these and other regions is extremely limited. However, the impact can be expected to vary from region to region given population differences, in terms of size, density and other characteristics of the rural populations and their linkages with urban areas. And differences in agricultural practices -- crops cultivated, farming systems and land tenure -- will also have an important impact on the epidemics. In each area, the spread and intensity of the epidemics will vary.
Women have been the most affected for physiological and cultural, including status, factors. Status differences are related to power and access to resources (economic, information, reproductive health, etc.), therefore women are often not in a position to negotiate protected sexual relations.
Young people have also been hit hard primarily because they lack information and negotiation skills when entering adult sexual life. It is important to recognize that this can happen at a relatively young age and programmes need to be designed accordingly. A particular problem is related to the age difference between men and women: customs such as "minor wives" and "sugar-daddies" make it very difficult for young, inexperienced girls to impose conditions on sexual relations with older men, often in a relative position of wealth and/or authority.
UNAIDS has noted successes in combatting the spread of the epidemic in certain areas of East Africa, where there has been some evidence of stabilization in HIV infection rates. For example, according to UNAIDS, in one rural district in southwestern Uganda, the percentage of the population aged 13 and above acquiring HIV infection each year declined from 7.5 percent in 1989-1990 to 4.5 percent in 1993.
This shows that prevention campaigns can have an impact, but it also shows that a certain level of mobilization of the society and communities is necessary. This can only be achieved if information and education are easily available and if discussion is carried out in an open way at all levels of society.
There has been quite a lot of foreign assistance in support of national information and prevention efforts. However, this needs to be related to the commitment of national political, social, economic and religious leaderships. When these provide support, the campaigns are much more effective. When deciding on the resources needed to be mobilized, not only must the present situation be considered, but much more importantly the long-term costs and implications of no or insufficient action to society and development.
But what we really need to do is:
19 December 1997