Chapter 3: The national context

The three IP partner countries differ in demographic and socio-economic characteristics (Table 1). Namibia has a small population with high per capita gross domestic product (GDP), but also the highest national income inequality in the world (UNDP, 2003). In all three countries, agriculture contributes a significant proportion of GDP and employs at least half of the population, the majority of whom are living in rural areas.

Table 1: Selected national characteristics, 2001

* UNDP Human Development Report 2002.
** UNAIDS Epidemiological update 2002.
*** World Bank World Development Indicators Database 2001.
**** UNAIDS, UNICEF, USAID. 2002. Children on the brink.
***** FAO, 2001.

Stages of the epidemic

Uganda, Namibia and Zambia are at different stages of the HIV/AIDS epidemic. The stage of the epidemic determines the level of impact it will have on people’s lives and the appropriate response strategies. HIV prevalence rates are commonly calculated using anonymous testing of samples of pregnant women attending antenatal clinics. While these antenatal clinic sentinel surveys are quite reliable for monitoring trends in HIV prevalence, this type of data is not an accurate indicator of changes in HIV prevalence levels (UNAIDS/UNICEF/WHO, 2002). Uganda is the only country that has demonstrated a clear decline in HIV prevalence rates using sentinel surveillance data. No such trend can be seen for surveillance data in Namibia or Zambia (Figure 1).

Figure 1: HIV sentinel surveillance for pregnant women for Uganda, Namibia, Zambia

Source: UNAIDS, UNICEF, WHO. 2002. Epidemiological fact sheets on HIV/AIDS and sexually transmitted infections. Update.

UNAIDS data indicate that in Zambia young adults have the highest rates of HIV infection, which peaks in the 20-29 years age group for women and the 30-39 years age group for men. However, there is encouraging evidence that infection rates are falling among adolescents of 15-19 years, and the incidence of new infections may be stabilizing. A similar pattern is observed in Namibia, with rates of HIV infection in 2000 peaking in the 25-29 years age group for women, and a very slight indication that infection rates in the 15-19 years age group are levelling off (UNAIDS, 2002).

To date, there is still no cure for HIV/AIDS. Anti-retroviral drugs can prolong life, but are only available for a minority. In sub-Saharan Africa, only an estimated 50 000 people had access to anti-retroviral treatment at the end of 2002, representing approximately 1 percent of the 4.1 million people in need (UNAIDS, 2003). This picture may change in the near future if rollout programmes are able to reach a significant proportion of rural populations, with funding from the World Bank’s Multi-Country HIV/AIDS Programme and the Global Fund.

Trends on the HIV prevalence curve are followed a few years later by similar patterns on the AIDS death curve. Figure 1 indicates that all three countries, at one time, reached quite high levels of HIV prevalence (approximately 30 percent), which means that at least this number of AIDS deaths is expected to occur typically within a seven- to ten-year time lag. By 2001, the estimated numbers of AIDS orphans were 884 000 in Uganda, 47 000 in Namibia and 572 000 in Zambia (Table 1). The epidemic has a protracted impact on a country’s economy and future development.

National policy environment

The most relevant development planning instruments for addressing HIV/AIDS and its impacts on rural livelihoods in poor countries are national poverty-reduction strategies and plans, HIV/AIDS policies, and policies promoting the advancement of women and gender equality. One of the difficulties in addressing HIV/AIDS in the policy environment is that the impacts of the epidemic affect all sectors at all levels, while most policies are formulated to achieve specific objectives. For example, agricultural sector strategies tend to prioritize national and household food security, while fiscal policies emphasize economic development and poverty reduction. However, there is an encouraging trend towards the multi-sectoral design of poverty-reduction strategies and plans and, in particular, of national HIV/AIDS strategies.

Namibia is committed to addressing poverty, and drafted a National Poverty Reduction Action Plan in 2001. Poverty is regarded as a cross-cutting phenomenon, requiring a multi-disciplinary response, participation and the mainstreaming of gender. Agricultural diversification is recognized as a key strategy in addressing rural poverty. HIV/AIDS is not addressed directly in the poverty reduction action plan. However, the disease is recognized as one of the greatest health challenges to the Namibian population, which experiences considerable social and economic costs resulting from HIV/AIDS-related losses of labour productivity. A multi-sectoral committee was set up to facilitate development of the second National Strategic Plan on HIV/AIDS 1999-2004 (RoN, 1999), which obliges all sectors to budget, initiate and integrate activities that address HIV/AIDS within their sectoral plans. The agricultural and rural development sector, however, has so far not identified agriculture-specific mitigation responses, and its current interventions are limited to information and education on HIV risk reduction.

In Uganda, the National Strategic Framework for HIV/AIDS (2000/2001-2005/2006) incorporates HIV/AIDS-related issues in the broad context of national development and in relation to other national policies. It emphasizes the need to integrate HIV/AIDS activities into all ministries and government sector initiatives. Uganda also embarked on a World Bank-funded Multi-Sectoral AIDS Programme in 2001 (UNAIDS, 2002). There are currently 47 HIV/AIDS policies covering 34 HIV/AIDS-related issues in Uganda (Okuonai, Karamagi and Kyomuhendo, 2003), including the Uganda Vision 2025 and the National Health Policy. Most sectors are implementing activities more or less in line with the key priority areas of the National Strategic Framework for HIV/AIDS, but according to an evaluation of HIV/AIDS policies, this effort could have been better co-ordinated (ibid).

In 2000, the Government of Zambia began to develop a Poverty Reduction Strategy Programme (PRSP), which identifies agriculture as one of the key sectors for economic growth. The agriculture contribution to the PRSP is the Agriculture Commercialization Programme, which has been designed to promote the development of an efficient, competitive and sustainable agricultural sector. The Ministry of Agriculture and Cooperatives recognizes that the unanticipated loss of progressive farmers and extension staff to HIV/AIDS, the reduction in the availability of farm labour and the increased money spent on attending the sick are seriously undermining efforts to develop a sustainable and viable agricultural sector that ensures food security and generates income. Nevertheless, agriculture-specific mitigation responses have not been included in the Agriculture Commercialization Programme of Zambia. The National AIDS Council (NAC) was established in 2002 to coordinate the actions of all segments of government and civil society against HIV/AIDS. Following a consultative process, a multi-sectoral National Strategic Framework has been developed and is being coordinated by NAC. The overall goal of the framework is to mitigate and reduce new infections and the socio-economic impact of HIV/AIDS, with the main focus on prevention.