| ARC/04/INF/8 |
TWENTY-THIRD REGIONAL CONFERENCE FOR AFRICA
Johannesburg, South Africa, 1-5 March 2004
HIV/AIDS AND THE FOOD CRISIS IN SUB-SAHARAN AFRICA
“The cost, whether measured in human misery today, or in loss of hope for tomorrow, is simply too high. We have to turn and face [HIV/AIDS] head on.”
Un Secretary-General Kofi Annan
1. HIV/AIDS is at last being recognised as a humanitarian disaster and is rightfully receiving the due attention it requires. With prevalence rates now rising to unprecedented levels of over 30% amongst adults in several countries in southern Africa, the region is bracing itself to weather the destructive forces of the disease on life expectancy, food security, development gains and general wellbeing.
2. The paper presented to the African Regional Conference in 2002, held in Cairo, discussed the impacts of HIV/AIDS on food security. The focus of this year’s paper is on FAO’s response to the changing context of agricultural development as it is being shaped by the epidemic. The paper is presented in three parts: the first provides an update on the state of the HIV/AIDS epidemic in the region; the second provides an overview of the breadth and depth of FAO’s responses to date; and the third concludes by identifying areas which require further action and follow-up.
3. HIV/AIDS is currently one of the greatest threats to global development and stability. Since the emergence of the epidemic in the early 1980s, more than 60 million people worldwide have been infected with the human immunodeficiency virus (HIV) and over 20 million have died from AIDS. At present, approximately 42 million people are estimated to be living with HIV/AIDS, of whom 5 million acquired HIV in 2002 alone. In the same year, AIDS claimed more than 3 million lives, most of them young adult breadwinners.
4. Sub-Saharan Africa is the hardest hit region of the world. In its total population of 711 million, about 30 million people are living with HIV/AIDS, more than 15 million have died from AIDS, and more than 11 million have lost at least one parent to the disease (UNAIDS, 2003). Adult HIV/AIDS prevalence rates of 10 per cent are common in many countries. In parts of Southern and East Africa, rates greater than 15 per cent are not exceptional; Lesotho, Swaziland, Zimbabwe and Botswana report rates of over 30 per cent and are still rising. The AIDS-related excess mortality has a profound impact on the demographic composition of communities and households. By 2010, AIDS is projected to leave 20 million African children under 15 years of age without one or both parents (UNAIDS and WHO, 2002). Moreover, the worst impact of the epidemic is still expected to come; so far, few countries have taken measures sufficient to see a decrease in their national infection rates.
5. The HIV/AIDS epidemic is a long-term event, lasting many decades which unfold in three waves: HIV prevalence, AIDS deaths, and wider impacts (De Waal, 2003). The world is in the third decade of the epidemic and at present the ‘impact’ wave is developing in Africa. As impoverished families try to cope with the HIV/AIDS-associated morbidity and mortality, a significant depletion of assets usually occurs, sending many into destitution. Community safety nets are breaking down because many households require assistance to meet their food, cash, care and labour needs, without being able to repay assistance in kind. The epidemic is also decimating staff of governmental as well as non-governmental institutions, thus fuelling widespread social and economic breakdown. In some countries, more school teachers die annually than can be trained. If left unchecked, this situation could give rise to socio-economic calamities of staggering proportions, including widespread food shortages and a weakened capacity for effective governance.
6. The humanitarian crisis in Southern Africa of 2002 – 03 highlighted the complex interactions between HIV/AIDS, food security and agriculture. The combination of HIV/AIDS-related morbidity and mortality with climatic variability, soil deterioration, ineffective water control, inadequate farming techniques and lack of extension services, has greatly undermined agricultural production and associated livelihood activities. Livestock, crucial to the coping strategies of vulnerable households, have been depleted beyond normal levels in several areas due to disease, theft and sale. Trade barriers and poor infrastructure have hampered the transfer of agricultural surpluses and reduced access to markets, impeding regional and in-country capacities to respond to localized food shortages. As a result, communities have become more vulnerable to AIDS-associated problems, such as declining education levels and increased crime. Although the famine was averted, the ability of many farmers in Lesotho, Malawi, Mozambique, Swaziland, Zambia and Zimbabwe to recover is severely compromised by the effects of HIV/AIDS. Unlike usual emergencies, the disease takes its toll particularly amongst adults in their most productive years and, during prolonged illness prior to death, household assets are often severely depleted. In some areas, households are spending more than 100% of their annual income on medical care. Even in non-emergency settings, the impact of HIV/AIDS is seriously undermining efforts to reduce poverty and is reversing many of the development gains made during recent decades. Seven million African workers died between 1985–2000 in the 25 most affected countries; it is likely that at least one quarter of economically productive adults in Southern Africa may die within next five to 10 years.
7. Addressing HIV/AIDS is now high on the development and humanitarian assistance agenda both within countries, through regional initiatives (such as the Abuja and Maseru Declarations, and the SADC strategic framework), as well as throughout the UN system. The latter includes the General Assembly Special Session (UNGASS) Declaration of Commitment on HIV/AIDS in 2001, the appointment of a Special Envoy of the Secretary-General for HIV/AIDS in Africa (Mr Stephen Lewis) in 2001, the establishment of the UN Regional Inter-Agency Coordination and Support Office (RIACSO) in 2002, and the formation of the Commission on HIV/AIDS and Governance in Africa in 2003. An inter-agency policy document of 2003, ‘Organizing the UN Response to the Triple Threat of Food Insecurity, Weakened Capacity for Governance and AIDS, Particularly in Southern and Eastern Africa’, sets out a coherent system-wide policy and programming approach for the UN on HIV/AIDS.
8. The agricultural and rural sectors present a unique opportunity to combat the epidemic in most African countries. Up to 80 percent of the population in some African countries depend on subsistence agriculture; crops, livestock and other natural resource products are the mainstay of economy and export earnings; and agriculture, forestry and fisheries provide vital safety nets. Good nutrition is often the only means for rural people to slow progression from HIV to AIDS. For the minority with access to AIDS drugs, improved nutrition enables them to be utilized effectively. Hence FAO, with the UN mandate for improving nutrition and food security, agriculture and rural development, has a major responsibility to contribute to tackling the impacts of the disease. The Organization has the opportunity to identify and promote ways to raise awareness and prevent the transmission of HIV amongst rural communities, and to draw on capacities of the natural resource environment (agriculture, fisheries and forestry) to provide AIDS care and mitigating strategies.
9. In order to engage effectively in responding to the widespread and long-term impacts of HIV/AIDS, particularly as it threatens to erode development gains and undermine the productive capacity of many countries in Africa, FAO is identifying new modes of working and innovative activities. The shift in operational focus is described in the first section below, and the details of in-country activities are presented in the subsequent section.
10. HIV/AIDS is not just another problem of health and under-development. It is a unique disease because of its devastating, systemic and cumulative impact. It stands apart from diseases like malaria due to the scale of morbidity and mortality among persons aged between 15 and 50 years, as well as its pattern of contagion. The effects of long illness and premature death amongst these age groups have profound implications for the agricultural sector, causing acute labour shortages at household and community levels; altering established technical relations between labour, land and capital; causing irreversible depletion of rural household assets; triggering the adoption of adverse, hard-to-reverse response strategies; weakening community structure and straining community safety nets; diminishing the resilience of farming and livelihood systems; reducing the capacity of household and communities to recover; and intensifying their vulnerability to food shortages.
11. In aggregate terms, the epidemic produces new mechanisms of impoverishment and thus creates new patterns of poverty and livelihood insecurity. The outcome is the emergence of a new category of poor people. The ‘AIDS-poor’ include: households with chronically ill young adults and those that have suffered a young adult death during the last two to five years; households headed by single parents, the elderly or orphans; and households fostering orphans. Women are amongst the most affected: not only are they more vulnerable to HIV infection biologically but they also bear the brunt of the social and economic costs of the disease.
12. This changing environment has three principal implications for the nature and style of FAO’s work. First, the epidemic diminishes the relevance and effectiveness of many conventional agricultural and food security strategies, especially those that are labour-intensive and market-oriented. Second, the reality of HIV/AIDS calls for new ways of identifying and targeting vulnerable groups because traditional classifications are no longer relevant. Third, the epidemic requires new strategies to effect development in a changing context with different needs and priorities. Thus FAO has to identify new modes of working, requiring closer collaboration between technical units within FAO, as well as between agencies, and joint initiatives between sectors. FAO’s experience with people-centred approaches can provide appropriate entry points and responses to affected households, communities and institutions.
13. The World Food Summit: five years later (held in 2002); the 2001 and 2003 sessions of FAO’s Committee on Food Security1; and the African Regional Conference of 20022 all acknowledged the devastating impact of HIV/AIDS on food security and pledged to fight the epidemic. FAO has created a new inter-departmental entity in the Medium Term Plan, 2004–2009, entitled “Analysis and mitigation of the impact of HIV/AIDS on food security and rural development”. During the last year, several technical services of FAO have reviewed their operations in order to identify opportunities for HIV/AIDS mainstreaming. FAO is collaborating with the other Rome-based UN agencies (IFAD and WFP) to address the epidemic more effectively along the continuum from preparedness to humanitarian relief and long-term agricultural and rural development.
14. FAO’s activities are broad, covering a wide spectrum of initiatives from preventing infection with HIV through to mitigating the impacts of HIV/AIDS. Initiatives take place at all levels, from the grassroots (individuals, their households and communities), through national policy environments and institutions (in particular, the ministries of agriculture) to the global level.
(i) Global and regional initiatives
15. FAO has played a key role in international advocacy, drawing the attention of key players from international agencies, donors, governments and NGOs to the inter-linkages between HIV/AIDS, food security, nutrition and the role of the agricultural sector in mitigation. Specific activities include:
Emergencies and early warning:
(ii) Policy and project environment
16. FAO is actively engaging in the debate about the need to better understand the relationship between agricultural policy and the HIV/AIDS epidemic9. Poverty, inequality, food and livelihood insecurity all influence the spread of the HIV/AIDS epidemic. Agricultural policies often provide a framework to address these wider concerns and in doing so, have an impact on the HIV/AIDS epidemic itself10. For example, agricultural policies that – either deliberately or unwittingly – promote migration may contribute to the spread of AIDS if adequate measures are not taken to avoid it. Without taking the various impacts of HIV/AIDS into consideration, agricultural policy may be ineffective or impossible to implement (for example, due to labour shortages). The resistance of HIV-infected persons to the development of the full-blown disease can be increased with good nutrition. Issues of this nature should be considered during policy design and appraisal to ensure that national agricultural policies play a role in combating the pandemic. At the programme and project level, FAO is working to integrate considerations of HIV/AIDS into design, monitoring and evaluation procedures.
Specific activities include:
(iii) Sectoral studies
17. In order to sharpen the focus of policy recommendations and interventions, it is essential to have a thorough understanding of their context. Since 1988, FAO has commissioned a range of baseline studies in order to understand the dynamics of the HIV/AIDS epidemic in various aspects of livelihoods in rural communities. Specific attention is paid to capturing the gender and age dynamics of the epidemic. Recent studies include:
(iv) Institutional level
18. The capacity of many government ministries has been severely weakened as a result of the HIV/AIDS epidemic, through staff attrition, compounded by the loss of their knowledge and expertise. Simultaneously, there is an acute need to re-orientate service delivery to meet the changing composition of communities and their challenging demands as they struggle to survive in the face of the HIV/AIDS crisis. FAO is helping to bridge this gap by:
Strengthening institutional capacity:
Strengthening communication materials:
(v) Household and community levels
19. In addition to the regular programme experiences, FAO has two activities which provide vital entry points to addressing HIV/AIDS at the field level: the Emergency Programme and the Special Programme for Food Security (SPFS). Both provide timely insights and valuable lessons for identifying suitable approaches to tackle the HIV/AIDS epidemic through the FAO global programme.
20. Under the Emergency Programme, FAO is integrating a rehabilitation dimension into the emergency activities (providing vulnerable households with access to seeds and other essential farm inputs), particularly in the southern African countries affected by the humanitarian crisis of food insecurity and HIV/AIDS. SPFS, with ongoing activities in more than 70 countries, has extensive experience in designing and implementing community-based projects to promote agricultural production. FAO is developing new initiatives to ameliorate the productive capacity of the agricultural sector following the impacts of HIV/AIDS.
21. A broad range of activities is being implemented at this level. They are grouped into four principal themes. Gender- and age-based considerations are cross-cutting issues which form an integral part of all these activities.
22. Activities include:
Improving access to farm inputs:
Securing the asset base:
23. As a result of the devastating effect of HIV/AIDS on the agricultural sector and rural economies of many African countries, several of FAO’s key strategic objectives are now in jeopardy. Under threat are the pursuit of sustainable rural livelihoods and equitable access to resources; access of vulnerable and disadvantaged groups to sufficient, safe and nutritionally adequate food; preparedness for, and effective and sustainable response to, food and agricultural emergencies. There are two critical areas for FAO’s future strategy37: one, to prevent the development of further double emergencies of HIV/AIDS and food shortages in Africa and elsewhere; and two, to assist member states to develop effective agriculture and rural resource-based mitigation and rehabilitation responses to the epidemic.
24. As has been demonstrated in section 2 above, the Organization has started moving towards defining new parameters for agricultural development and emergency assistance; establishing links between short-term and long-term crisis response; and redefining and prioritising working with vulnerable beneficiary groups, including orphans, vulnerable children and adolescent youths. However, FAO has not yet been able to mount a response which is commensurate with the scale required to effectively address the HIV/AIDS crisis at present, let alone provide the level of service which will be required to deal with the impacts of the disease as they will unfold and evolve during the coming years.
25. As an Organization, FAO needs to develop a corporate strategy for addressing HIV/AIDS in the context of agricultural and rural development. The Organization and its staff members, both collectively and individually, have to recognise the relevance of the epidemic for its work in agriculture and rural sectors; internalise the responsibility for addressing HIV/AIDS considerations in all aspects of its mandate; adapt and develop its actions to work within this new and evolving environment; develop new ways of targeting priority groups; and move forward with new alliances within FAO, with other international and national players, and at the community level.
26. In view of the foregoing, three priority areas may be identified for further action:
27. The responses to date demonstrate FAO’s capacity to innovate. However, in order to realise the Organization’s enormous potential to contribute to tackling HIV/AIDS, the activities need to be scaled up, integrated and sustained. Without this change in tempo, the Organization will not only fail to address the most pressing needs of millions of the rural poor in Africa but also may not be able to overcome the epidemic’s undermining threat to its ongoing development initiatives. In the words of FAO’s Director-General, Jacques Diouf, “The potential for real growth and development in Africa is dependent upon successfully addressing key challenges - hunger and poverty, agriculture production and HIV/AIDS38."
De Waal, A. (2003) HIV/AIDS and Emergencies: Challenges of Measurement and Modelling, Presentation for the RIACSO Technical Consultation on Measuring Vulnerability in the Light of the HIV/AIDS Pandemic, 9-11 September 2003, Johannesburg: RIACSO
UNAIDS and WHO (2002) AIDS epidemic update: December 2002, Geneva: UNAIDS and WHO
UNAIDS (2003) Accelerating Action against AIDS in Africa, Geneva: UNAIDS
1 FAO (2001) The Impact of HIV/AIDS on Food Security, Paper for 27th Session on Committee on World Food Security, 28 May – 1 June, Rome: FAO; and FAO (2003) Food Security and HIV/AIDS: An Update, Paper for 29th Session on Committee on World Food Security, 12-16 May, Rome: FAO
2 FAO (2002) HIV/AIDS, Agriculture and Food Security in Mainland and Small Island Countries of Africa, Paper for 22nd Regional Conference for Africa, 4 – 8 February, Cairo, Rome: FAO
3 FAO (2003) Mitigating the impact of HIV/AIDS on food security and rural poverty, Results of a multistakeholder meeting and outcomes of subsequent strategy development, Rome: FAO HIV/AIDS Programme
4 FAO and WHO (2002) Living well with HIV/AIDS – A manual on the nutritional care and support of people living with HIV/AIDS, Rome: FAO Food and Nutrition Division
5 Workshop website: www.sarpn.org.za/mitigation_of_HIV_AIDS/index.php
6 FAO’s HIV/AIDS website: www.fao.org/hivaids/ for all FAO HIV/AIDS publications
7 FAO (2001) Emergencies and HIV/AIDS: Exploring the Role of FAO and Mainstreaming HIV/AIDS in the Organization’s Emergency Response with a Priority Focus on Sub-Saharan Africa, Rome: FAO
8 IASC (2003) Guidelines for HIV/AIDS Interventions in Emergency Settings, Geneva: IASC
9 du Guerny J (2000) AIDS and agriculture in Africa: Can agricultural policy make a difference? Rome: FAO Sustainable Development Department
10 Topouzis D (1998) The implications of HIV/AIDS for rural development policy and programming: Focus on sub-Saharan Africa, FAO: Sustainable Development Department and UNDP HIV and Development Programme
11 Topouzis D and du Guerny J (1999) Sustainable agricultural/rural development and vulnerability to the AIDS epidemic, FAO and UNAIDS joint publication, UNAIDS Best Practice Collection, Geneva: UNAIDS
12 FAO (2003) Incorporating HIV/AIDS considerations into food security and livelihood projects, Rome: FAO Food and Nutrition Division
13 Stokes C S (2002) Measuring impacts of HIV/AIDS on rural livelihoods and food insecurity, Rome: FAO HIV/AIDS Programme
14 University of Namibia (2001) The impact of HIV/AIDS on the different farming systems in Namibia, Accra: FAO Regional Office for Africa (Sustainable Development Extension Service)
15 FAO (2003) Inter-linkages between HIV/AIDS, agricultural production and food security, Baseline report for Southern Province, Zambia, compiled by Farming Systems Association of Zambia for Integrated Programme, Rome: FAO Integrated Programme (www.fao.org/sd/ip)
16 FAO (2003) HIV/AIDS and agriculture: impacts and responses, Case studies from Namibia, Uganda and Zambia, Rome: FAO Integrated Programme
17 Rugalema G, Weigang S and Mbwika J (1999) HIV/AIDS and the Commercial Agricultural Sector Of Kenya: Impact, Vulnerability, Susceptibility And Coping Strategies, Rome: FAO And The Hague, Netherlands: Institute of Social Studies
18 FAO (2004 forthcoming) Impacts of HIV/AIDS on livelihoods in fishing communities in Benin and Uganda, A synthesis report, Rome FAO HIV/AIDS Programme and GTZ
19 Engh I, Stloukal L and du Guerny J (2000) HIV/AIDS in Namibia: Impact on the Livestock Sector, Rome: FAO
20 Forestry website:
21 Connolly M (2003) Study of Practices Implemented to Mitigate the Impact of HIV/AIDS at Farm Household Level in Three African Countries: Malawi, Zambia and Zimbabwe, Harare: FAO Sub-Regional Office for Southern and East Africa and GTZ-SNRD
22 Michiels S I (2001) Strategic approaches to HIV prevention and AIDS mitigation in rural communities in sub-Saharan Africa, Rome: FAO Extension, Education and Communication Service
23 Qamar K (2001) The HIV/AIDS epidemic: An unusual challenge to agricultural extension services in sub-Saharan Africa, in J of Agricultural Education and Extension, Vol 8, No 1, 1 - 11
24 Topouzis D (2003) Addressing the impact of HIV/AIDS on ministries of agriculture: focus on eastern and southern Africa, Joint FAO and UNAIDS publication, Rome: FAO Sustainable Development Department
25 MAAIF (2002) The impact of HIV/AIDS on agricultural production and mainstreaming AIDS messages into agricultural extension in Uganda, Rome: FAO Integrated Programme
26 FAO (2004 forthcoming) Series of extension leaflets, Rome: FAO HIV/AIDS Programme
27 Michiels S (2001) Considerations for developing a communication plan for HIV prevention and AIDS mitigation in Sub-Saharan Africa, Rome: FAO Extension, Education and Communication Service
28 Household food security and community nutrition website: www.fao.org/es/ESN/nutrition/household_hivaids_en.stm
29 Drimie S (2002) The Impact of HIV/AIDS on Land: Case studies from Kenya, Lesotho and South Africa, A synthesis report, Harare: FAO Sub-Regional Office for Southern and East Africa (www.sarpn.org.za/documents/d0000147/P143_Impact_of_HIVAIDS.pdf); EASSI (2003) The impact of HIV/AIDS on women’s land rights in Uganda, study supported by FAO and NORAD; and FAO/OXFAM GB (2003) Report of Workshop on Women’s Land Rights in Southern and Eastern Africa, Harare: FAO Sub-Regional Office for Southern and East Africa
30 du Guerny J (2002) Meeting the HIV/AIDS Challenge to Food Security, The role of labour saving technologies in farm-households, Joint FAO and UNAIDS publication, Rome: FAO and Thailand: UNDP South East Asia
31 Bishop-Sambrook C (2003) Labour constraints and the impact of HIV/AIDS on rural livelihoods in Bondo and Busia districts, Western Kenya, Report for study on labour saving technologies and practices for farming and household activities in Eastern and Southern Africa, Rome: IFAD and FAO
32 Bishop-Sambrook C, Kienzle J, Mariki W, Owenya M and Ribero F (2004 forthcoming) Suitability of reduced tillage and cover crops as labour saving practices for vulnerable households in Babati and Karatu Districts, Northern Tanzania, Report for study on labour saving technologies and practices for farming and household activities in Eastern and Southern Africa, Rome: IFAD and FAO
33 NARO (2002) Study in support of transfer, adoption and dissemination of labour saving technologies in Wakiso and Masaka Districts, Uganda, Rome: FAO Integrated Programme
34 Sones K R, Duveskog D and Minjauw B (Eds) (2003) Farmer Field Schools: the Kenyan experience, Report of the Farmer Field School stakeholders’ forum held 27 March 2003 at ILRI, Nairobi, Nairobi: FAO/KARI/ILRI
35 LinKS website: http://www.fao.org/sd/links/gebio.htm
36 Gari J (2002) Agrobiodiversity strategies to combat food insecurity and HIV/AIDS impact in rural Africa, Advancing grassroots responses for nutrition, health and sustainable livelihoods, Rome: FAO Population and Development Service (http://www.geocities.com/rural_africa/contents.html) and Gari J and Villarreal M (2003) Agrobiodiversity and Indigenous Knowledge in Mitigation of the Consequences of HIV/AIDS, paper presented to HIV/AIDS Mitigation workshop, May, Pretoria, Rome: FAO HIV/AIDS Programme
37 Barnett T and Topouzis D (2003) FAO and HIV/AIDS, Towards a food and livelihood security based strategic response, Rome: FAO HIV/AIDS Programme
38 Address to Congressional Black Caucus (CBC) during its annual legislative conference in Washington, D.C., September 2003.