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1. Introduction

1.1 Overview of youth and HIV/AIDS in Uganda
1.2 Background of mission
1.3 Terms of reference
1.4 The research team
1.5 Methodology
1.6 Acknowledgments

1.1 Overview of youth and HIV/AIDS in Uganda

Uganda is one of the least urbanized countries in Africa, with over 90% of the population living in rural areas. About half the population of the country (8.5 million) is under 15 years of age, according to the 1991 Population and Housing Census, while those under 25 years make up about 67% of the population. Youth, as defined by the government of Uganda, includes boys/girls and young men/women from 10 to 25 years of age.

Agriculture accounts for over 60% of GDP, claims about 98% of export earnings and over 40% of government revenue, according to 1987 figures. Farming is labour-intensive, with 60%-80% of the labour for food and cash crops for household consumption and local markets provided by women.

HIV/AIDS is the most serious health problem in Uganda today and the leading cause of death for adults: About 1.5 million people (10% of the total population and 20% of sexually active men and women) are estimated to be infected with the HIV virus.1 Since 1982 when HIV/AIDS was first recognized in the country, 41,193 cases have been reported. However, according to the Uganda AIDS Commission, this represents only a fraction of the actual number of people infected with HIV due to under-reporting and under-diagnosis.

1 Uganda AIDS Commission Secretariat, Uganda National Operational Plan for HIV/AIDS/STD Prevention. Care and Support. 1994-1998.

According to some estimates, up to one million men and women could become infected with HIV in the next five years as seropositivity rates have been rising by about 25%-30% per year since 1988. The population of Uganda could plunge from 30 to 20 million by the year 2010 as a result of the HIV/AIDS epidemic, it has been argued by some epidemiologists. While estimates of the magnitude of the HIV/AIDS epidemic vary the common denominator of all projections is that the demographic structure of the country is undergoing considerable transformation.

Nearly 80% of those infected with HIV are between the ages of 15 and 45 - the breadwinners and parents of families which have on average more than seven children. AIDS orphans2 are estimated to be in the vicinity of 115,000 and rising, and some experts fear that this figure could increase five-fold in the next five years. War, an increase in children born out of wedlock and the collapse of health services account for the overall rising number of orphans, estimated at between 400,000 and 1,100,000. About 69% of all orphans in Uganda are between 10 and 19 years of age. According to one estimate reported by UNICEF, half the children in Uganda under 15 years will be orphans by the year 2,000.3

2 An orphan in Uganda is a child who has lost one or both parents.

3 UNICEF, Safeguard Youth From AIDS, New Phase of UNICEF Support for AIDS Control Programme in Uganda, April 1992.


1993 Currently living with HIV and AIDS

1998 Projected1 living with HIV and AIDS






0-14 years both sexes





15-19 years both sexes





20 - 49 women





20 - 49 men





50 +

1 68,000









Maternal orphans2




Cumulative deaths 1993-1998





Source: Uganda National Operational Plan for HIV/AIDS/STD Prevention, Care and Support, 1994-1998.

1 Projections f calculated under the assumption that the current level of intervention for prevention is maintained.

2 Cumulative number of children below 15 years who have loft their mother due to AIDS. Some of these will olio have loft their father. Some (not included in the figure) will have lost their father only.

The economic repercussions of the AIDS epidemic at the macro level are already being felt in the public and private sectors. Overhead costs are increasing as a result of rising medical expenditures, absenteeism from work and training of replacements, according to the National Operational Plan for HIV/AIDS/STD Prevention. Care and Support. 1994-1998. The Plan predicts a shift in national investments from long-term to short-term, indicating that investment and productivity in agriculture and industry are endangered. Labour shortage as a result of HIV/AIDS mortality and morbidity may well result in a crisis in the traditionally labour-intensive agricultural system in areas that have been severely hit by HIV/AIDS. National capacity-building efforts may be imperiled and decline in income is expected to affect the balance of payments.

Geographic location, age and gender are key variables in the incidence of HIV/AIDS. Prevalence of HIV varies considerably from district to district. Infection rates are at their highest in urban centres (in the town of Mbarara and the city of Kampala, 24-36% of ante-natal mothers are HIV positive) and in the southern districts of Rakai and Masaka, where more than 12% of the entire population is believed to be infected with HIV.

Age Distribution of Ugandan AIDS Cases

Source: AIDS Control Programme: HIV/AIDS Surveillance Report. December 1992

Age Distribution of Adult AIDS Cases Stratified by Sex

Source: AIDS Control Programme: HIV/AIDS Surveillance Report. December 1992

According to the Uganda AIDS Commission, the vast majority of new infections occur as a result of sexual transmission (84%), followed by perinatal transmission (14%), which are also a result of earlier sexual infection, while other routes of transmission account for only 2% of new infections.

HIV infection increases rapidly between the ages of 11 and 19, especially among girls of 15 to 19 years, who are five times as likely to become infected as boys.4 Girls in the 20-24 age group are twice as likely to be infected as boys. Peak infection occurs between 15 and 24 years, which implies that 15-year-old girls with AIDS are infected before or during puberty. There are 10% more women among the newly infected with HIV than men, largely as a result of women's vulnerability and inequality before the law.

4 UNICEF, SYFA. New Phase of UNICEF Support for AIDS Control in Uganda, April 1992.

Clearly, the need to target rural youths, who are among the most vulnerable groups to HIV/AIDS, is urgent. Prevention of sexual transmission is the main strategy. This is recognized in the 1994-1998 National Operational Plan for HIV/AIDS/STD Prevention. Care and Support of the Uganda AIDS Commission:

"The main emphasis of the Plan will be prevention of HIV-infection through behaviour change, promotion of STD-care and condom use for targeted groups of people with focused educational messages. The promotion of behaviour change will focus not only on the individual behaviour, but will equally focus on the collective behaviours, and the norms and the values of the community." "In order to achieve this," indicates the Plan, "it is necessary to give first priority to children and youth and to start addressing norms and values right from school entry, gradually making it more specific as the child grows." The second priority of the Plan is to address the status and needs of women, including rural women, and the third is to address cultural and traditional customs and specific sites with concentration of risk behaviours.

The Plan identities three age groups for youth: 6-10, 11-14 and 15-20 year olds and indicates-that different approaches need to be developed for each age group. It also recognizes that as less than half the child/youth population is in school, out-of-school youths will be addressed with appropriate approaches.

Gender issues are accorded top priority in the National Operational Plan for HIV/AIDS, given the fact that the pattern of sexual transmission of HIV infection is determined by the social, legal and economic relations between the sexes. Women are identified as a "highly vulnerable group" for the following reasons: a) less than half of the women can read and be reached by written messages; b) rural women do not often participate in discussion and decision fora; c) women do not often receive services from extension or outreach health workers; d) women are economically and socially dependent on men. The Plan also recognizes that customs and socially accepted practices including wife sharing, divorce practices, widow inheritance, polygamy, property inheritance practices and the lack of income-generating opportunities for single women increase their risks and restrict their decision-making status vis-a-vis high risk situations. Rural women are one of two target groups identified by the Plan in urgent need of intervention.

A critical point recognized in the Plan is that while women are targeted as a particularly vulnerable and disadvantaged group, men have a key role to play in interventions designed to reach and benefit women. In particular, it is indicated that "A meaningful decrease in HIV risk in Ugandan society will require changes in male behaviours and attitudes concerning gender relationships and sexuality." In particular, norms, values, practices and relations between men and women create situations and sites (alcohol drinking, visits to bars, discos and social functions) with increased risk of sexual transmission of HIV infection.

Lastly, it is clearly indicated that "prevention activities should be integrated into mainstream health programmes and other programmes dealing with community, women and youth development." HIV/AIDS initiatives are to be decentralized and the RC system will be the key instrument of implementation. According to the Plan, "NGO support will be encouraged to develop activities to reach specific sites and populations, such as: trading centres, make-shift markets, bar girls and prostitutes, etc. and in the areas of home/community based care and support to surviving family members in the form of e.g. income-generating projects."

1.2 Background of mission

TCP/UGA/2256 "Strengthening Programmes for Rural Youth and Young Farmers in Uganda," was designed to a) revitalize the rural youth programme which has been declining over the past two decades and, b) given the magnitude of the HIV/AIDS epidemic in Uganda, to assess the socio-economic impact of HIV/AIDS on rural families and develop the framework for an HIV/AIDS component for the Young Farmers Programme (YFP).

The YFP is a programme for rural youth administered through the Agricultural Extension Service of the Ministry-of Agriculture, Animal Industry and Fisheries (MAAIF). Founded in 1964-with assistance from the-United States Agency for International Development (USAID), the YFP focused on improved agricultural practices, income-generating activities, leadership training and improved farm and home practices. The objectives of the Programme were to create opportunities for young people living in rural areas; increase food/cash crop and livestock production; instill respect for agriculture as a profession; and improve the living conditions and health standards of rural families.

TCP/UGA/2256 is the first initiative that addresses the AIDS epidemic within the MAAIF. It is also the first HIV/AIDS activity of FAO's ESH Division. The findings and recommendations of this constancy could therefore assist in the formulation of policy with regard to HIV/AIDS for FAO's Rural Youth Programme and for the organization as a whole.

The consultancy took place from 2 May to 30 August 1993 and from 15 November to 9 December 1993. During the first two weeks, the consultant and the FAO Associate Professional Officer for Rural Youth gathered documentation on HIV/AIDS and met with the major organizations and institutions dealing with HIV/AIDS in Uganda, including: the Uganda AIDS Commission, the AIDS Control Programme, the World Health Organisation (WHO), the United Nations International Children's Fund (UNICEF), the United Nations Development Programme (UNDP), the World Bank, the United Nations Educational. Science and Culture Organisation (UNESCO), USAID. GTZ, the Child Health and Development Center, YMCA/YWCA, the Virus Research Institute, World Learning and the African Medical and Research Foundation. Next, the field research was designed and pre-tested in Mpigi District. Field work was conducted in Kabarole District (26 May-4 June). Tororo District (8-17 June), and Gulu District (22 June-2 July). Data processing and analysis took place from 5 to 20 July and the first part of the draft report was completed by 6 August and submitted to the FAO Resident Representative. The draft report was revised in Rome from 19 to 29 August, after which it was distributed to staff members for review. The second draft was revised between 15 November and 9 December 1993. A summary of the findings and recommendations was presented during a lunchtime seminar in FAO in December 1993 and in an informal meeting with UNDP, WHO and IFAD in late January 1994 in Rome.

1.3 Terms of reference

a. Review existing literature to assess the impact of HIV/AIDS on farm families, on agricultural production and on response actions at the household level. Through the period of preparation and through the country missions there will be close collaboration with the proposed TSS-1 on "The Impact of HIV/AIDS on Agricultural Production Systems in East Africa (Tanzania. Uganda and Zambia."

b. Cooperate closely with the national AIDS Programme/National AIDS Commission which tries to coordinate the numerous on-going AIDS-related activities in Uganda. He/she will also cooperate with UNDP whose Fifth Country Programme has a strong focus on the socio-economic impact of HIV/AIDS and might be a possible source for financing follow-up projects.

c. Carry out a rapid review and appraise the activities and capacity of NGOs, community based organizations and other institutions in Uganda which are already involved in activities-to mitigate the-socio-economic impact of HIV/AIDS. Determine whether and how linkages can be established to the Young Farmers Programme. Make proposals on if and how these institutions would need to be strengthened in order to provide effective support and training for the YFP.

d. Using rapid rural appraisal and other survey techniques, determine the impact of HIV/AIDS on rural socio-economic systems, with special attention on the target age group (10-15) and evaluate existing coping actions. In this respect, analyze the differential impact of HIV/AIDS on gender and age groups. Determine which responses have the most positive results and determine the importance of organizations at the village, district or national level for the success of coping strategies. Look at the effect of loss of knowledge through the death of professional and skilled labour.

e. Develop together with the CTA and the NPC, the capacity of the Young Farmers Programme to plan, implement, monitor and evaluate effective HIV/AIDS programmes for preventing the infection of young men and women with HIV and for alleviating the impact of HIV/AIDS on agricultural and rural development.5

f. Prepare a mission report, giving his/her findings and conclusions of the field research. There will also be a report analyzing the effect of HIV/AIDS on rural families with special attention to the situation of rural youth.

5 Given changes within the project, this item of the TOR was revised and a general framework for an AIDS component for the youth programme was proposed instead.

1.4 The research team

The research team consisted of the international consultant on HIV/AIDS and field research, the national counterpart on HIV/AIDS and the Associate Professional Officer (APO) from the Rural Youth Programme, ESHE, FAO. In each district, the team worked closely with YFP Field Officers, Subject Matter Specialists on Women and Youth, Agricultural Extension Officers and HIV/AIDS councillors.6

6 In Kabarole, the research team included: Mr. S. Kamba, YFP Field Officer and Ms. Deborah Mouhoumouza, former teacher. In Tororo, the team worked with Mr. Haumbahatagata, YFP Field Officer, Mr. A. Ofono, Agricultural Extensionist, Ms. Helen Onyango, TASO Councillor and Ms. Deborah Musuane, Field Officer. In Gulu, the team comprised Mr. Otto Alli, YFP Field Officer, Ms. Florence Opoka, Gulu Government Hospital AIDS Councillor and Senior Nursing Officer, and Mr. William Odu, AIDS Councillor, Gulu Government Hospital.

1.5 Methodology

1.5.1 Selection criteria:

Kabarole, Tororo and Gulu Districts were selected on the basis of the following criteria:

1. Geographic, agro-ecological, ethnic and linguistic diversity to ensure a representative picture of the country.

2. Low, medium and high HIV/AIDS infection rates and AIDS cases. According to surveillance reports of the Uganda AIDS Commission, Gulu ranks among the highly infected districts, Kabarole among the medium infected districts and Tororo among the districts with a low rate of infection.

During the field work, however, this criterion turned out to be largely irrelevant and inaccurate. Tororo, for instance, is considered to be among the districts with a low rate of HIV infection. This is, however, primarily due to the lack of data and the absence of research activities in the region. The only available data for Tororo concern HIV infection rates from antenatal clinic attendees which stand at about 13.2% in 1992 - a comparatively low figure.7 Part of the reason for the paucity of data is that there is only one NGO, The AIDS Support Organization (TASO), providing assistance with regard to HIV/AIDS in Tororo. A handful other projects have HIV/AIDS components but there is no coordination between them and the Ministry of Health or TASO. TASO has baseline data which have not been compiled or analyzed on a systematic basis.

7 Progress Report on AIDS Control Programme. Ministry of Health, 1.5.-30.9.92.

In terms of the number of reported AIDS cases by district and intensity of population, Gulu has the third largest number of AIDS cases in the country, but this may largely due to Lacor Hospital, which attracts people from many other districts and collects data on a systematic basis. According to this indicator, Kabarole and Tororo are close together in the low to medium category.



Intensity of Reported AIDS Cases per 10,000 of Population







Kampala (highest in the country)


Moyo (lowest in the country)


Source: UNICEF. SYFA, New Phase of UNICEF Support for AIDS Control in Uganda, April 1992.

With regard to the number of orphans in the three districts, Gulu ranks "high". Kabarole ranks "medium" and Tororo "low," as shown in the table below. However these figures can also be misleading: in Gulu, for instance, many of these children are war orphans and not AIDS orphans. Similarly, in Kabarole, many of the orphans are born to unmarried mothers and are not necessarily AIDS victims.



Total Population

Number of Children

Number of Orphans

















Mpigi (highest)





Mbale (lowest)





Source: Ministry of Labour and Social Affairs.

Thus, after carefully considering statistical shortcomings, the difficulties involved in classifying districts according to one indicator, and the complexity of infection patterns within a given region, ranking districts according to "low," "medium," and "high" HIV rates or according to the number of reported AIDS cases ceases to be a valid and useful criterion. It may be more accurate to argue that each district has high, medium and Sow infection rates which vary considerably from one village to another, as the pattern of AIDS can differ radically from one community to another.

3. The third criterion was to conduct field work in districts where little research has already been undertaken, where there are few local and international NGOS active on AIDS, and where the need for intervention is great.8 Virtually no research has been conducted in Gulu, largely due to insecurity and distance from Kampala. Similarly, Tororo, as mentioned-above, has been largely neglected by HIV/AIDS researchers and NGOs. Kabarole has a comprehensive HIV/AIDS Control Programme supported by GTZ, but this has a limited radius at present, focusing mostly on urban centres and along the main road.

4. The fourth criterion was to visit two villages per district, one with an active Young Farmer Society (YFS) and another with an inactive YFS, as YFS were used as entry points for the field work on AIDS. Where possible, one of the two villages was off the main road. In Gulu, however, due to security reasons, both villages had to be chosen close to the town. The team first made a comprehensive assessment of the YFS, evaluating on-going activities, analyzing constraints and identifying ways of reviving youth groups before dealing with the socio-economic impact of HIV/AIDS and Knowledge-Attitude-Practice of youths on HIV/AIDS.

8 We are greatly indebted to Dr. Tom Barton of the Child Health and Development Center for his advice on the selection of the districts and on research methodology.

1.5.2 Procedure

In Kabarole District, the research team briefly visited Kantarara Village, but focused on Nyankuku and Bwabya villages. In Tororo District, field work focused on Kabosa Zone 2 and Bumanda villages, while additional research on HIV/AIDS was also conducted in Kwapa Village which borders Kabosa 2. In Gulu, research focused on Lawiye Adul and Layibi villages.

The first day was spent at the district headquarters, where meetings where held with key district officials, including District Administrators (DA), District Agricultural Officers (DAO), District Medical Officers (DMO), District Education Officers (DEO), Agricultural Assistants (AA), Field Assistants (FAs). NGOs involved in HIV/AIDS activities. Youth Organizers and Field Officers for Young Farmers. These meetings enabled the team to assess YFP activities in the districts and to get an overview of the impact of HIV/AIDS on agriculture, health and rural communities.

On average, the team spent three days in each village and applied Rapid Rural Appraisal and Participatory Rural Appraisal techniques. The first day began with informal talks with the Resistance Council Chairmen (RC1) and YFS leaders and was followed by transects. Focus group discussions with the YFS members focused on constraints, felt needs, reasons for the decline of YFP and lessons learned from the old YFP.

On the second day, focus group discussions on Knowledge-Attitude-Practice (KAP) on HIV/AIDS and sexual behaviour were held with young men and women separately. Assessing risk behaviour, identifying obstacles to behaviour change and identifying strategies and appropriate messages for HIV/AIDS education involving the youths themselves were among the key objectives of these discussions. Focus group discussions developed into participatory HIV/AIDS sensitization fora with lively contributions, question/answer sessions with the researchers and condom demonstrations. In-depth semi-structured individual interviews with HIV/AIDS afflicted and affected families and youths were also conducted, with assistance from TASO or other trained AIDS councilors. Interviews with key informants on the impact of HIV/AIDS on agriculture and farming systems were also undertaken.

The third day included a visit to the local primary school where grade 7 (P7), and on one occasion female P6, pupils completed a questionnaire on HIV/AIDS and sexual behaviour. The number of respondents varied from school to school and from district to district. The KAP school questionnaire was followed by a focus group discussion on HIV/AIDS with the pupils and the teachers separately, a general talk on felt needs of school youths and on the role of the youth programme.

1.6 Acknowledgments

The consultant would like to thank the people from the villages of Nyankuku, Bwabya, Kabosa, Kwapa, Bumanda, Lawiye Adul and Layibi who extended their warm hospitality, generously shared their views with us and made this work possible. District officials, agricultural extension workers, youth leaders, teachers, young men and women and schoolchildren also went out of their way to help us. They are too many to mention by name but their contribution is much appreciated. The consultant would also like to thank the field research team for its commitment and hard work, especially Ms. Helen Onyango, Ms. Florence Opoka, Mr. Andrew Ofono, Ms. Deborah Mouhoumouza, Mr. S. Kamba. A special word of thanks goes to Mr. Gunter Hemrich, FAO APO for Rural Youth, who contributed substantially to all the phases of the field work, led one of the research teams and commented extensively on this report. Last but not least, the consultant would like to thank the FAO Representative in Uganda, Mr. N.L. Lexander for his generous support and assistance and Ms. Elizabeth Reid of UNDP for contributing valuable comments to the draft report.

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