The HIV/AIDS pandemic
Livestock in Uganda
The impact of HIV/AIDS on the rural household
Livestock in Rakai
Coping mechanisms in the livestock sector
HIV/AIDS and its impact on pastoralists
The impact of HIV/AIDS on the veterinary extension service
Conclusions and recommendations
The author can be contacted at Zensenstrasse 7, D-84508 Burkirchen, Germany.
Since the first AIDS (acquired immune deficiency syndrome) case was recognized in the United States in 1981, the human immunodeficiency virus (HIV) has spread, largely unnoticed in the beginning, throughout the world. The World Health Organization (WHO) estimates that, by mid-1993, 8 million people were HIV-infected in sub-Saharan Africa (Figure 1). Of this total, about one-half to two-thirds were in East and Central Africa, an area that accounts for only about one-sixth of the total population of the sub-Saharan region. It is further estimated that more than 1.5 million AIDS cases have occurred in this region since mid-1993. The current WHO projection is that, by the year 2000, there will be a global cumulative total of 30 million to 40 million HIV-infected men, women and children and a cumulative total of adult AIDS cases of close to 10 million (WHO, 1993). The predominant mode of transmission is heterosexual, therefore more than 90 percent of infected individuals are in their economically most productive years, between the ages of 15 and 49.
Uganda was one of the first countries in sub-Saharan Africa to report its AIDS seroprevalence levels. More than a decade has passed since the first case was identified in this country. Today, approximately 1.5 million Ugandans are estimated to be infected with HIV, out of a population of 17 million. This means the national seroprevalence rate is close to 10 percent. AIDS is now the main cause of death among Ugandan adults and the eighth cause of death for children under five years old (Hunter, Bulirwa and Kisseka, 1993). HIV seroprevalence varies considerably within the country and ranges from 7.5 to 30.2 percent among pregnant women attending antenatal clinics (Uganda AIDS Commission Secretariat, 1993). Although the disease primarily affects urban areas, it has already spread rapidly into rural areas. Some districts of Uganda, such as Rakai and Masaka, have been exposed and devastated by AIDS since its onset, while other districts have barely been affected, for example, Arua and Moyo. In Rakai, approximately 18 percent of all children are already orphaned (at least one parent dead) and this figure is expected to double by 1998 (IFAD/FAO Cooperative Programme, 1994). Infection rates were highest along major transport routes and around trading centres. It is assumed that 30 percent of the child-bearing population in Rakai is HIV-infected (Figure 2).
Livestock products account for 17 percent of the agricultural gross domestic product (GDP) in Uganda. West and southwest Uganda are currently the richest areas in livestock, with about two head of cattle per household, compared with one per household in the rest of the country. Cattle are the most important type of livestock, in numbers and in value. The national cattle herd, which once numbered between 5 million and 5.5 million, was decimated during the 15 years of civil war and disruption from 1972 to 1987. Mixed-farming smallholders and pastoralists own over 90 percent of the national cattle herd (World Bank, 1993b).
Indigenous zebu cattle total some 70 percent of the cattle population, followed by indigenous Sanga (Ankole) with 15 percent and the intermediates - crosses between these two breeds - with 13 percent. Indigenous sheep and goat breeds predominate, as well as indigenous poultry in the traditional sector.
In 1993, FAO undertook a study financed by the United Nations Development Programme (UNDP) to assess the impact of HIV/AIDS on agricultural production systems in Uganda, the United Republic of Tanzania and Zambia. The use of Rapid Rural Appraisal (RRA) techniques generated results that were more qualitative in nature than quantitative (FAO, 1994). This article will highlight the findings of the livestock sector in Rakai District of Uganda. This region has a high adult mortality rate resulting from AIDS, and its impact on rural life is already visible, while in other regions included in this study, the full impact will be felt in approximately two to five years and is still hypothetical.
HIV/AIDS is not only a medical problem, it has social and economic dimensions as well. In most of the countries in sub-Saharan Africa small farmers are not part of a fully operating medical care system. Medical costs associated with caring for the sick and bedridden must be borne by the family, along with the funeral expenses of family members who die of the disease. Besides the costs of drugs and conventional medical treatment, households caring for AIDS patients are often faced with meeting expenses for additional special food to comfort the sick or for items such as extra blankets.
Funeral costs appear to be even higher than medical expenses. A household study carried out by the World Bank in Kagera, United Republic of Tanzania, revealed that on average US$ 60 is spent on an AIDS victim, 60 percent of which goes to funeral expenses and the remaining 40 percent for medical care (World Bank 1993a). This amount is probably close to the annual per caput income in Kagera, which has a similar farming system to that in Rakai District in Uganda. Since AIDS is predominantly a sexually transmitted disease, there is often more than one death in a household. As a result, numerous cases can be observed where a family's entire savings, often meagre before the onset of AIDS, are completely spent, leaving the surviving family members without means
The second serious effect of HIV/AIDS on the farm household is the loss of labour. Rapid population growth has long been considered the greatest problem in Africa. In some rural communities, however, HIV/AIDS is now causing labour shortages for both farm and domestic work. Besides the loss of labour of the AIDS patient through sickness and subsequent death, family members have to set aside time to care for the sick and, in the end, neglect their farm or off-farm activities, with the subsequent loss of potential income. The situation is aggravated in farming systems with labour peaks during certain times of the year and by a marked gender division of labour, which means that with the death of the husband or wife the other party does not necessarily take over the work of the deceased. Labour-intensive farming systems with a low level of mechanization and agricultural input are also particularly vulnerable to the impact of HIV/AIDS. In addition, traditional customs such as the time of mourning, which can last as long as 40 days depending on the importance of the dead family member and when no farming activities can be carried out, can adversely affect labour availability.
In Rakai, livestock is kept by mixed-farm smallholders and pastoralists. Farmers usually have a banana plantation for matooke (the staple cooking banana). Coffee used to be the major cash crop, but it has lost its importance because of low prices and labour constraints. In addition, cassava, sweet potatoes, groundnuts and beans are grown for home consumption as well as for commercial purposes. Vegetables and fruit complement the diet. As a result of the closeness to Lake Victoria, farmers frequently engage in fishing activities.
Approximately 20 percent of the farmers, mostly the richer ones, own some cattle, either Ankole or zebu. Cattle keepers follow the transhumant system: the animals graze and stay in the flat lowlands during the dry season and are driven back to the foothills and common grazing uplands in the wet season, when the lowlands are too wet and often flooded. Cow dung is transported to the fields, particularly to the banana plantations. Villagers also keep goats and occasionally sheep and for some years now small-scale pig rearing has entered the community. Poultry is kept for home consumption to enrich the diet with protein, but it is also sold. Although livestock keeping is not a predominant occupation, the sale of animals and animal products contributes considerably to the generation of extra income for regular and extraordinary expenses, including education and medical care.
Estimated global distribution of cumulative HIV infections in adults, by continent or region, mid-1993 - Estimation de la répartition mondiale des infections VIH cumulées chez les adultes, par continent ou région, à la mi-1993 - Distribución mundial estimada de las infecciones acumuladas del VIH en adultos, por continentes n regiones, a mediados de 1993
Districts in Uganda - Districts ougandais - Distritos de Uganda
Farmers reported that ten years ago they had more livestock than today about 70 percent of all households had cattle. The livestock decline is in line with the findings of the land utilization survey conducted in Rakai and Masaka in 1991. Over the last four years cattle have decreased by 32 percent, goats by 13 and poultry by 11percent (Hunter, Bulirwa and Kisseka, 1993). The reasons for this have been a decline in grazing land because of the resurgence of large ranches and the consequent reduction in size of landholdings. Moreover, animals have been devastated by tick, pest and worm infestations because farmers can no longer afford acaricides and drugs to combat them.
For some years the decline has been worsened by AIDS, especially for the rich cattle owners, who were among the first AIDS victims. People who fall sick usually sell off their cows to meet the costs of medical care and drugs. One farmer reported that he used to own 100 head of cattle but all died of diseases, even before the introduction of AIDS. Later, five of his children contracted AIDS and eventually died. Cattle had to be sold to take care of them and then to pay for their funerals. Now there is not a single cow in the family. The District Veterinary Officer in Rakai cited another example of a farming household that had owned 15 head of cattle. When the parents fell sick, five animals were sold. After the deaths of both parents the children were forced to sell the remaining cattle, one by one, in order to survive.
Even if cattle are not sold during the sickness or after the death of a household member, the remaining family members often do not have the management skills or knowledge to care for the livestock. This was observed especially where the head of the family, usually the man, had died. The wife and children did not have the time nor the knowledge and financial resources to care adequately for the cattle. The wife often did not have the same access to extension services and other ways of acquiring knowledge as her late husband did. As a result, numerous cases were found in the communities under study where cattle had died soon after the death of the head of family. Nowadays, even goats are considered to be too labour demanding. The Box illustrates the story of a typical AIDS-affected household in the community under study.
Farmers have developed mechanisms to cope with the impacts of HIV/AIDS on their rural livelihood strategies. Poultry keeping has increased in AIDS-afflicted households, especially those with orphans. Chickens and eggs are usually not kept for home consumption, but are sold to raise some income.
BOX - The story of Joseph and his family
Joseph, aged 35, and his wife Vincentia, 33, had tour girls and one troy. The current ages of these children are 4 to 12. Joseph had married a second wife who left him when he became sick in 1989. Prior to his illness and death. farm work was mainly done by his first wife.
Joseph was a farmer and a successful petty consumer goods trader in a fishing village, about ten mites away from his home village. He had approximately one acre of land, where he had his new house and banana plantation. The family used to borrow tend and plant cassava, sweet potatoes and groundnuts. They owned five cows and it was Joseph's responsibility to transfer the cow dung from the cattle kraal to the banana plantation to maintain soil fertility. Joseph's plans were to buy and cultivate more land.
However, these plans were abandoned when Joseph started having multiple illnesses in 1989 and was bedridden for several months in 1991. During this time, his wife had to abandon the field she had ploughed for groundnuts so as to be able to look after her sick husband. Joseph was no longer able to transport the cow dung. Therefore the yield of the banana plantation started slowly to decline because of lost fertility. Joseph finally died of AIDS in 1991.
In June 1992, Vincentia fell seriously ill and was bedridden for three months. During her sickness the banana plantation and cassava/sweet potato fields gradually turned from weeds to bush. By the time of her death in October 1992, all fields and the plantation were covered and the children had to eat the leftover cassava and sweet potatoes. Nobody cared for the cows and when they became sick, there was no money to buy drugs. All the cattle died.
Currently, Joseph's 27-year-old brother is trying to reclaim the former banana plantation from the bush and weeds. He has also started to keep pigs and chickens on his late brother's land. He also would like to keep cattle, but lacks the capital to start. Joseph's two eldest children are staying with him, while the three younger ones are cared for by their maternal grandmother, who is herself of advanced age and suffers ill health
Previously, the free-range system of rearing chickens did not allow farmers to keep many of them at one time since the chickens would scratch at the mulch used on banana plantations in addition to damaging the beans grown on the plantation. This generated serious conflicts where a neighbour's plantation was involved. Most households, therefore, would own only three to five chickens. Today, however, the banana plantations are no longer mulched because of lack of labour, and chickens can roam freely. AIDS has also had a negative impact on poultry. Wild cats are the main predators of chickens, and their numbers are on the rise because of the considerable number of plantations and fields turning to bush as a result of a lack of people to take care of them.
Pig rearing is another activity new to the community. Widows, especially, started this income-generating activity (50 percent are widows of AIDS victims). Pigs are less labour demanding and the current market price is satisfactory. Since farmers are gradually substituting the production of matooke with that of cassava and sweet potatoes, they have enough feed for one to three pigs. Most farmers still lack marketing experience, however.
As a new income-generating activity, farmers have shown keen interest in taking up beekeeping, especially the male youths. Honey, a non-traditional export product of Uganda, requires limited labour input and currently enjoys good prices.
Pastoralists in Rakai, the Bahima, are affected by HIV/AIDS in the same way as the mixed farmers are. The Bahima have close relationships with the crop farmers and practice cultural traditions that favour the spread of HIV/AIDS; for example, several brothers may share one wife.
Also with pastoral farming, there has been a tendency for herd sizes to diminish. One of the reasons for this was an outbreak of the serious disease contagious bovine pleuropneumonia, another was the introduction of HIV/AIDS. Like mixed farmers, pastoralists also sell their animals when they fall ill to pay for drugs and hospitalization.
In the district of Rakai, HIV/AIDS has also had a marked impact on the local extension service. Between 20 and 50 percent of working time is lost because of the disease. Extension workers are often absent from work to attend funerals and care for sick relatives. At the same time, several staff members from all levels have contracted the disease and some have died. The problem was compounded by the fact that it is difficult to find trained people to replace former staff, both because the area is remote and also because it has the reputation of being a highly HIV/AIDS-affected area.
The epidemic has also made it more difficult for extension staff to meet the farmers; if a meeting should coincide with a funeral, the meeting has to be rescheduled. As there were as many as ten to 15 deaths a month in the community, such meetings were difficult to organize.
Extension messages will have to be revised to take into account the impact of the disease on agricultural systems. Extension packages appropriate for families with plenty of labour might not be suitable for households where several adults have died. Special target groups such as widows and orphans will have to be paid special attention.
One of the more positive effects of the HIV/AIDS epidemic, according to the District Veterinary Officer in Rakai, is that it makes farmers more receptive to innovations and more willing to organize themselves in groups. Some self-help groups have been formed spontaneously and some under the aegis of a non-governmental organization (NGO). The members pool their knowledge and give each other confidence and support in undertaking on-farm as well as income-generating activities. Such activities range from common field preparation to vegetable growing, from pig and poultry raising and beekeeping to brick making, carpentry and tailoring Widows and youths both male and female, are especially interested in being organized into groups.
HIV/AIDS is a serious threat to household food security. The fact that people are forced to sell their assets for AIDS-related reasons leads to impoverishment of households and a decline in the standard of living. Farmers tend to sell their large livestock and concentrate on the smaller animals. Even if they keep small livestock, it is not used for home consumption but sold to raise a little cash, and as a consequence their nutritional status declines. The use of cow dung as organic fertilizer has been largely abandoned because of the lack of cattle and labour, which has had a serious effect on soil fertility. The decline of livestock has also had an effect on education, since livestock used to be sold to pay for school fees.
The main burden falls on the labour economy of the household. This has considerable implications for targeting assistance at women, children and, in some cases, widowed men who are raising children. Policy responses should integrate all aspects of poverty relief, domestic and farm labour, educational needs of orphans and other young people, food security and income -generation.
Communities and households have developed their own coping mechanisms, which could be expanded. Some of the accumulated information should be documented and members of experienced" communities should be encouraged to share their experiences with others who are at the beginning of the coping process or those who have not yet been affected. This sharing could be achieved through the extension services, but also by facilitating direct communication between members of different communities.
Adequate HIV/AIDS-impact training programmes at all levels should be developed to include:
· general training in HIV/AIDS-impact issues for politicians and departmental heads;
· extension messages containing explicit HIV/AIDS components that should include both general HIV/AIDS advice and education, as well as sensitization to the known impacts of HIV/AIDS on agricultural production;
· labour-saving strategies should be developed and disseminated with the active participation of the rural communities through extension services, research stations and NGOs;
· community-based participatory analysis of the situation and needs in specific communities;
· promotion of animal breeds that require limited attention;
· pig keeping may be encouraged as a labour-economizing replacement for cattle, having advantages both as a source of cash and of protein, which may be particularly beneficial for female-headed households;
· poultry keeping may be encouraged especially for orphans to raise some cash;
· promotion of non-traditional livestock activities, such as beekeeping (apiary).
Still, not enough is known about the impact of HIV/AIDS on the livestock sector. It would be desirable if more research could be carried out in different countries with different farming systems, particularly on systems where livestock plays a bigger role than in the one described above. Also, not very much is known about the effects of HIV/AIDS on the local market economy. Does the sale of cattle because of AIDS affect the price of meat? It has been said that the decline in cattle is welcome since it would solve the problem of overgrazing. Is this true? The effect of the epidemic on pastoral systems is the least researched subject to date; pastoralists are often marginalized in other aspects as well. Priority for future work on HIV/AIDS impact should therefore be given to this group.
FAO. 1994. The effects of HIV/AIDS on farming systems and rural livelihoods in Uganda, Tanzania and Zambia. Consultancy report prepared by Tony Barnett. Rome, FAO.
Hunter, S., Bulirwa, E. & Kisseka, E. 1993. AIDS and agricultural production: report of a land utilization survey, Masaka and Rakai districts of Uganda. Draft submitted in Land Use Policy.
IFAD/FAO Cooperative Programme. 1994. Project brief: Uweso support programme. IFAD/BSF fact-finding mission, January 1994. Rome, FAO.
Uganda AIDS Commission Secretariat. 1993. Uganda national operational plan for HIV/AIDS/STD prevention, care and support 1994-1998.
WHO. 1993. The HIV/AIDS pandemic: 1993 overview, global programme on AIDS. Geneva, Switzerland, WHO.
World Bank. 1993a. The economic impact of fatal adult illness in sub-Saharan Africa. Bukoba, Kagera Region, Tanzania, 16-20 September 1992. Washington, DC, USA.
World Bank. 1993b. Uganda. Agricultural sector memorandum vol. II, March 1993. Washington, DC, USA.
Poster prepared as part of the Uganda school health kit on AIDS control by Ministry of Education, Ministry of Health (AIDS Control Programme), UNICEF, Kampala - Affiche destinée à faire partie de la documentation pédagogique la lutte contre le SIDA, réalisée par le Ministère de l'éducation, le Ministère de la santé (Programme de lutte contre le SIDA) et l'UNICEF à Kampala - Cartel preparado, como parte de la carpeta de salud escolar de Uganda sobre la lucha contra el SIDA, por el Ministerio de Educación, el Ministerio de Salud (Programa de Lucha contra el SIDA) y UNICEF Kampala