Recent data suggest that the HIV/AIDS epidemic is continuing to evolve. It is estimated that over 90 percent of the close to 30 million people who are thought to have been infected worldwide with the virus since the start of the epidemic live in developing countries. With around 14 million HIV-infected adults and children as of late 1996, sub-Saharan Africa is the region hardest hit. This represents around 65 percent of the world total. Of the 8 500 new infections that occur daily worldwide, 50 percent are in sub-Saharan Africa. It is estimated that around 5 million adults and 1.4 million children worldwide have already died since the start of the global epidemic. (For the end 1996 global estimates, see Annex I.)
In each country the details of the epidemic vary, having its own distinct origin, geographic patterns of dispersion and particular population subgroups affected. At present, reliable comprehensive statistics for HIV/AIDS infections do not exist; however, those that do exist are alarming. If the current epidemic trends continue through the end of this decade, it is estimated that between 30 and 40 million adults will have been infected with HIV by the year 2000. Of these, about 60 percent will be in sub-Saharan Africa.
Over 50 percent of new HIV infections occur in women. This is alarming since women carry the main burden of care of family members with HIV/AIDS. In countries where young people account for 60 percent of all new infections, infected young women outnumber their infected male peers by a ratio of 2 to 1. UNAIDS estimates that close to 8 million women in sub-Saharan Africa (out of 10 million women infected worldwide) are HIV-positive.
HIV/AIDS is no longer restricted to cities. The disease is now spreading with alarming speed into rural areas and affects the farming population, especially people in their most productive years (ages 15 to 45). However, there is also some evidence of stabilization in HIV infection rates in certain areas of East and Central Africa. In one rural district of southwest Uganda, the percentage of those aged 13 and above acquiring HIV infection each year declined from 7.5 percent in 1989-1990 to 4.5 percent in 1993. This is attributed to success in changing sexual behaviour.
Although interrelations between the epidemic and overall development have been acknowledged, the linkages to agriculture have received less attention because the epidemic was perceived as being largely urban. The existing evidence of the spread of the epidemic to rural areas was often overlooked because of poor data, the irregular patterns of spread and lower prevalence than in urban areas. A lesson that should be drawn from this epidemic of global dimension is that technical assistance agencies, including FAO, should combine their efforts to improve the existing mitigation and prevention strategies to manage the impact of the epidemic on agricultural production and food security and combat the disease in rural areas.
While prime concern was aimed at eastern Africa in assessing the socio-economic impact of HIV/AIDS on rural households and their production systems, little is known about the impact of the epidemic on agriculture and rural societies in West Africa. FAO is currently carrying out a UNDP-funded TSS-1 project "The Effect of HIV/AIDS on Agricultural Production Systems and Rural Livelihoods in Western Africa (Côte d'Ivoire, Burkina Faso)" which focuses on the pastoral population, rural migrants, nutritional implications, etc.
A previous paper, "The Impact of the HIV/AIDS Epidemic on Agricultural Production and Productivity and the Role of Extension Services in Combating the Disease in Rural Areas (Especially in Africa)", explores the impact of the HIV/AIDS epidemic on agricultural production systems and highlights the consequences for agricultural extension programmes in rural areas affected by the disease. The present paper follows up on the issues presented in the previous paper and focuses on the impact of the epidemic on rural households/communities and the need for immediate, medium-term and long-term strategies to control and combat the disease and to mitigate its consequences in rural areas.
For this purpose, selected study findings on the impact of HIV/AIDS on agricultural production systems and rural household food security will be reiterated and fundamental problems and major challenges for agricultural extension, including HIV/AIDS-related farmer education and training programmes, will be highlighted. In addition, possible directions and actions to strengthen agricultural extension programmes are proposed, especially with regard to farmer education and training activities.
The immediate and medium-term response of agricultural extension programmes to the effects of the HIV/AIDS epidemic could focus on a reorientation of extension programmes with an emphasis on problem-solving activities for affected households and communities (focusing on training and extension activities for women, orphans and youth) and on the initiation of collective efforts to strengthen community and group organization in support of traditional coping mechanisms to mitigate the effect of the disease. In addition, systematic, location-specific surveys could collect relevant information on the actual impact of the disease on rural households and extension programmes.
A long-term strategy to strengthen extension programmes in countries affected by HIV/AIDS could include a systematic approach to improve research inputs for the development of less labour-intensive crops and production methods. Furthermore, priority should be given to the integration of gender issues into extension programmes and an effort made to improve women's participation in extension activities. In addition, assistance (including appropriate legal support for HIV/AIDS widows) could be provided to vulnerable groups/communities through multidisciplinary HIV/AIDS programmes. Ministries of agriculture and their outreach programmes will have to play a key role in addressing the special needs of rural households/communities in such multidisciplinary HIV/AIDS programmes, which could be launched as integral part of a poverty alleviation Program me in HIV/AIDS-affected areas.