3. The impact of HIV/AIDS on traditional coping mechanisms in rural economies
The economic and social consequences of the disease directly affect the rural family. In the absence of functioning medical care systems in African countries, medical costs and caring for sick family members must be borne entirely by the nuclear family or by the extended family network. In addition to the medical costs, which include the cost of drugs and traditional medical treatment, funeral expenses of family members are a heavy burden on the family budget. Funeral costs appear to be even higher than medical expenses in some settings.
Farmers have developed mechanisms to cope with the impacts of HIV/AIDS on their rural livelihood strategies. Traditionally, in emergency situations caused by natural disasters and in hardship situations, the extended family network has developed successful coping mechanisms, which are still operational in pre-impact and early impact communities. However, the rise of HIV/AIDS related morbidity and mortality in full-impact communities, where the impact of the disease already leads to the breakdown of the nuclear families, the traditional coping mechanisms are strained to the breaking point.
Traditional coping mechanisms are based mainly on returns to labour at the farm and/or family unit. Even the contribution of child labour may be increased (with children, particularly girls, withdrawn from school) as the family struggles to maintain the current cropping patterns. But, as a family becomes more impoverished, it may have little choice but to produce for its own consumption needs. Even then, family nutrition levels could be gradually compromised. It is not uncommon in full-impact districts/communities to observe entire families of children with elderly grandparents as their only form of support.
Since HIV/AIDS is above all a sexually transmitted disease, very often more than one family member is affected and dies. As a result, the entire assets and savings of many families, which are generally meagre before the onset of the disease, may be completely spent, leaving the surviving family members without means of support. A study in Uganda has shown that the burden of the socio-economic impact of HIV/AIDS is disproportionately affecting rural women. In the districts studied, more households were found to be headed by AIDS widows than by AIDS widowers. Widows with dependent children became entrenched in poverty as a result of the socio-economic pressures related to HIV/AIDS. Widows lost access to land, labour, inputs, credit and support services. HIV/AIDS stigmatization compounded their situation further, as assistance from the extended family and the community, their main safety net, was severed. The extent to which malnutrition rates in affected households rises depends on the type of coping mechanisms, household resource constraints, socio-cultural context and emotional stress. As the ability to produce and accumulate food and income decreases, the household falls into a downward spiral of increasing dependency ratios, poorer nutrition and health, increasing expenditure of resources (time and money) on health problems, more food shortages, decreasing household viability, and increasing reliance on support from extended family and the wider community. The effects of HIV/AIDS on rural households, and the likely impact of the disease on farmers' health and the nutrition of farm families, is depicted in Table 1. The complexity of the impact of the disease on agricultural production and household food security requires a multisectoral response that should include agricultural extension, primary health care, education and appropriate non-governmental organizations (NGOs).
Furthermore, it has been observed that the decline in farm income caused by a decline in cropping intensity and livestock production, which is accompanied by an increase in medical expenses and funeral costs, can lead to the breakdown of the nuclear family and the traditional support system. The interlinkages between the increase of HIV/AIDS-related mortality and morbidity, the lack of farm inputs and labour force, the deterioration of household economy and the impact on education, health and the social system, which eventually lead to a breakdown of the traditional coping mechanisms, are presented in Table 2 on page 9.
The Joint United Nations Program me on AIDS (UNAIDS), which is the UN System's main advocate for the global response to the epidemic, is dedicated to preventing the transmission of HIV, reducing the suffering caused by HIV/AIDS, and countering the epidemic's impact on individuals, households, communities and societies. UNAIDS brings together at country level the many and varied technical and operational strengths of its cosponsoring agencies to enhance the quality of assistance to national responses to AIDS. UNAIDS can thus assist in strengthening traditional coping mechanisms by, first of all, ensuring effective and coordinated support by the UN System to the national HIV/AIDS Program me UNAIDS provides technical support, training and monitoring to ensure that all national actors have access to information on international best practices and, in turn, to ensure that their country experiences help shape the global policies and programmes. It is to be noted that UNAIDS does not fund projects except under specific circumstances. UNFPA CSTs, UNFPA Country Representatives, FAO regional, subregional and country offices should collaborate with UNAIDS at regional and country levels to promote a multisectoral response to the epidemic.
Table 1 The impact of HIV/AIDS on the food and nutrition situation of rural households