Communication Knowledge

April 2001

Strategic approaches to HIV prevention and AIDS mitigation in rural communities and households in Sub-Saharan Africa

Part 2

1 2 3 4

1. Introduction

1.1. The silent epidemic

"Indeed, the stigma surrounding AIDS serves some governments quite well. As long as their voters are in denial about the epidemic, they will not raise their voices to demand responsible action, including the provision of basic services for affected individuals and families."
Pisani, 1999

In December 1999, the AIDS Epidemic Update stated that the overwhelming majority of people with HIV live in the developing world, a proportion of the population that is set to grow even further as 15,000 people are infected every day. Poverty, crumbling and under-resourced health infrastructures and the limited resources invested in prevention and care, fuel the spread of the deadly virus.

Today, nearly 34 million people are living with HIV/AIDS and one third of them are young people between the ages of 10 and 24. Of the 34 million, 70% are in Africa. The World Health Organisation and the United Nations Joint Programme on HIV/AIDS estimate that the African continent hosts some 23.3 million people living with HIV. By the end of the year 2000, 13 million children (of whom 10.4 of them are under 15) will have lost their mother or both parents to AIDS. The World Bank states that Southern Africa is hardest hit, especially Zimbabwe with up to 50% of pregnant women being infected. Similarly, in Botswana, Namibia and Zambia prevalence rates among pregnant women are 20-40 %.

These figures speak for themselves. There is no need for translation. Yet, the silence persists. Infections are on the rise. People continue to die.

With the exception of leaders in Uganda and Senegal, most leaders in Eastern and Southern Africa kept their eyes well shut until HIV "established a firm grip on their populations" (SAfAIDS: Pisani 199913 ). Last year the continent lost over 2 million people to the disease. Four burials every minute!

The figures cited above are not a secret. They appear on news releases, policy documents, articles in medical and development journals, project documents, teaching aids, prevention campaigns, on television, yet the silence surrounding the epidemic persists. Clearly, the disease still carries a strong stigma even though the official silence seems to be breaking slowly. The presidents of Zimbabwe and Kenya are calling AIDS an urgent problem. Botswana, Namibia and Swaziland have announced new anti-AIDS initiatives. Perhaps one of the most important breakthroughs will be the XIII International Conference on AIDS to be held in Durban, South Africa in July 2000: an event that hopefully will shake up, if not break, the conspiracy of silence.

Breaking the silence is definitely one of the first steps that will need to be taken. Like any other problem, AIDS cannot be dealt with effectively if it cannot be talked about.

1.2. AIDS: a threat to development?

"If rural society is seen as having a living organism, the systemic impact of HIV/AIDS can be depicted as a series of attacks on its immune system, leading to a host of chain reactions as the society and its various organs try to fight back and adjust."
(Topouzis 1998:16)

The impact14 of the HIV/AIDS epidemic on development, agriculture and food security is by no means clear-cut but rather multi-dimensional, multi-faceted, multi-sectoral and thus quite complex. A number of studies undertaken by FAO (1994; 1995; 1998) in Eastern and Western Africa have shown that AIDS follows a different pattern in each village and district. The extent and nature of impact will depend on a wide range of factors including: the number of people infected, the rate at which the epidemic moves, the rate at which it is transmitted, the socio-cultural and economic location of those infected, agro-ecological conditions, the livelihood strategies in place, ethnicity, religion, gender, age and marriage customs. All these factors can play a decisive role in determining the nature, pattern and extent of the impact of HIV/AIDS.

The consequences of HIV/AIDS are closely associated with wider challenges to development such as poverty, food and livelihood security and gender inequality and this makes it quite difficult to separate its impact from the general deterioration in economic and social conditions in many parts of Africa. One certainty is that the high mortality due to AIDS tends to eliminate or reverse development gains and thus place huge burdens on social support systems. Furthermore, many countries that host a high HIV prevalence rate also suffer from indifference from the authorities, corruption, unrest and conflict and although the contribution of AIDS to this already destabilised status quo is hard to pinpoint experience from the front line has shown that AIDS exacerbates this already precarious situation especially at the household and community level.

On the other hand, vulnerability to poverty, food and livelihood security has a catalytic effect on vulnerability to HIV. The equation seems simple: poverty exacerbates AIDS and AIDS exacerbates poverty.

Although we have acknowledged that the impacts of AIDS are heterogeneous and changing over time, there are several impacts that have been observed in the research literature (Topouzis 1998:6). These state that HIV/AIDS will:

FAO (Barnett: 1994; Hemrich: 1995; 1997; Topouzis: 1998) has confirmed that the impact of AIDS on the economy at the macro level will be felt through its effect on two key factors of economic activity: labour and capital. It will affect the age, gender, size, composition and productivity of the labour force and will have negative consequences for capital formation, both physical and human. The impact of AIDS on development is felt most at the micro-level, namely the household and community where one of the main consequences of AIDS is a high change, or loss, in wealth.

Not only is the AIDS epidemic a human tragedy but it can severely impact on achievements in rural development and the economy of whole regions.

Impact on various segments of society:

In areas heavily affected by HIV/AIDS the catalytic effects and systemic impact of the epidemic on rural development, may either amplify existing development problems or create new ones. The list below examines both the causes of HIV and the consequences of AIDS. The reason they are grouped together is because they are difficult to disconnect.

National income. An increase in adult mortality (25% in some countries) will inevitably impact on national productivity and earnings and thus a possible decline in Gross Domestic Production or Gross Geographic Production. AIDS would affect the macro-economy by reducing the number of productive people in a nation and diverting resources from investment to care. Loss of human capital will affect production and quality of life inexorably putting the security of the food supply of the population at risk.

Commercial agriculture. This is the largest sector and backbone of most African economies accounting for a large portion of production and employing the majority of workers. Most countries affected by HIV/AIDS are heavily reliant on agriculture and agricultural exports. Commercial agriculture and non-agricultural firms are experiencing declines in productivity due to absenteeism, losses of trained workers and increases in benefit expenses. Indeed, HIV/AIDS is also likely to increase the costs in commercial agriculture, as demonstrated by an FAO study conducted in Kenya (Rugalema, Weigang & Mbwika FAO: 1999) by leading to an increase in expenditures and a decrease in revenues of commercial companies mainly due to high rate of absenteeism caused by HIV/AIDS morbidity and mortality.

Sustainable agriculture and rural development. HIV/AIDS is a threat to sustainable agriculture and rural development through its systemic impact. Smallholder agriculture is a vital sector for rural households and national economies in many developing countries. HIV/AIDS is affecting agricultural production through:

Zimbabwe: How AIDS undermines the sustainability of the agricultural sector

In Zimbabwe, communal agriculture output has over the past five years been slashed by a staggering 50%, largely due to HIV/AIDS, according to a recent report (Report of the Regional Conference for Eastern and Southern Africa on Responding to HIV/AIDS Technology Development Needs of Smallholder Agriculture, Harare, June 8-10, 1998, p.2) Maize, cotton and sunflower yields have been particularly affected. Maize production, which amounts to over 4 million tons, has been marked by a decline of 54% of harvested quantity and a further drop of 61% in marketed output. The total area under cultivation for this crop has been greatly reduced as well. Cotton hectarage has decreased by about 34%, marketed output by a further decline of 40%.

Source: Sustainable Agricultural/Rural Development and Vulnerability to the AIDS Epidemic by Jacques du Guerny & Daphne Topouzis, 1999, p.16, FAO/UNAIDS

Education. AIDS is reducing hard won gains in education. Both students and teachers are dying or leaving school for economic reasons because of illness or to care for a sick relative. When teachers and learners get ill or die, schools suffer disruption, loss and sorrow. Over 30% of teachers in Malawi and Zambia are already infected (UNAIDS 1998). AIDS will affect the demand for education because (i) there will be fewer children to educate, (ii) fewer children will be able to afford the costs of education, (iii) and for socio-economic reasons they will have to drop out of school without completing the normal primary school cycle. AIDS will also affect the process, content, role and resources of education.

The impact of HIV/AIDS on the Education System

Health sector. The health sector in many African countries is already stressed beyond its limits. Facing difficulties to cure malaria or diarrhoea, it is not difficult to imagine how hard it is to meet the needs of AIDS patients. Treating an AIDS patient for one year is almost as expensive as the education of 10 primary school students for one year. Recently at a Meeting between African Health Ministers, Peter Piot, Executive Director of the Joint United Nations Programme on HIV/AIDS said: "HIV does to society what it does to the human body. It undermines the very institutions that are meant to defend society-its teachers, its doctors." (7 May 2000)

Labour/work. A recent study conducted by the International Labour Office (ILO) warns of catastrophic consequences of HIV/AIDS for workers and employers worldwide. The study indicates that sub-Saharan Africa is the worst affected area. In Botswana, Kenya, Malawi, Mozambique, Namibia, South Africa, Uganda and Zimbabwe where the adult HIV prevalence rate is higher than 10%, the ILO estimated that the labour force in the year 2020 will be 10 to 22% smaller (or 11.5 million fewer people) than it would have been without HIV/AIDS. The report also states that HIV/AIDS will have a significant impact on the composition and size of the labour force in those countries in terms of gender, skills, age and experience while at the same time engendering more child labour.15

From adult- to orphan-headed households. AIDS has the capacity to drastically reduce households' coping capacity. As households are confronted with an increase in adult deaths or illness due to HIV/AIDS, they experience a reduction in productivity and an increase in expenditures (health care, burial fees).16 One of the main consequences of these changes in wealth is that it alters household composition and size as well as change adult and child roles. AIDS-affected parents are unable to care for their children and no longer able to guarantee a secure livelihood for their family. This is often reflected by quantitative and qualitative food deficit, modification of the staple diet, lack of diversity. Children are taken out of school to care for the sick and to meet the increased demands of labour. In fact, one of the most alarming consequences of AIDS is the alarming increase in orphan-headed households. These children are unlikely to attend school, and likely to be undernourished, poor and end up on the streets where they will be forced to pursue survival strategies that put them at great risk of contracting HIV themselves. (USAID 1997)

Migration: cause or effect? Poverty is an important determinant in this epidemic, forcing people to migrate away from their families to find employment or into sex work for survival, which places them at high risk of HIV infection. In most African countries, large concentrations of men are separated from their families to work in mining, commercial agriculture and other industries. This phenomenon contributes to the spread of the disease as men seek alternative forms of entertainment (e.g.: commercial sex workers) that put themselves, and their partners, at risk of contracting HIV.

AIDS and women. A study conducted in Uganda (Topouzis 1993:14) demonstrated that the burden of the socio-economic impact of HIV/AIDS disproportionately affected rural women. Widows with dependent children were immersed in poverty as a result of the socio-economic pressures related to HIV/AIDS. Widows, lose access to land, labour, inputs, credit and support services. Totally destitute, at times their only survival strategy can turn out to be dangerously unsafe.

Similarly, the number of adolescent girls taking over the household is increasing steadily. As parents die, children and elderly are forced to take over the reins of impoverished already households who often lack the means (labour and capital) to maintain the livelihood system. Adolescent girls have an important role to play in maintaining the livelihood of the household. They take over the role of mother, carry out domestic chores, work the land, take care of the crops, prepare food, engage in income-generating activities and care for the sick and small children.

Teenage infections on the rise. Facing a double burden, more and more girls and young women, with little or no prospects of work, are exchanging sex for schooling and some type of job or a roof over their heads. A series of community-based studies conducted in sub-Saharan Africa have shown that alarmingly high proportions of girls are infected with HIV during their teens and before marriage. Most of them are infected by older men (sugar daddies) who admit to preferring young girls for sex because they believe they are less likely to be infected with HIV or STDs.

Potential impacts of AIDS on the household and community

Impacts of AIDS on families

Impacts of AIDS on children (and adults)

Impacts of AIDS on community

Loss of members, grief

Loss of family and identity

Reduced labour

Impoverishment

Reduced well-being

Increased poverty

Change in family composition and in adult and child roles

Increased malnutrition, starvation

Inability to maintain infrastructure

Loss of labour

Failure to immunise or provide health care

Loss of skilled labour, including health workers and teachers

Forced migration

Loss of health status

Loss of agricultural inputs and labour

Dissolution

Increased demands of labour

Reduced access to health care

Stress

Loss of schooling and educational opportunities

Elevated morbidity and mortality

Inability to parent and care for children

Loss of inheritance (assets and land)

Inability to marshal resources for community-wide funding schemes or insurance

Loss of income for medical care and education

Forced migration

 

Number of multigenerational households lacking in middle generation will increase

Increased street living

 
 

Exposure to HIV infection

 

Source: adapted from Hunter and Williamson (1997) cited in UNAIDS Best Practice Collection Key Material (June 1999)

1.3. HIV/AIDS, agriculture and food security

The impact of HIV/AIDS on agriculture and food security is multi-dimensional, multi-faceted and quite complex. Many factors such as the type of agro-ecological zone, the household and community coping capacity, and the presence of off-farm income will determine the degree and nature of the impact.17 HIV/AIDS begins by attacking the quality and quantity of labour, in terms of productivity and later in terms of the supply, both of the infected person and of their caretakers.

Households adopt a wide variety of strategies to mitigate the effects of HIV/AIDS. They can be divided into three basic categories: (1) strategies aimed at maintaining food security; (2) strategies aimed at alleviating the loss of labour; and (3) strategies aimed at supplementing income. (UNAIDS: Mutangadure, Mukurazita & Jackson 1999)

The strategies aimed at reducing food insecurity and those to alleviate loss of labour are practically intertwined. FAO ( 1994, 1995, 1997 ) and UNAIDS (1999a) outline the following:

In turn, the strategies aimed at reducing food insecurity lead to the following:

Over time, the combination of these factors leads to household food insecurity and consequently to malnutrition. Finally the strategies aimed at supplementing and/or raising income include:

The literature on household coping strategies suggests that households go through "processes of experimentation and adaptation as they attempt to cope with immediate and long-term demographic changes"( Mutangadura, Mukurazita & Jackson UNAIDS 1999). This is mainly due to the fact that the impact of AIDS in Africa can be described as a long wave and unpredictable disaster. Donahue (1998) describes "three stages in loss management strategies" beginning with the reversible mechanisms and disposal of self-insuring assets to the disposal of productive assets and finally destitution.

The impacts of AIDS on agriculture and those on food security are not separate phenomena (although they have been divided for analytical purposes). The problems are entirely intertwined. The combination of a decline in food production, the sale of food reserves, a diminished source of income and an overall increase in expenditures cause food shortages, long-term nutritional deficiencies and thus contribute to a state of increased poverty.

1.4. The impact on rural institutions

The sickness and death of working adults affect the labour supply and its division between adults and children as well as between men and women. AIDS is thus a challenge to all agricultural institutions, both at central and local levels. The epidemic may have an important impact on formal and informal rural institutions by impoverishing affected clients, eroding the capacity of rural institutions through losses in human resources and disrupting the smooth operation of rural institutions by severing key linkages in the organisational and/or production chain. (Topouzis 1998)

The effects of HIV/AIDS on rural institutions may create a crisis of unprecedented proportions particularly among the extended family and kinship systems who in times of crisis become entirely dependent on them for support and assistance in coping with the various impacts. This creates a strong demand for capacity building and crisis management training of those institutions that operate on the front line. These institutions need to reassess their mode of operation to be able to respond effectively to the rapidly changing needs of rural populations.

Extension

A joint FAO/UNDP Paper (Topouzis 1998) highlights the urgency and need for formal and informal institutions to respond to the challenges posed by the epidemic by modifying their approaches and methodologies in order to make them more relevant to the needs of rural populations.

There is mounting evidence that (1) the capacity of the public extension organisations for delivering satisfactory services is being affected by HIV/AIDS due to an increase of HIV/AIDS-related morbidity and mortality, (2) the clientele demanding extension services is changing rapidly from healthy middle aged men to sick middle ages men, to women, to children and teenagers and at times even to the elderly, (3) farmers are beginning to rely on extension workers as a source of HIV/AIDS-related information, and, (4) that extension services are linked to many other institutions and organisations providing credit, technical packages, marketing facilities which will also be affected in their operations due to the effect of HIV/AIDS on the farming population.

Given this new reality, FAO has decided to undertake a study in Malawi and Zimbabwe to assess the impact of HIV/AIDS on organisations and institutions engaged in the delivery of rural and agricultural support services.

On the other hand it is essential to note that the programmes of rural institutions may have a positive or negative effect on the HIV epidemic (i.e. by enhancing mobility and strengthening urban-rural linkages) and consequently the programmes and policies will need to be revised. (This will be discussed in more detail in the next chapter)

1.5. The implications of HIV/AIDS for FAO programmes and projects

Rising mortality and morbidity as a result of HIV/AIDS are likely to have an impact on project performance since health is a necessary precondition for development. One of the most serious threats to any project is absenteeism on the part of both beneficiaries and project and extension staff, which can be caused by mortality and morbidity, funeral attendance, respect for traditional mourning practices, etc. Absenteeism from project activities may set back the progress of projects in countries severely affected by the disease.

Rural development programmes may in turn indirectly contribute to the spread of the epidemic by displacing farmers and stimulating labour migration, encouraging migration, increasing disposable incomes of male workers and exacerbating gender disparities. (Topouzis 1998)

Although this is not commonly accepted or acknowledged, there is a pending need to quantitatively measure this impact in order to adjust programs and activities and better cater to the changing needs and demands of the new clientele (who are no longer the healthy fit middle aged male but more often ill and weak middle aged men, women, adolescents, children and elderly).

In the past, conventional rural development policies and programmes were characterised mainly by a series of technical transfers targeted at medium to large scale producers and aimed at boosting production and generating wealth. Today, this practice can no longer hold its grip. Not only because the overall development discourses have changed over time but also because in the case of the development emergency triggered by the impact of AIDS, there is an urgent need for reviewing the conventional approach both in terms of whose needs should be catered to but also in terms of the content of the interventions.

In conclusion, the adverse impact of HIV/AIDS on household food security and agriculture through loss of labour and additional expenses appear to be a critical link between FAO's mandate and the epidemic.

Box 2: The Cost of HIV/AIDS for Development Programmes

The costs of HIV/AIDS for development programmes include:

  • HIV absenteeism
  • AIDS absenteeism
  • Health care costs
  • Recruitment costs
  • Burial costs
  • Training costs
  • Labour turnover
  • Funeral attendance
  • Productivity loss after training
  • Loss of knowledge, skills and experience


Source: The implications of HIV/AIDS for rural development policy and programming: focus on sub-Saharan Africa, a joint UNDP/FAO publication by D.Topouzis

2. Preventing and mitigating HIV/AIDS19

"As the technical implications cut across the responsibility of various FAO units, such as Agricultural Services, Investment, Research and Extension, Fisheries, Women in Development, operational modalities for the implementation of cross-sectoral programmes such as HIV/AIDS-related household food security programmes would need to be developed."
Hemrich 1995

A developmental rather than an AIDS-specific focus is critical to tackling the multi-sectoral complexity of the epidemic and its systemic impact 20 and to ensuring the sustainability of both HIV/AIDS responses and rural development efforts. It is no longer possible to control the spread of AIDS through traditional sectoral thinking; what is needed instead is a multi-sectoral, multi-dimensional and multi-disciplinary approach which is put into practice both at the community and national levels.

Given the wide range of HIV/AIDS situations in place and over time, and the unpredictable and often rapid course of the epidemic, planning effective national responses calls for approaches that are able to take into account the unique dynamics of HIV. Since the socio-economic burden is felt first by the households of those stricken, the first line of response should be to mitigate the impact on those households by improving their coping capacity. Programme interventions should therefore (1) assist households in both reducing their exposure to economic risk and improving their ability to cope once a loss has occurred, and (2) strengthen and build the capacity of community-based safety nets and support groups. The overall emphasis thus being on helping households avoid jeopardising long-term survival to meet short-term needs.

Communication can play an essential role in all of the activities proposed since it can be used for (1) fostering people's participation and community mobilisation, (2) sharing knowledge and changing attitudes, behaviour and lifestyles, (3) improving learning and training and rapidly spreading information, (4) better planning and programme formulation, and (5) fostering the support of decision-makers.

The activities proposed for communication, mitigation and support should not be considered mutually exclusive; they have only been separated to facilitate analysis and comprehension. In order to avoid adopting a sectoral approach, the idea presented here is that most prevention and mitigation activities and programmes should ideally go hand in hand regardless of the prevalence rate.

FAO has the strategic and comparative advantage to be active both at the prevention and mitigation level. HIV/AIDS has a significant impact on food production and security and therefore the question now is: What can FAO do?

2.1. Communication for prevention and mitigation

"Communication for development is the use of communication processes, techniques and media to help people towards a full awareness of their situation and their options for change, to resolve conflicts, to help people plan actions for change and sustainable development, to help people acquire the knowledge and skills they need to improve their condition and that of society, and to improve the effectiveness of institutions." (Restrepo-Estrada & Fraser 1998:63)

Within the overall context of development, communication is pivotal in bringing about processes of sharing knowledge and informed decision making so that the people themselves change those attitudes and behavioural patterns which impinge heavily on the quality of their life. Planned and research-based communication programmes can enable people to exchange development experiences, trigger social dialogue, find common ground for collective decisions and action and actively participate in and guide development activities.

The concept of communication includes:

  1. institutional communication, which strengthens multi-sectoral coordination and teamwork, generates the support of decision-makers, keeps a dialogue open between stakeholders, and narrows the gap between programme technicians and policy-makers.


  2. educational communication, which energises training and improves the effectiveness of front line communicators, promotes reflection and action at community level, increases coping skills, strengthens non-formal learning processes.


  3. social communication, which allows for people's participation and community mobilisation, breaks the barriers of illiteracy, creates a social dialogue on even the most sensitive issues, and ultimately brings about processes of informed decision making and social change.

FAO has had more than twenty-five years experience applying the Communication for Development approach to rural and agricultural development and population education, using media such as rural radio, small format video, photography and print, popular and traditional media, and more recently the Internet.

Communication can be used for:

In the context of HIV/AIDS, communication for development can create an enabling environment and a culture of non-discrimination in the community and in the long run influence behavioural change. It can facilitate mutual assistance (mitigation/support) and serve as a means to aid community-based development as well as to promote grassroots communication. The emphasis is thus more on communication as a means to enhance social dialogues and processes of sharing information and knowledge rather than on communication as an end in itself.

The emphasis is rather on communication as a social process. A process which facilitates common understanding among all participants of a communication initiative. Communication media and messages are important, but they should not be considered as ends in themselves. Communication should also be about "handing over the stick" and listening to rural people, taking into account their perceptions, needs, knowledge, experiences, cultures and traditions.

Communication programmes and activities are most successful when they are planned systematically and strategically. Often the haphazard use of communication activities piggy-backed onto a programme leads to top-down design and implementation and has a high chance of not reaching the intended audiences simply because they have not been involved.

Communication in low prevalence areas 21

Low rates of infection provide an opportunity to effectively prevent the spread of the epidemic. In low prevalence areas it is absolutely essential to engage in communication programmes and activities that inform and educate rural populations (adults and youth) about the potentially devastating impact of HIV/AIDS. The aim is to promote AIDS preventive behaviours, or safer behaviours, amongst people at high risk and/or to contain problems such as discrimination against people with HIV or those perceived to be at risk of AIDS. FAO will have to collaborate closely with other partners such as UNAIDS22, WHO, UNFPA and NGOs working in the field of AIDS prevention and education, since these organisations have valuable experience in developing HIV/AIDS communication and education strategies and therefore also a comparative and strategic advantage.

Prevention should also consist of putting in place, or strengthening, those organisations and institutions (international, national and local) working in the field of HIV/AIDS and developing communication strategies to trigger behaviour change to reduce or eventually eliminate behaviours that put people at risk.

Communication in high prevalence areas

"Compassion. The tendency to discriminate against those who have HIV is the worst killer. It is not HIV itself but lack of compassion and lack of information that is making people die from AIDS. So, when we think of people with HIV, we have to think of them exactly the same way as you would think of those who have contracted some other type of illness or disease that is difficult to cure or that is not curable. "
Aung San Suu Kyi's addressing the 13th International AIDS Conference in Durban from house arrest in Myanmar

When a community is faced with a high adult HIV prevalence rate, communication can (1) act as a mediator between those seeking information (people from affected households) about the services available to assist them and those offering these services (service providers), and, (2) be a medium to channel nutritional information and education, (3) evaluate, and monitor the process of channelling the mitigation and support services and if necessary work on adapting them (4) serve as medium for the intergenerational sharing of technical knowledge and skills.

When people die of AIDS, it represents a great human loss but also a significant loss in knowledge and skills. There is thus a definite need to promote the transfer of technical knowledge and skills from PLWHA to family members and the community at large. This is important especially for those who are left behind (children, widows, widowers) who have not yet had access to this information (which is often made accessible on the basis of age and gender) but who are left with a household to take care of. Communication can play a significant role in the process of intergenerational knowledge transfer by acting as a vehicle/facilitator for those who hold specific technical knowledge (PLWHA) and want to impart/share it with those who will be left behind and who will need this knowledge to be able to secure their livelihoods.23

Furthermore, appropriate communication activities need to be developed in order to prevent stigmatisation and marginalisation of PLWHA and affected households because HIV-related discrimination and stigmatisation:

Source: HIV/AIDS prevention in the context of new therapies. Report of a meeting organised by UNAIDS and the AIDS Research Institute of the University of California, at San Francisco, Geneva February 1998

Efforts should be made to reduce the stigmatisation and discrimination of PLWHA. This would allow for greater involvement of PLWHA in prevention efforts and encourage communities to be more supportive and as Aung San Suu Kyi stated in her speech at the 13th International AIDS Conference 2000 in Durban last July, greater openness will lead to greater compassion. She said that: "Openness will help us to control the spread of HIV and compassion will help those who are already suffering from HIV."

The communication focus should be on encouraging safer sex practices and avoid further transmission of HIV by increasing the knowledge base of all stakeholders. Communication can also be used as a vehicle to provide necessary information to PLWHA about appropriate diets, nutrition and safer sex.

Communication needs 24 and applications

2.2. Education 25 and Training

AIDS affects people in their most productive years. Around half of all new infections occur among those aged between 15 to 24 years. Infection rates amongst children and adolescents are skyrocketing in Africa. No or little access to education can drastically reduce the capacity of young adults to find employment and support themselves. No or little access may even constrain them to turn to risky survival strategies. Lack of access to education may also reduce the opportunities to learn about HIV/AIDS and about the methods available for protection oneself from infection.

This is why it is crucial to work with young people. Crucial because they are very numerous (230 million in SSA are of school age), extremely very vulnerable to HIV/AIDS, at a period of sexual awakening and discovery, optimistic and hopeful and represent a window of hope for the future. They are therefore part of the problem but also an essential part of the solution.

The education sector needs to be more involved in caging the HIV/AIDS epidemic. Formal or non-formal education, are important settings in which to educate young people about relationship and responsibilities and providing a range of decision making skills that will enhance young people's ability to prevent HIV/AIDS, but also help to lead a healthier, productive life. Information about HIV/AIDS, how it is transmitted and how it is prevented, needs to be integrated into education and training curricula at all levels, including primary and secondary education, universities and colleges and also in agricultural extension training programmes.

Like communication, education can help to prevent the further spread of HIV as well as mitigate the impact of AIDS. It can do so at three different stages of the epidemic:

  1. While the individual is still HIV-free
  2. When the individual has become HIV-infected and eventually suffers from AIDS-related illnesses
  3. When AIDS has resulted in death

Interventions will vary according to the level of impact reached. In level 1, the objective of interventions is to preserve one's HIV-free status. In level 2, the aim is to ensure that a person with HIV can continue to live positively and productively. Finally, in level 3, the aim is to contribute to helping the concerned survivors to adjust to the psychosocial and economic changes brought about by the death of a salient other. (Box 6 lists what education can do to prevent and mitigate HIV/AIDS.)

In order to plan for sustainable and participatory education programmes there are a few conditions that need to be taken into serious consideration. These include the need to

  1. Engage children/youth (but of course also adults) in programme design and implementation to ensure that the programmes focus on issues important to young people
  2. Make HIV/AIDS education and peer counselling available
  3. Set up appropriate behaviour change communication programmes should be set up, and
  4. Involve family and other supporting social structures in the programmes

Box 6: What education can do to prevent and mitigate HIV/AIDS

The transformations required can be put into practice more effectively if they are carried out with the support of strong policies mandating the changes so as to overcome the fears that HIV/AIDS education and prevention will increase sexual promiscuity among youth.26 Zambia, for instance, has recently developed a policy on HIV/AIDS for learners in public schools and for students and educators in further education and training institutions. The policy points to the urgent need to take action and slow down the spread of the disease.27 Along the same lines, Zambia has also developed the HIV/AIDS Emergency Guidelines for Education, which are to help educators teach their students about how the disease is transmitted, how it affects one's body and how to protect oneself. The activities outlined should also make it possible for educators to contribute significantly to building an enabling environment and a culture of non-discrimination.28

Box 7: Integration of HIV/AIDS issues into the school curriculum in Zimbabwe

With regard to content, education should be expanded to include skills (life skills approach) that enhance livelihood (e.g. income-generating activities, agricultural production, knowledge and skills, food production and preparation, natural resource management) especially for those children and youth that are at risk of being infected with HIV (See Box 7). As a general rule, formal and informal education is responsible for helping students develop practical psychological and social skills that equip them for positive social behaviour and for coping with negative pressures (Kelly, 2000:31). The life-skills approach, also endorsed at FAO, includes decision making, problem-solving, creative thinking, critical thinking, effective communication, interpersonal relationships, self-awareness, coping with pressures, self-esteem, and confidence, all the ingredients necessary for the success of prevention programmes and activities. (See Box 8)

Formal and non-formal education has an important to play as focal point for the community where educators, parent-teachers associations and governing bodies, all have a significant role to play in mobilising community action. Schools can act as centres of information not only for children but also for adults, for parents and other members of the community.

Non-formal education

The existing non-formal education sector must expand its reach into the community to serve the needs of all those who become excluded from formal schooling due to the impact of HIV/AIDS. They can provide content of immediate importance such as (life skills education, behaviour change) and of longer-term relevance (literacy and numeracy, employment skills for the formal and informal sectors).

Furthermore, non-formal education has particular potential to help mitigate the economic and social impacts of the disease on those who are affected, by combining basic education with the acquisition of skills for employment, entrepeneurship and income-generation and for the assertion of legal rights.

Tertiary institutions

Tertiary institutions represent concentrations of education and respected citizens who can act as focal points for out-reach into the community leading information campaigns, promoting behaviour change and galvanising action to mobilise resources from governments and civil society. They also have a significant role to play by contributing to the HIV/AIDS research agenda (for more details on the kinds of research topics see section on Agricultural research in this paper).

The same principles apply to agricultural training centres or other centres that act as hubs of information, communication and education for the community at large.

Planning for an effective response from the education sector will require undertaking an initial (disaggregated and participatory) research phase29 to identify the problems, constraints and corresponding education needs of children (orphans) and youth from different backgrounds and areas but also of adult men and women.

Box 8: FAO's Programme for Child and Youth Development in Agriculture and Rural Living30

HIV/AIDS-related education needs

Local strategies will need to be developed that draw on the available resources and supplement them by collaboration with NGOs and the private sector to mobilise action. Rather than develop alternative learning systems that cater specifically and exclusively to the special needs of children/youth/adults, the approach proposed here is to utilise the educational structures already in place and strengthen their short and long-term coping capacity. The contrary approach, i.e. to develop new and separate structures, centres institutions or programmes solely for PLWHA, could possibly lead to their marginalisation and discrimination because they would be isolated in special educational centres which cater to their specific needs. However this does not mean that PLWHA do not have special needs, nor that the existing educational structures should not take them into consideration.

In conclusion, AIDS prevention and education require consideration of a wider range of concerns than just provision of information. Behaviour change will not occur simply by providing access to information, but rather from a combination of knowledge, attitudes, socio-cultural contexts, and available behaviour options. Communication clearly lays a paramount role in this process.

One plan does not fit all. Interventions must match the needs of specific populations.

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