December 2001
Prepared by Sabine Michiels
in collaboration with
The Extension, Education and Communication Service
FAO Research, Extension and Training Division
Draft for Discussion
Part 1 of 2
The present document is a follow-up to an earlier paper produced by the FAO Extension, Education and Communication Service (SDRE) of the Food and Agriculture Organization (FAO) entitled "Strategic approaches to HIV prevention and AIDS mitigation in rural communities and households in Sub-Saharan Africa". The paper provided a framework of action for FAO' s engagement in HIV/AIDS prevention and impact-mitigation in rural Sub Saharan Africa at the community and household level with special emphasis on the role of communication for development.
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"We are not clear what AIDS is. We have seen many people suffering from headaches, stomachaches and diarrhoea, and only after they are dead do we hear rumours that they had AIDS. Some lose weight, and only after they are dead, you hear talk that they had AIDS. We do not know what AIDS is."
Woman in Zimbabwe quoted in AIDS in Africa. A Crisis of Leadership. The Hunger Project, October 13, 2001.
"I would like to lecture more and more people, all over the world...to teach them to not be afraid...You can't get AIDS by hugging, kissing, holding hands. We are normal human beings. We can walk. We can talk. We are just like everyone else. We are all the same."
The late Nkosi Johnson, South African boy who was living with AIDS.
"Communication is central to prevention strategies aimed at influencing individual and social behaviour."
(UNAIDS/Penn State 1999:19)
AIDS has emerged as one of the most serious diseases facing the world. As the twentieth century comes to a close, over 34 million people with HIV/AIDS face a future darkened by the fatal disease. Of these 34 million people, 70% live in Africa and one third of them are young people between the ages of 10 and 24 (UNAIDS 1999). Alarmingly, this percentage will grow even further as infection rates continue to climb where a combination of endemic poverty, fragile health services and limited investments in prevention programs fuel the spread of the deadly virus.
Nowhere has the impact been more devastating than in Sub-Saharan Africa. More than 11 million Africans have already died and the World Health Organization (WHO) and the Joint United Nations Program on HIV/AIDS (UNAIDS) estimate that another 24.5 million are now living with HIV/AIDS. In countries like Botswana and Zimbabwe, more than one in four adults is infected. By 2000, a cumulative total of 13 million children had lost their mother or both parents to AIDS; 10.4 million of these children are under 15 years of age. The reality is that a child born in Zambia or Zimbabwe is more likely than not to die of AIDS.
The most frightful long-term characteristic of the HIV/AIDS epidemic is its impact on life expectancy. Instead of reaching an average of 64 years, by 2010-2015, life expectancy in several Sub-Saharan countries will regress to an average of just 41 years. People have died partly because of the alarmingly high concentration of HIV in Africa, but also because the continent's leaders and the international community have been irresponsibly slow to respond to the epidemic.
Today, it is widely acknowledged that HIV and AIDS have substantial economic and social impacts on individuals, on families and households, on communities and thus on society as a whole. The disease is killing people in their most productive years, decimating the workforce, impoverishing households, shredding traditional safety nets and tearing the social fabric of the communities, for many the only reliable support systems. Furthermore, in many Sub-Saharan African nations AIDS has destabilised the health systems, education, industry, the formal and informal agricultural sector, transport, civil society and political stability.
Orphan-headed households, grandmothers struggling to care for their numerous grandchildren, farm-households completely asset-less, income-less and food-less, people living with HIV/AIDS marginalised with nowhere to turn to for support, community-based organisations and self-help groups with limited coping capacity and scarce resources, companies and firms with a drastically reduced skilled workforce, highly trained extension staff dying off, schools without teachers...without students… such is the reality of an Africa destroyed by AIDS.
Out of 18 countries in Sub-Saharan Africa that experienced a declining or stagnating life expectancy during 1990-1995, all but one (Togo) were described as having a general HIV/AIDS epidemic, that is an HIV prevalence of more than 5% in the adult population. (World Bank 1999) |
AIDS: the last and most severe stage of the clinical spectrum of HIV-related diseases.
Communication: "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)
Community: a specific group of people usually living in a common geographical area who have a common culture, are arranged in a social structure and exhibit some awareness of their identity as a group. (Allman et. al 1997 cited in UNAIDS 1999a). This group will also tend to act together in their common interest if they have a clear understanding of what it is they have in common.
Food security: exists when all people, at all times, have physical, social and economic access to sufficient, safe and nutritious food which meets their dietary needs and food preferences for an active and healthy life. (Rome Declaration on World Food Security, 1996)
Food insecurity: low level of food intake, which can be transitory (when it occurs in times of crisis), seasonal, or chronic (when it occurs on a continuing basis).
HIV: a retro-virus that damages the human immune system thus permitting opportunistic infections to cause eventually fatal diseases. HIV is the causal agent for AIDS.
HIV prevalence rate: total number of persons (usually adults aged 15-49) with HIV infection alive at any given moment in time. In this paper the author refers to High adult HIV prevalence as 7% or more and to Low adult HIV prevalence as less than 7% in accordance with the distinction made by the World Bank Strategy (1999).
Household: a group of persons who live in the same dwelling and eat meals together. (UNAIDS 1999)
The Communication approach proposed should be:
In view of its devastating health, economic, social and more recently political impact, international agencies have increasingly begun to regard the AIDS epidemic not only as a health problem but more importantly as a legitimate development issue.
FAO perceives the HIV/AIDS pandemic as a problem of critical importance for development in general, and agriculture and food security in particular. FAO was one the first United Nations Agency to apply the development perspective by carrying out several studies on the impact of HIV/AIDS on agriculture, nutrition, food security and people's livelihoods5 (see FAO 1988, 1995, 1997). Henceforth, FAO' s activities in the field of HIV/AIDS have focused mainly on two aspects of the epidemic:
FAO's involvement in HIV/AIDS-related work has been advanced further by signing a Cooperation Framework with UNAIDS in Geneva in July 1999. The Framework legitimises to the development community that FAO regards the HIV/AIDS epidemic as an integral part of its activities aimed at reducing the impact of HIV/AIDS on rural populations, their livelihoods, food security and farming systems.
It is within this conceptual framework that an interdisciplinary collaboration between FAO's Extension, Education and Communication Service (SDRE) and the Population Program Service (SDWP) was agreed upon to develop a set of guidelines for the preparation of national communication plans for HIV prevention and AIDS mitigation in Sub-Saharan Africa.
These guidelines are a follow-up to an earlier paper produced entitled "Strategic approaches to HIV prevention and AIDS mitigation in rural communities and households in Sub-Saharan Africa". (FAO April 2001). The previous paper provided a framework of action for FAO' s engagement in HIV/AIDS prevention and impact-mitigation in rural Sub Saharan Africa at the community and household levels with special emphasis on the role of communication for development.
In addition, the guidelines include a discussion of the steps towards the participatory, research-based development of a national communication plan for HIV prevention and AIDS mitigation. The underlying approach intrinsic in the guidelines is one that combines a developmental perspective to HIV/AIDS with the Communications Framework for HIV/AIDS proposed by the Joint United Nations Programme on HIV/AIDS and Penn State University (UNAIDS & Penn State University, 1999). The framework stresses the importance of fostering the right social, cultural, political, economic and environmental context for positive change rather than focusing solely on attempting to change individual behaviour through top-down communication approaches such as health-behaviour change campaigns.6
These guidelines are generic. The process will need to be initiated in-country, building on the outcomes and findings of participatory needs assessments and action research with major stakeholders, including Persons Living With HIV/AIDS, their relatives and other indirectly affected individuals.
Table 2: Impact of HIV/AIDS on agricultural labour force in the most affected African countries |
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(Projected losses in percentages) |
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2000 |
2020 |
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Namibia |
3.0 |
26.0 |
Botswana |
6.6 |
23.2 |
Zimbabwe |
9.6 |
22.7 |
Mozambique |
2.3 |
20.0 |
South Africa |
3.9 |
19.9 |
Kenya |
3.9 |
16.8 |
Malawi |
5.8 |
13.8 |
Uganda |
12.8 |
13.7 |
Tanzania |
5.8 |
12.7 |
Central African Rep |
6.3 |
12.6 |
Ivory Coast |
5.6 |
11.4 |
Cameroon |
2.9 |
10.7 |
Source: FAO/SDWP
"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 impact of the HIV/AIDS epidemic on development, agriculture and food security is 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. Many countries that have a high HIV prevalence rate also suffer from corruption, unrest and conflict, and although the contribution of AIDS to already destabilised situations is hard to define, experience shows that AIDS exacerbates already precarious situations, 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 straightforward: poverty exacerbates AIDS and AIDS exacerbates poverty. Although 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 research (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 also 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 and other productive resources.
Not only is the AIDS epidemic a human tragedy, but it can severely impact achievements in rural development and the economy within countries.
Clearly, the need for a communication for development rather than an AIDS-specific, or health approach, is critical to tackling the multi-sectoral complexity of the epidemic and its systemic impact7 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, regional and national levels and takes into consideration the unpredictable, systemic and often rapid course of the epidemic.
"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 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 processes
.The concept of communication includes:
FAO has had more than twenty-five years experience applying the communication for development approach to rural and agricultural development and population education, using a range of media such as rural radio, small format video, photography and print, popular and traditional media, and more recently Internet-based information technologies.
Communication can play an essential role in prevention and mitigation efforts by:
Furthermore, communication for development can create an enabling environment at all levels, and a culture of non-discrimination 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 more on communication as a means to enhance social dialogues and processes of sharing information and knowledge related to HIV prevention and AIDS mitigation rather than on communication as an end in itself.
Communication is a social process. A process that facilitates common understanding among all who participate in, and contribute to, a communication initiative. Communication is about "handing over the stick" and listening to people, taking into account their perceptions, needs, feelings, knowledge, experiences, cultures and traditions. Communication is therefore a crucial process in preventing the further spread of HIV and alleviating its impact.
Low rates of infection provide an opportunity to effectively prevent the spread of the epidemic. In low prevalence areas, it is essential to implement communication programmes and activities that inform and educate rural populations (adults and youth) about the potentially devastating impact of HIV/AIDS.
According to Piot and Aggleton (1998), there are several key elements of an effective national prevention effort, namely:
Factors to be taken into consideration at both the programme and community level can be added to the above prevention elements. They include:
Overall, the aim of national communication programmes should be to contribute significantly to the creation of enabling social and political environments to promote AIDS preventive behaviours, or "safer behaviours", amongst people at high risk and/or to address problems such as discrimination against people with HIV or those perceived to be at risk of AIDS. National institutions, with FAO support, will have to collaborate closely with other partners such as UNAIDS9, WHO, UNFPA, international NGOs and local 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.
"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 medium of exchange between those seeking information (people from affected households) about the services available to assist them and those offering these services (service providers); (2) be a medium to channel nutritional information and educational content; (3) provide information to evaluate, monitor and, as necessary, re-direct the channelling of mitigation and support services; and (4) serve as medium for the intergenerational sharing of technical knowledge and skills.
AIDS causes a significant loss in knowledge and skills both individually and collectively at the level of communities. There is thus a 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 living (children, widows, widowers) who may not yet have had access to this information (which is often made accessible on the basis of age and gender), but who are left with a household or farm to take care of. Communication can play a significant role in the process of intergenerational knowledge transfer by acting as a vehicle for people with AIDS who hold specific technical knowledge and want to share it with family and others who will need this knowledge to be able to secure their livelihoods.
The intention should be (1) to foster the active participation of PLWHA and affected families/communities and (2) contribute to breaking the standardised fear and stigmatisation of PLWHA, i.e. moving from the view that PLWHA are victims/patients/passive to a more positive view that PLWHA can be knowledgeable/active participants in society by contributing to the education and learning of others.
Socially and culturally appropriate communication activities need to be developed in order to prevent stigmatisation and marginalisation of PLWHA and affected households that:
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. As Aung San Suu Kyi stated in her speech to the AIDS conference 2000 in Durban, greater openness will lead to greater compassion: "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 avoiding further transmission of HIV by increasing the knowledge base of all potentially at risk groups, and especially youths. Communication can also be used as a vehicle to provide necessary information to PLWHA about appropriate diets, nutrition and safer sex.
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