Sustainable Development Banner
Population

January 2003

Measuring impacts of HIV/AIDS on rural livelihoods and food security

C. Shannon Stokes, Visiting Scientist
Population and Development Service
FAO Gender and Population Division
Professor of Rural Sociology, Pennsylvania State University, USA

Part 2 of 2

A. METHODOLOGICAL CONSIDERATIONS

Studies of the impacts of HIV/AIDS on rural livelihood assets that use these indicators need to take into account the major alternative factors that could also produce the same or similar effects, e.g. illnesses or deaths from other causes, conflict and civil unrest, droughts, floods and so forth. While the methodological challenge of separating out the effects of HIV/AIDS from other deleterious effects is indeed difficult, detailed knowledge of local conditions should permit identification of the major alternative factors likely to have produced changes in livelihood assets at both the household and community levels. Studies of communities with quite different levels of HIV/AIDS prevalence would also assist in this process. In addition, focusing on a subset of livelihood assets thought to be most affected in a given community or region would help to delimit the number of plausible alternative explanations. Identification and control of these other major factors is essential to the development and implementation of effective mitigation strategies.

As with any research, control of alternative explanations is essential to inferring the impacts of one variable or set of variables on another. In this case, we wish to examine the impacts of HIV/AIDS on rural livelihoods and food security. Obviously, major disruptions such as armed conflict and civil disorder make it virtually impossible to sort out the impacts of the epidemic, and studies should not be undertaken under these conditions. However, in any given area, not all alternative factors are operating. For example, drought is often identified as a major threat to rural livelihoods and food security. If a survey is undertaken in an area suffering from the effects of drought and it is thought to have major impacts on livelihood assets, at least two strategies to deal with this issue are available. First, if a PRA reveals that all households in a given area are experiencing the effects of drought to roughly the same extent, then while drought may indeed impact rural livelihoods and increase poverty and food insecurity in the area, it is likely to affect all households in a somewhat similar manner. Thus, it becomes a constant rather than a variable and is not likely to account for inter-household variations in livelihood assets and food security. Second, if the effects of drought are variable across households, affecting some households more severely than others, then data on the estimated severity of the drought on each household should be gathered. Even if a crude measure of drought effects (severe, moderate, mild) can be made for each household, then a partial control for the effects of drought can be incorporated into a multivariate analysis. Although controls for such effects are less than ideal, they are practical and permit some control for one major alternative explanation. Other competing explanations can be handled in a similar manner. This again illustrates the necessity of applying these indicators with firm knowledge of the local situation obtained through secondary data, Rapid Rural Appraisal (RRA), PRA analyses or other means.

A more problematic methodological issue is identification of those households that have experienced an AIDS death or that have one or more individuals currently afflicted with HIV/AIDS. In some locations, people are able and willing to openly discuss HIV/AIDS. In other places, people are not willing to admit being HIV-positive or to be suffering from AIDS even when they have accurate information about their status. Once again, knowledge of the local community's attitude and willingness to discuss HIV/AIDS is crucial in determining how a household survey utilizing these indicators should proceed. If people are unable or unwilling to attribute illnesses or deaths to HIV/AIDS, an indirect measurement strategy must be employed. Individuals can be asked if anyone in the household has died in the past three years and, if so, how long they were ill before they died. In addition, their age and sex should be ascertained. Moreover, as part of the information obtained for a household register, the health status of each household member should be obtained. A list of major and/or minor symptoms of HIV/AIDS can then be asked for each person said to be suffering from a chronic illness. Although this process will undoubtedly result in some misclassification, if the PRA analysis has identified the major illnesses in the community and HIV/AIDS has been identified as a serious threat, the researcher can infer with some confidence whether or not the household has an HIV/AIDS-afflicted member.

Finally, this set of indicators focuses primarily upon the impacts of HIV/AIDS on rural livelihood assets and not directly on food security. This restriction was based on several considerations. First, rural livelihood assets are viewed as the proximate determinants of food security at the household level. Second, other than emergency food aid, medium to longer-term mitigation strategies for the effects of HIV/AIDS on household food security are likely to focus on one or more of these asset classes. Thus, it is essential that household-level impacts on assets be identified. Third, indicators of food security ranging from process indicators that reflect aspects of food supply and food access, to outcome indicators taken as proxies for food consumption, have been identified and described in earlier work (Maxwell and Frankenberger 1992). Moreover, the methodological difficulties described in measuring and separating the impacts of HIV/AIDS on rural livelihood assets are compounded several fold when measures of household food security are used as the outcome variables. For example, common measures of the nutritional status of children (weight and/or height for age) can reflect a variety of factors other than food availability and access. Household sanitation, disease prevalence, activity level and maternal care are just a few of the factors that can affect these measures (Frankenberger 1992).

B. MITIGATION STRATEGIES IN THE AGRICULTURAL SECTOR

The Expert Meeting held at FAO in December 2001 identified a number of strategies within the agricultural sector that could assist in mitigating the effects of HIV/AIDS on food security and rural poverty, a selected set of which are considered here. One objective of this paper is to identify potential measures for evaluating the impacts of mitigation strategies in the agricultural sector on HIV/AIDS-induced food insecurity. Because several of the mitigation strategies address livelihood assets, many of the indicators listed in Table 1 have potential use in monitoring and evaluating the impacts of mitigation efforts. However, these indicators would need to be adapted to the particular strategy being evaluated and, more importantly, a longitudinal study design that involved examining the same households at different times represents the best opportunity to evaluate the impacts of mitigation efforts. Before discussing the methodological issues involved in evaluating mitigation strategies, a brief description of selected strategies emerging from the Expert Meeting is presented.

Labour-saving technology

The impact of HIV/AIDS on household labour has been found repeatedly to be one of the major losses to the household's human capital assets. As the hypothetical example presented earlier illustrates, the loss of the afflicted member's productive labour both on- and off-farm leads to marked declines in the financial capital of the household. In addition, the reallocation of the wife's time away from economically productive activities and to caring for the afflicted member further reduces the household's labour supply. One coping strategy employed by many households is to withdraw older children from school to assist with agricultural, household and child care activities. However, this is a short-term strategy that may provide immediate relief, but that has long-term negative repercussions for the child's future.

In response to such findings, the recommendation has been made that labour-saving technologies represent an important mitigation strategy to relieve the labour constraint on the household labour supply. These recommendations include the use of technologies that would save both agricultural and household labour. They include small-farm mechanization, low-input agriculture, lighter ploughs and tools that can be used by older children, women and the elderly, improved seed varieties that require less labour for weeding, intercropping, zero or minimum tillage, access to potable water and fuel-efficient stoves that can free women for more economically productive activities, among other possibilities (Topouzis 2001).

A number of alternatives exist for monitoring and evaluating the impacts of such strategies. A baseline study of the use of these practices would be important in establishing how many of the recommended practices are currently being used. If resources permit a panel of households to be followed over time, the adoption of selected labour-saving practices can be monitored to see if recommended practices are being adopted and the extent to which the new practices have alleviated the labour shortage at the household level. Alternatively, if agricultural extension personnel in some regions, districts and communities are actively promoting the adoption of such practices, while others are not, comparisons can be made between the different areas in adoption rates and the effectiveness of extension educational programmes in promoting recommended practices. Although a comparison of different areas is less rigorous than a panel study of households, if resources are the constraint, it represents one plausible alternative.

To evaluate the effects of labour-saving technologies on human capital, several of the household-level indicators in Table 1 would be useful. For example, has the household decreased the area cultivated, changed its cropping patterns, experienced reduced yields, or begun to farm less intensively? If households that use labour-saving technology have been available to maintain their productivity despite the HIV/AIDS-induced illness and/or death of one or more members, while afflicted but non-adopting households have not, a strong case can be made for the effectiveness of the mitigation strategy on alleviating a major determinant of household poverty and food insecurity. Again, a panel study of selected households would provide the strongest evidence of the impacts of labour-saving technology. However, a cross-sectional survey of households using different technology packages could be employed to examine differences in cropping patterns, area cultivated and animal production practices to see if differences obtain. Systematic differences would be expected if the technologies used are effective. Such evidence is necessary for demonstrating the impacts of labour-saving technology, but it is not as strong as that obtained from a panel study.

Knowledge Preservation and Transmission

Another major impact of the AIDS epidemic on the human capital of households has been the loss of agricultural knowledge, practices and skills (Table 1). Households headed by women and orphans are particularly disadvantaged because many agricultural tasks are gender-specific and knowledge is not shared between the sexes. Thus, women may possess inadequate understanding of cash crop production requirements, prices and markets, animal husbandry practices and food storage practices when the male head dies. The impact of knowledge loss is not restricted just to female-headed households. Male-headed households in which the wife has died are similarly ill-equipped to carry out what are locally defined as female tasks and which are often the basis of household food consumption and food security. Similarly, children in rural areas typically learn agricultural skills and practices from their parents. When one or more of the parents die before children have learned the necessary skills, they are ill-prepared to maintain the household. Indeed, one study found that only one-tenth of orphan-headed households possessed adequate knowledge of agricultural production techniques (Ayieko, 1997).

At an informal level, community organizations such as seed banks can assist in maintaining needed resources for production, particularly of staple food crops such as cassava and sweet potato. As Topouzis (2001) notes, these crops have not been in the mainstream of agricultural research, yet they are critical to the food security of rural households. Supporting informal community efforts to promote these crops can be important to maintaining household food security in areas hard hit by the epidemic. Strategies to promote and support ongoing efforts in this area need to be developed.

Extension education programmes have traditionally been directed to male members of the household and toward the more successful and commercially-oriented agricultural households. These programmes need to be reoriented to meet the needs of households that have lost one or more adult members of either sex, whether to HIV/AIDS or other diseases. Orphan- and elderly-headed households undoubtedly have different information and technology needs than those units that are still intact.

The information needs of adult-loss households should be monitored and evaluated to determine their educational needs. The ability of household members to draw up cropping plans, their knowledge of prices and markets, gender-specific knowledge of land preparation techniques, animal husbandry practices, grain storage techniques and other agricultural skills and practices need to be ascertained if effective strategies to meet these needs are to be devised. A cross-sectional survey of households that have experienced different types of adult-losses should be undertaken to ascertain the state of their agricultural knowledge, practices and skills. Table 1 suggests some of the indicators that would be useful in this effort.

Rural institutions/capacity building

Mitigation strategies obviously apply not only to efforts to assist individuals and households in coping with the epidemic, but as the discussion of the community-level effects noted, community organizations and institutions are also impacted. Rural institutions need to be strengthened to assist individuals, households and communities in coping with the epidemic. Rural service providers of all types, education, health, agricultural extension, credit and finance, women's associations, nutrition groups, irrigation committees and terrace maintenance associations, need to be enhanced. Because most assistance provided to AIDS-affected households comes from family, neighbours and local informal community institutions, it is important that these institutions be monitored and evaluated.

Micro-finance institutions represent one example of a rural institution that has been found to be important in mediating the impacts of HIV/AIDS (Parker et al. 2000, cited in Topouzis 2001). Micro-finance is important to rural households unaffected by AIDS because it permits them to be economically productive and accumulate savings that may be needed later. Once a household has experienced an HIV illness or AIDS-related death, credit institutions are central to maintaining the economic viability of those household members who are able to work and care for the afflicted household members. Finally, as Parker and others note, "after AIDS sweeps through a family, survivors (often grandparents and older children) must rebuild the economic base of the remaining household" (Parker et al. 2000:1-2, cited in Topouzis 2001:30). Thus, indicators of credit availability at the community level, as well as at the household level, can be employed to evaluate mitigation efforts aimed at micro-finance institutions.

Some communities have been extremely responsive to the epidemic, and institutions have been strengthened and created to deal with a variety of problems created by increased morbidity and mortality. Studies of existing institutions need to be made to monitor how they are adapting to the increased demand for assistance and to evaluate the effectiveness of their efforts. Informal institutions centering on traditional labour-sharing arrangements and communal farming, as well as self-help efforts to provide home care for sick and dying members, child care, apprenticeship training for orphans or educational and nutrition assistance to affected households should be examined and strengthened. PRA techniques would be helpful in identifying those local organizations and institutions that are assisting individuals and households in adjusting to the epidemic. Monitoring efforts employing indicators of the social capital of communities would be useful in this endeavour.

Gender equality

Although gender equality is an issue that is not specific to the agricultural sector, it is so integral to the HIV/AIDS epidemic and its social and economic consequences, it should be a part of any agriculturally-oriented mitigation strategy designed to alleviate the impacts of the epidemic. Not only are women physically more vulnerable to HIV infection than men, they are also more vulnerable to negative social and economic outcomes as a result of HIV/AIDS. Women's access to and control of resources and livelihood assets (human, social, natural, financial and physical capital) are often negatively affected by HIV/AIDS. Inequalities in access to land (inheritance rules), credit, employment, education and information all make women more vulnerable to negative outcomes.

Legislation has been passed in some countries to give women inheritance rights to land when their husband dies. While this is an important legal precedent to establish, the enforcement of law at the local level in light of traditional inheritance patterns is equally critical. Monitoring and evaluation efforts need to examine local laws and traditions and work with local officials and organizations to negotiate access to land and other productive resources at the local level. Women's access to and control of land are critical to their households' well-being. Similarly, access to productive credit to enable them to continue agricultural production is also important. In light of the gender division of labour, new information needs have been created by the epidemic. These information needs not only apply to agricultural production activities, but given women's role as the predominant care givers for those suffering from AIDS, they also include health and nutrition. Extension education efforts of all types need to be reoriented to include women and to address their emerging information needs.

Cultural practices such as widow inheritance and ritual sexual cleansing reflect some of the inequalities that women experience. Although such practices change slowly, there is some evidence that the epidemic is leading to changes in some of these traditions. Assisting individuals and communities in understanding the different vulnerabilities to the epidemic of women and men is an important part of enhancing gender equality.

Evaluating the impacts of mitigation strategies on gender equality is challenging. However, the sustainable livelihoods approach provides a set of delimited areas in which inequalities, as well as changes, can be monitored and evaluated. Gender differences in access and control of each of the five livelihood assets presents a starting point from which analyses can begin. While we do not recommend that any one study attempt to include all five livelihood assets, a PRA can be used to identify the major dimensions of inequality exacerbating the impacts of HIV/AIDS at the local level. Once these dimensions have been identified, Table 1 provides possible indicators to measure their impacts and to monitor changes. Once again, a panel study would provide the strongest evidence of the impacts of mitigation strategies on these dimensions. Alternatively, the identification of communities that differ significantly in their gender equality might reveal important differences in their responses to the epidemic and point to key areas for possible intervention strategies.

Improving nutrition

People living with HIV/AIDS (PLWHA) have special nutritional needs to assist them in remaining active and productive workers, warding off the opportunistic infections that accompany the disease and in prolonging their lives. Mitigation efforts can range from nutritional education programmes aimed at infants, children, adults and the elderly, nutritional support and education for afflicted individuals, orphan support programmes, infant feeding, to increased agricultural productivity through improved plant varieties and better crop management techniques. Nutritional gardens can provide needed nutrients and add variety to the staple foods consumed by households. Efforts to provide a balanced, nutritious diet help to strengthen the immune systems of healthy persons and assist them in warding off other infections that render them more vulnerable to HIV/AIDS. Moreover, food secure households are less vulnerable to the poverty-induced risks of contracting HIV.

Mitigation strategies designed to improve household nutrition are not independent of other efforts to improve households' livelihoods and food security. Topouzis (2001:33-34) lists a number of strategies that would improve food security and nutrition, including the following:

Adoption and use of these practices by AIDS-affected households, as well as unaffected households, should be monitored and evaluated. Traditional extension programmes aimed at male household heads are not likely to reach orphan- or female-headed households, or even the elderly - exactly those households that most need labour-saving practices and technologies. Thus, nutrition and agricultural extension programmes need to be gender- and age-sensitive in reaching those households most in need. Monitoring and evaluation of these strategies will obviously depend upon the mix of programmes and practices that are promoted in any given area. Indicators would include measures of nutritional knowledge, adoption of recommended practices and technologies and the mix of crops and animals produced and consumed by households. Given the short-term need to monitor and evaluate the effectiveness of mitigation efforts, indicators such as these are more likely to be responsive to recommended practices and technologies than more direct indicators of household nutrition and food consumption such as stunting or wasting in children that reflect longer-term processes.

Social and economic safety nets

Communities have developed a range of strategies to assist residents in surviving the impacts of HIV/AIDS, as well as other threats to their livelihoods. Most of these strategies are traditionally based, and coupled with extended family support, they constitute the vast majority of assistance provided to AIDS-affected households. One study in Tanzania reported that among families that had lost breadwinners "90% of their material and other assistance came from family and community groups" (Mutangadura et al. 1999:28-29). Thus, these authors argue that external support from donors, NGOs, religious organizations or other groups should be directed toward strengthening community-based initiatives, rather than replacing them.

Among the support and mitigation responses of communities, Mutangadura et al. (1999:29) list "social support groups, savings clubs and credit associations, self-help groups, community based organizations, income-generating projects, and voluntary labour." Community support through labour sharing and food sharing from communal plots are important to households affected by HIV/AIDS. What is not known is how these institutions are holding up under the demands created by the epidemic. What happens to households that are unable to contribute their share of labour due to the illness and death of one or more members? Monitoring and evaluating the operation of these traditional safety nets is essential if external organizations are to be helpful in assisting them in mitigating the impacts of the epidemic. Because these traditional safety nets represent community-level social capital, PRA techniques, key informant interviews and other participatory methodologies would be useful in gathering information on their operation. Household surveys could ascertain the percentage of households reporting help from these sources.

Direct food aid such as that from the World Food Programme (WFP) is also required in emergency situations. The current critical food shortage in southern and eastern Africa will likely require food aid as an initial step in providing food security to households. Emergency food aid or food-for-work programmes represent short-term answers to the problem of food security. Providing food rations to school children is important in meeting their nutritional needs, and supplying an extra ration for children to take home is important in mitigating their removal from school. Longer-term mitigation strategies will likely seek to influence one or more of the livelihood assets. Seed distribution programmes that permit households to re-establish their agricultural base can also provide a safety net to afflicted households in their recovery. These efforts need to be monitored and evaluated for their impacts on rural livelihoods and food security.

V. IMPROVING IMPLEMENTATION: MONITORING AND EVALUATING IMPACTS OF MITIGATION STRATEGIES

It should be kept in mind that the purpose of evaluating mitigation strategies is to assist in the design and implementation of more effective programmes to alleviate the impacts of HIV/AIDS on rural livelihoods and food security. Thus, the purpose of research on mitigation strategies is to evaluate the effectiveness of programmes in a cost-effective manner. Although a thorough discussion of research issues involved in evaluating the impacts of mitigation strategies is beyond the scope of this paper, several issues merit consideration. First, what dimensions or outcomes of the strategies are most important to monitor and evaluate? That is, what livelihood assets are the strategies designed to affect? Which outcomes are thought to have the greatest ameliorative impact? No study can evaluate all of the potential impacts of a mitigation strategy. Thus, selected outcomes must be chosen to focus the monitoring and evaluation effort. Secondly, once the desired mitigation strategy outcomes have been identified, indicators must be developed and the type of research methodology to monitor and evaluate the outcomes must be chosen. Whether a household survey, a PRA, focus groups, key informant, or other methodology should be used will depend upon the strategic focus of the study and whether the strategy is aimed at the household or community level.

Attempts to summarize the indicators and research methods needed to evaluate mitigation strategies run the risk of over-simplifying a complex set of decisions. Nonetheless, Table 2 outlines possible approaches to these issues. For example, if the strategy is designed to preserve knowledge and transmit it across sexes and age groups in light of the loss of experienced agricultural workers, then impacts on human capital are the desired outcomes expected. In contrast, if the emphasis of a strategy or programme is to promote labour-saving technology, then adoption of recommended practices and their effects on cultivation patterns, crop yields and intensity of cultivation may be important.

In the human capital example given above, individual knowledge of cropping plans, agricultural prices and markets, and animal husbandry practices of the various types of adult-loss household heads are examples of important outcomes to measure. If the purpose of the study is to evaluate a mitigation programme, rather than identify perceived information needs, then a panel design that would interview individuals at two different times would provide the best measure of the programme's impact within a given area. If resources do not permit such a design, then a cross-sectional survey of the agricultural knowledge, practices and skills of different adult-loss households could be employed.

Mitigation strategies designed to influence rural institutions and build capacity require a different approach. Because the extended family, neighbours and local informal institutions provide most of the assistance to AIDS-affected households, programmes to strengthen these efforts necessarily focus primarily on building community-level social capital. Indicators to measure the activities and impacts of these efforts include monitoring and evaluating the presence and effectiveness of social support groups, credit associations, self-help groups, CBOs and voluntary labour practices, among others. Participatory methodologies, including PRA techniques, key informants and focus groups would appear to be the most effective means of evaluating these institutions and implementing programmes to strengthen them. Household surveys could augment such techniques and could be used to estimate the extent of coverage by local institutions.

Table 2. Selected indicators and recommended methodologies for evaluating and monitoring mitigation strategies

Measuring the impacts of efforts to mitigate gender inequality require a number of research methodologies because gender equality, or the lack thereof, affects all five capital assets. Given the importance of women's access to and control of resources such as land, water, livestock, credit, information and technology in reducing rural poverty and food insecurity, gender inequalities in these factors exacerbate the effects of HIV/AIDS. Focus groups, PRA analyses and other participatory methodologies are useful in understanding the constraints women face in their livelihood strategies. Particular attention should be focused on their access to and control of resources. Where monitoring and evaluation resources permit, household surveys of women can supplement these more participatory methodologies to obtain an estimate of how widespread the constraints are experienced.

Efforts to improve nutrition range from direct food assistance to households in emergency situations, to the use of recommended practices such as improved crop management techniques, nutritional gardens, use of staple crops and small ruminants, nutrition education and labour exchange arrangements, among others. The indicators used and the methodology employed obviously will depend upon the specific intervention or strategy being evaluated. The adoption of nutritional gardens by women, the cultivation and consumption of key staple crops and the use of small ruminants all can be employed to provide measures of household nutrition and food security. Alternatively, a focus on community-level nutrition efforts such as food- and labour-sharing practices would need to use more participatory approaches. Again, a range of methodologies can be employed (Table 2).

Finally, monitoring and evaluating social and economic safety nets require a primary focus on community-level social capital. Indicators such as the presence and activities of social support groups, self-help organizations, CBOs, labour- and food-sharing practices, as well as direct assistance by external organizations, can all be used to monitor and evaluate the impacts of traditional and externally-supported community safety nets. PRA techniques and focus groups can be used to identify the presence and effectiveness of these activities in a community. The extent of coverage and the type of assistance received from these efforts can be estimated from household surveys. Regardless of the mitigation strategy to be evaluated, the important point from a methodological perspective is that the studies focus on those outcomes of the programme that are thought to have the greatest ameliorative impact on rural livelihoods. Although such a focus will reveal that some strategies and programmes have little impact, others may be demonstrated to provide genuine benefits to rural households. By focusing evaluation efforts on a delimited set of outcomes and using appropriate methodology, information useful in improving implementation efforts can be generated.

VI. CONCLUSIONS

The HIV/AIDS pandemic has been demonstrated to have far-reaching impacts across all sectors of society. Although the health sector has received the most attention and resources, in the hardest hit countries the epidemic has had serious impacts on the economy, education, public welfare, government, the labour force, and especially on labour-intensive sectors such as agriculture. These macro-level effects are matched by equally negative consequences for rural, agricultural households. The epidemic has increased livelihood insecurity and rural poverty in a number of countries resulting in increased food insecurity for millions of households.

Efforts to measure the impacts of the epidemic on rural households have been diffuse and many studies have consisted of small-scale, intensive investigations of one or a few communities within a region. While this approach has been fruitful in identifying many of the impacts of the epidemic, it has not resulted in a systematic analysis of the potential impacts on rural livelihoods. This paper draws upon the sustainable livelihoods approach in organizing a framework for examining the effects of HIV/AIDS on rural livelihoods and food security. Using the sustainable livelihoods framework, the paper identifies indicators to measure the impacts of the epidemic on each of the five livelihood assets rural households are viewed as possessing. The analysis focuses on the livelihood assets of both rural households and communities. The sustainable livelihood framework is demonstrated to provide a delimited set of capital assets likely to be affected by HIV/AIDS. By focusing measurement on those assets rural households use to seek their livelihoods, research is oriented toward identifying potential areas in which mitigation efforts can be directed.

The sustainable livelihood approach posits that rural households possess five sets of livelihood assets essential to their livelihood strategies: human capital, financial capital, natural capital, physical capital and social capital. Using these assets and capabilities, households develop livelihood strategies to cope with their physical, social, economic and political environments. The environments in which households operate contain a number of threats that render them vulnerable to negative livelihood outcomes. These threats include periodic droughts, floods, pest infestations, crop and livestock shocks, economic shocks and the illness and death of household members, among others. Sustainable households are those that are able to adjust to these threats without compromising their future ability to survive shocks. HIV/AIDS represents a potentially debilitating shock to farm households. While most ameliorative efforts have been directed toward preventing the spread of HIV/AIDS, this analysis focuses on possible efforts to mitigate the impacts of the epidemic on rural livelihoods. A large number of possible indicators are identified to measure the impacts of the epidemic on household- and community-level livelihood assets. Although it is difficult to prioritize the indicators in order of their importance, several considerations emerge in the selection of indicators. First, because the preservation and enhancement of human capital is so essential to improving the sustainability of rural livelihoods, reducing poverty and insuring food security, indicators of human capital are viewed as essential to virtually every effort to examine and mitigate the impacts of HIV/AIDS. Second, the type of indicator selected will depend upon whether the focus of the study or mitigation effort is at the household or community level. Different measurement strategies are called for if programmes are aimed at one level or the other. Third, the stage of the epidemic and the prevalence rate of HIV/AIDS should be used to select indicators. Communities with long-term experience and high prevalence rates are not expected to show the same impacts on community-level social or financial capital as a community with low rates and comparatively recent experience with the epidemic. In addition, the level of awareness and perceived seriousness of the epidemic by communities is a factor in the selection of indicators.

Studies of the impacts of HIV/AIDS on rural livelihoods and food security face a number of methodological challenges. The epidemic is only one of a number of factors that threaten rural households. As noted earlier, droughts, floods, shocks to crops and livestock and price fluctuations are just a few of the alternative factors that can alter households' livelihood strategies and negatively affect their capital assets. Use of the indicators identified should only be undertaken with detailed knowledge of the HIV/AIDS-affected communities to be studied. Knowledge of local conditions permits the identification of the major alternative factors likely to be influencing livelihood assets at both the household and community levels. Household surveys can obtain information on these alternative factors and estimate their separate effects from those of HIV/AIDS through a multivariate analysis. Alternatively, communities can be selected in which other important factors are not operating or whose effects are constant across households, thus controlling their effects through the sampling design.

Perhaps a more problematic issue is identifying those households that have experienced an AIDS death or that have one or more individuals currently afflicted with HIV/AIDS. The general level of awareness of the epidemic in a community and the willingness of people to openly discuss HIV/AIDS will influence the measurement strategy and type of indicators used. In some locations, people are able and willing to openly discuss HIV/AIDS. In other places, they are unwilling to admit their HIV-positive status or that they are suffering from AIDS even when they have accurate information about their status. If people are unwilling to attribute illness or deaths to HIV/AIDS, an indirect measurement strategy is recommended. This involves obtaining information on whether or not anyone in the household is suffering from a chronic disease or if anyone has died in the past three years and how long they were ill before they died. In addition, their age and sex should be ascertained. A list of major and/or minor symptoms of HIV/AIDS can be asked for each person who has died or who is suffering from a chronic illness. Although this will result in some misclassification, it should identify the majority of AIDS-afflicted households. Selection of communities that vary in the prevalence of HIV/AIDS is also helpful in measuring adult deaths from this cause.

Impact studies are not an end in themselves, but rather a useful step in identifying mitigation strategies to ameliorate the effects of the epidemic on rural households. The Expert Meeting held at FAO in December 2001 identified a number of mitigation strategies-six of which are included in this analysis. These strategies contain recommendations for programmes ranging from efforts to alleviate household labour constraints caused by AIDS-induced illness and death to institutional reform aimed at strengthening rural institutions and promoting gender equality

.

The impact of the epidemic on household labour represents one of the major losses to the household's human capital assets. Thus, the recommendation is that labour-saving technology should be promoted to relieve the labour constraint. The suggestion has been made that these technologies should save both agricultural and household labour. They include small-farm mechanization, lighter ploughs and tools that can be used by older children, women and the elderly, improved seed varieties that require less labour, intercropping, zero or minimum tillage, improved access to potable water and fuel-efficient stoves that can free women for more economically productive activities. Monitoring and evaluation efforts should be directed toward studying the impacts of these technologies among households that use the recommended practices in comparison to those who do not. Evaluation of the impacts should not stop with ascertaining whether or not a household has adopted a given technology or set of technologies, but whether or not it has had positive impacts on the household's cultivation patterns, crop yields and agricultural production practices.

Knowledge preservation and transmission represents yet another dimension of human capital that is thought to be severely impacted by the epidemic. Thus, extension education programmes, as well as informal community organizations, need to be reoriented toward the information needs of adult-loss households. The ability of household members of both sexes and different age groups to draw up cropping plans, implement animal husbandry practices, maintain cash and food crop production and store grain need to be ascertained if effective mitigation strategies are to be developed. While some programmes have been implemented to address these needs, careful monitoring and evaluation studies are needed to determine their effectiveness.

Rural institutions, along with extended families and neighbours, provide most of the assistance received by AIDS-affected households. Thus, mitigation programmes need to focus their efforts on strengthening rural service providers of all types including education, health, extension, micro-finance, women's associations, irrigation committees and nutrition groups. The presence and effectiveness of these institutions depends upon the social capital extant in rural communities. Given the increased demand for the services stimulated by the epidemic, studies need to monitor and evaluate how communities are responding and attempt to replicate those deemed to be successful. Participatory methodologies using indicators of communities' social capital are recommended to evaluate these efforts.

Gender inequality has been demonstrated to exacerbate the impacts of HIV/AIDS on rural households. Women are not only more physically vulnerable to HIV infection than men, they are also more susceptible to negative social and economic outcomes caused by the epidemic. Upon the death of their husbands, women in many societies lose their access to and control of resources and livelihood assets. Thus, they not only lose the income and support of their husbands, they may also lose access and control of the assets they need to earn a living (land, water, livestock, credit, information and technology). Gender differences in access to and control of the five livelihood assets represents a starting point for evaluating programmes to promote gender equality. No one study should attempt to measure all possible differences in livelihood assets; rather, participatory methodologies are recommended to identify the major dimensions of inequality operating in a local area. Once the more important livelihood assets affected have been identified, indicators to monitor changes can be selected.

I

mproving the nutrition of persons living with HIV/AIDS is important in maintaining their productivity and prolonging their lives. Mitigation efforts range from nutrition education programmes to recommendations for improved crop management practices, nutritional gardens and labour exchange arrangements. Monitoring and evaluation of these strategies necessarily depends upon the mix of programmes and practices that are promulgated. Given the need to monitor and evaluate nutrition programmes in the short-term, indicators such as measures of nutritional knowledge, adoption of recommended practices and technologies, and the mix of crops and livestock produced and consumed by households, may be more sensitive indicators of nutrition mitigation programmes than more direct indicators of nutritional status such as stunting or wasting in children that reflect longer-term processes.

Traditional social and economic safety nets devised by communities to assist residents in coping with shocks to their livelihoods, including HIV/AIDS, are being severely tested by the increased demands generated by the epidemic. It is not known how these institutions are holding up and adapting to the new situation. What happens to households that are unable to contribute their share of labour to traditional labour-sharing practices in communal fields due to the illness or death of one or more of their members? Monitoring and evaluating the operation of traditional safety nets is important if external agencies are to be helpful in mitigating the impacts of the epidemic. These traditional safety nets rely heavily upon community-level social capital. Thus, participatory methodologies, including PRA, key informants and focus groups are recommended to monitor and evaluate the effectiveness of these institutions. Similarly, more direct safety nets such as food aid or food-for-work programmes need to be monitored and evaluated for their effectiveness.

Finally, the recommendation is that evaluation of mitigation strategies focus on only a limited number of livelihood assets and outcomes designed to be influenced. Selection of a small number of livelihood assets focuses the monitoring and evaluation process, leads to the selection of key indicators to measure their impacts and suggests a choice of methodologies to use in studying their effectiveness.

VII. References

Ayieko, M. A. 1997. From Single Parents to Child-Headed Households: The Case of Children Orphaned by AIDS in Kisumu and Siaya Districts. New York, UNDP HIV and Development Programme (available at www.undp.org/hiv/publications/study/english/sp7e.htm).

Carney, D. 1998. Sustainable Rural Livelihoods: What Contribution Can We Make? London, Department for International Development.

DFID/FAO. 2000. Inter-Agency Experience and Lessons: from the Forum on Operationalizing Sustainable Livelihood Approaches. Rome, Food and Agriculture Organization of the United Nations and Department for International Development (also available at www.fao.org/docrep/x7749e/x7749e00.htm).

FAO. 2002. HIV/AIDS, Food Security and Rural Livelihoods. FAO Fact Sheet. Rome, Food and Agriculture Organization of the United Nations.

Frankenberger, T. R. 1992. Indicators and data collection methods for assessing household food security. In: S. Maxwell & T. R. Frankenberger, eds. Household Food Security: Concepts, Indicators, Measurement, A Technical Review. New York and Rome, UNICEF and IFAD Joint Publication, pp. 73-134

Maxwell, S. & Frankenberger, T. R., eds. 1992. Household Food Security: Concepts, Indicators, Measurement, A Technical Review. New York and Rome, UNICEF and IFAD Joint Publication.

Parker, J., Singh, I. & Hattel, K. 2000. The role of micro-finance in the fight against HIV/AIDS. In: Economics and AIDS in Africa: Getting Policies Right, UNAIDS CD-Rom for African Development Forum 2000, Appendix D.

Rugalema, G. H. R. 2000. Coping or struggling? A journey into the impact of HIV/AIDS on rural livelihood in Southern Africa. Paper prepared for the expert meeting on Mitigating the Impact of HIV/AIDS on Food Security and Rural Poverty: A Framework for the Agricultural Sector. Rome, Food and Agriculture Organization of the United Nations.

Topouzis, D. & du Guerny, J. 1999. Sustainable Agricultural/Rural Development and Vulnerability to the AIDS Epidemic. Geneva, FAO and UNAIDS Joint Publication.

Topouzis, D. 2000. Measuring the Impact of HIV/AIDS on the Agricultural Sector in Africa. Geneva, UNAIDS Best Practice Collection.

Topouzis, D. 2001. Strategy Paper on HIV/AIDS for East and Southern Africa. Rome, International Fund for Agricultural Development.

Go back to Part 1



SD Homepage Back to Top FAO Homepage