Education Knowledge

Posted July 1999

Summary of findings and recommendations

HIV/AIDS and the commercial agricultural sector of Kenya:
Impact, vulnerability, susceptibility and coping strategies

by Gabriel Rugalema
Institute of Social Studies, The Hague, Netherlands
with Silke Weigang (FAO/SDRE) and James Mbwika, Consultant
Study prepared and carried out under the guidance of the Extension, Education and Communication Service (SDRE), FAO Research, Extension and Training Division, in cooperation with and funded by UNDP. The full report may be downloaded as a PDF file (550K). To obtain a hardcopy of the report, please e-mail Ms. Ester Zulberti, Chief, SDRE (ester.zulberti@fao.org), or write to: FAO/SDRE, C-616, Viale delle Terme di Caracalla, 00100 Rome, Italy. Fax: (++39-06) 570-53152

Summary of findings

Agro-industry in Kenya severely affected by HIV/AIDS epidemic

Findings of this study will show that the commercial agricultural sector of Kenya is facing a severe social and economic crisis due to the impact of HIV and AIDS. Protracted morbidity and mortality have profound financial, economic, and social costs for industry. The loss of skilled and experienced labour to the epidemic continues to be a serious concern. If agro-estates are to remain viable businesses, it will be necessary and urgent to approach the epidemic with the seriousness it deserves. This includes well-elaborated prevention programmes and concerted mitigation strategies at the company level, in collaboration with other sectors of the economy including the government, NGOs, and civil society.

This comparative study forms an integral part of the Programme Support Implementation Arrangement (PSIA) by the Government of Kenya and UNDP on the Support to Combat the Development Effects of HIV/AIDS, under the title Capacity Building for Enhanced Public Administration and Participatory Development. Due to the strong interest of the Ministry of Planning and National Development, the focus of this study was placed on the effects of the epidemic on the commercial agricultural sector. Accordingly, in various agro-estates the mitigating effects, vulnerability, and coping mechanisms to the epidemic have been studied comparing the situation in East and West Kenya. Finally, the report presents policy recommendations on how to confront HIV and AIDS in the workplace, particularly in the context of agro-estates and the wider Kenyan society.

The objectives of the study are:

The findings confirm that the effects of HIV/AIDS on agriculture in Kenya and on the economy as a whole are alarming. The epidemic severely hits the Kenyan workforce in its prime. Many of the victims are in their 20s and 30s, their most productive years, when they develop AIDS symptoms and begin to fall ill. These severe losses affect an entire generation. Beyond the human tragedy, this situation results in steadily rising costs to companies. These companies also suffer sharp profit losses as a result of the loss of workers and decreased working hours due to illness, death, overwork and stress, attendance at funerals, and home care of ill dependents.

Medical and funeral costs for companies greatly exceed budget provisions. Moreover, terminal benefits, re-training and replacement measures are among the expenses incurred by the epidemic. Labour-intensive companies, such as sugar estates, depend heavily on out-growers (individual farmers' supply of raw cane.) These estates are heavily hit by the loss of reliable workers and farmers to the epidemic. As a consequence, these agro-industries face a decrease in the quantity and quality of their inputs and achieve a poor recovery ratio in their sugar production. Cultivation patterns of some of the affected out-growers have exhibited a shift to the less labour intensive agricultural production of cassava and maize. Much of the fertile land of families hard hit by the epidemic remains idle due to labour force shortages and death.

Findings of the study indicate that:

  1. HIV and AIDS are prevalent on all agro-estates surveyed. Quantifying the impact that the epidemic has on the estates proves quite difficult for two reasons: (1) the widespread attitude of indifference towards the disease, and (2) the poor quality of records kept. Nonetheless, available data indicates that the situation in most agro-estates is grave. HIV prevalence and AIDS cases are higher in agro-estates in Nyanza and Rift Valley Provinces than in the Eastern Province. However, a similar risk environment is found in the Eastern Province and most of the agro-estate workers have temporarily migrated there from Nyanza. As a result, it appears that it is only a matter of time before the agro-estates in the Eastern Province begin to experience high morbidity and mortality levels.

  2. HIV is a significant social and economic problem in the agro-estates. These effects show:

    Example: Medical expenditure of agro-estate C (with and without AIDS)

    The without AIDS curve illustrates the normal increase of medical expenses that agro-estate C was projected to have reached by 1995 (Kshs 5.8 million.) The difference between the two curves is approximately Kshs 68.8 million ($1.15 million), reflecting the costs of providing medical care to employees living with AIDS (1989 to 1995.)

    The relationship between increased AIDS cases and morbidity of the workforce of agro-estate C is also illustrated below. The medical expenditure curve depicts the increase in medical expenses, while the vertical bars indicate newly diagnosed cases of AIDS among company employees. The more AIDS cases the company has, the higher their medical expenses.

    Example (agro-estate C): Relationship between AIDS cases and medical costs

  3. Agro-estates are highly susceptible to the transmission of HIV because their social and economic environments constitute a risk.

  4. Because of their heavy dependence upon human labour and the absence of any clear HIV policy within the workplace, agro-estates are extremely vulnerable to the harmful impact of the epidemic. Four out of the six agro-estates surveyed for this study have no HIV policy in place.

  5. Firm-level coping strategies are, in some instances, ad hoc and reactive rather than proactive. Some of the strategies employed, such as pre-employment HIV testing, are against basic human rights as set forth in the Kenyan AIDS Policy. (Parliamentary Sessional Paper No. 4 of 1997.)

  6. Awareness about HIV and AIDS and knowledge of the basic facts about prevention do exist. Nevertheless, this knowledge is not always put into practice. Transmission of HIV is very high among agro-estate workers. The current approach to education about HIV and AIDS prevention appears flawed. AIDS education in Kenya is based solely on behavioural change (Public Health models), without considering that (sexual) behaviours are a product of the social, cultural, and economic contexts in which they are found. UNAIDS Executive Director, Peter Piot, recently observed that narrowly conceived medical and behavioural interventions alone will not halt the spread of HIV. Instead, economic intervention must be part of the overall strategy.

  7. The effects of the epidemic are largely of an economic nature and go well beyond the concern about company financial losses. The Government of Kenya must seriously consider redirecing resources in order to counter the rapid spread of HIV and AIDS. The current effects of HIV on production units throughout Kenya, from the household level up to the corporate level, must also be addressed.

Case: A recently afflicted household

Before his death in July 1998, Omolo was, by local standards, a millionaire farmer. His household earned much of its income from cane farming. They also had livestock from which they obtained money, manure, and milk. As a successful man, Omolo was married to four wives (Akinyi, Agita, Bita, and Maria), all of whom lived (and still live) in one compound. The women, now widows, farmed the land and produced subsistence crops including maize, sorghum, tubers and legumes.

Three years before his death, Omolo inherited a wife whose husband had died of a 'long illness'. All four of his wives were fiercely opposed to the inheritance of the new wife; they banded together to reclaim him. Informants claim that, in protest, the four wives stripped themselves naked at the home of the widow being inherited by Omolo. In the eyes of many of their people, the four wives had committed an inexcusable offense, punishable by 'chira'. Two years later, Omolo began to fall sick and later died of a 'long illness...', according to one of the widows. Claims that Omolo died of 'chira' abound in the village. Omolo is survived by a number of children. The eldest daughter is married and has a young child. The four widows are still young and have their mothers living with them; each has children. The youngest child is hardly two years of age and is visibly sick. The widow who talked to us, on behalf of her co-wives, was emaciated, had dry skin, and a consistent dry cough, which would suggest a TB infection.

At the time of our visit, three of Omolo's young brothers, all of whom are under 30, were staying in the compound. Their presence in the compound may be explained by the fact that the funeral was still going on, or perhaps because the process of internal negotiation of 'who will inherit whom' had begun.

During Omolo's prolonged illness, most of the household labour was withdrawn from farming. Farm plots around the household had crops smothered by weeds, the bright purple colors of striga [2] abundant, if not eye catching. Much of the current year's crop had been destroyed because the women, while caring for their critically ill husband, had been unable to find the time to weed. A few heads of sorghum were being dried on a patch of ground in front of one of the houses; the widows informed us that they were all that they had managed to harvest. Considering the number of people living on the compound, the harvested grains would last them no longer than a week while, in the meantime, income from cane had dried up.

Following the findings, two sets of recommendations have been made based on the analysis. One set comprises recommendations to be implemented by companies (agro-estates), while the other set addresses the Government of Kenya in co-operation with other stakeholders, including civil society and donors.

The key to maintaining the commercial viability of agro-estates is to reduce operational costs incurred by HIV and AIDS and to formulate sound workplace HIV prevention programmes. The report emphasises the cross-sectoral nature of the HIV epidemic and recommends that realistic prevention programmes and mitigation strategies be implemented in collaboration with various stakeholders in Kenya. An elaborated set of recommendations is summarized below and is presented, in its entirety, in Section 5 of the report.

Figure: Conceptual map of the impact of HIV/AIDS on a business firm


Recommendations

Kenya's GDP will be 14.5 percent lower than projections without AIDS-related costs included. Per capita income will decrease by 10 percent. (Hancock et al., 1996)

The above calculation depicts the frightening scale of the HIV epidemic on the economy of Kenya. The epidemic is eroding the foundation of Kenya's present and future prosperity. The severe impact that the HIV epidemic has had on the agro-estate sector and its long-term implications for Kenya's social and economic development, heightens the need for strong, well co-ordinated policies. Such action is necessary in order to prevent further harmful socio-economic effects of the epidemic and to mitigate those already present. In response to the deepening impact of the epidemic on society, the Government of Kenya has articulated its priorities and strategies aimed at combatting the epidemic and its harmful effects (Parliamentary Sessional Paper of 1997.) The strategies articulated by the Government are twofold: (1) to prevent the transmission of HIV, and (2) to reduce the impact of the epidemic on society. The present study has revealed that the HIV epidemic is a significant threat to agro-estates and, subsequently, to the economy of Kenya. Therefore, there is an urgent need to prevent the transmission of HIV and to address the adverse impact of the epidemic on the sector and the nation. It is in this context that the following recommendations are made:

1.1. The agro-estate sector

1.1.1. Convening an Urgent National Workshop on AIDS

There is an urgent need to convene a National Workshop on How to Mitigate the Impact of the HIV Epidemic on the Commercial Agricultural Sector in Kenya. The workshop should aim to bring together participants from various parts of Kenyan society, including:

  1. the Government of Kenya (Ministries responsible for Planning and National Development, Agriculture, Livestock, Trade and Commerce, Health, Labour, Social Welfare);

  2. the agro-estates and other business sectors, individually, or through umbrella organizations ( e.g., Kenya Association of Manufacturers);

  3. key research institutions, such as the Kenya Agricultural Research Institute (KARI) and the Kenya Medical Research Institute (KEMRI);

  4. key institutions responsible for AIDS watch, particularly NASCOP;

  5. NGOs working on HIV and Rural Development (e.g., KANCO, Action AID, FARD, AMREF, Family Health International, etc.);

  6. representatives of civil society (including religious groups);

  7. members of Parliament; and

  8. representatives of bilateral and multilateral development agencies.

Workshop organising committee. It is recommended that the Ministry of Agriculture and Ministry of Planning and National Development, in collaboration with some of the agro-estates (particularly those covered by this study), take the initiative of organising the workshop. Some NGOs (e.g., KANCO) and multilateral agencies should be co-opted into the workshop organising committees.

Focus of the workshop. The workshop should focus on the HIV epidemic as an immediate threat which has already had a disastrous impact on Kenya's agro-estate sector (as revealed by the findings of the present study and by Roberts et al., 1996). It must be stressed that the HIV epidemic and its effects are systemic on the commercial agricultural sector as well as other sectors of the economy. The workshop should serve as a forum to disseminate the findings of the present study and related studies (Forsythe, Rau, et al., 1996) and to hear directly from agro-estates about the effect of the epidemic on their operations. As part of the overall strategy, several managers from the agro-estates in Kenya should be requested to make brief presentations about the effects that the epidemic has had on their businesses.

Workshop participants should discuss a multi-sectoral framework in which to confront the epidemic as a developmental and a public health problem. It is recommended that the workshop form a BUSINESS TASK FORCE on AIDS. The Task Force should be made up of not more than seven people, representing a variety of stakeholders and drawn from the public and private sectors, as well as from civil society. The objective of the task force would be to create and sustain a structure through which the HIV epidemic could effectively be addressed as a business and work place issue. The task force should also be a forum through which businesses could discuss and share their experiences on the effects of the epidemic and strategies for prevention and mitigation.

The task force would serve its clientele by:

  1. providing access to national and international sources of information and education on HIV epidemic,

  2. acting as a springboard for further discussion and debate on practical issues in response to the epidemic as a business and workplace issue, and

  3. creating a mechanism for identifying locally-relevant examples of good practices to be adopted by agro-estates and other businesses in Kenya.

Once formed, the task force could approach UNAIDS (Nairobi office) for technical support in gathering/collecting information on workplace best practices on AIDS. For example, the business sector in Botswana (both private and public) has already formed a well-run umbrella body to address HIV as a workplace problem. The Nairobi office could facilitate communication between the Botswana Business Coalition and AIDS and the Kenya Business Task Force on AIDS.

In its 1999-2003 Strategy Paper, the Kenyan UN Theme Group on AIDS proposes allocating some of its funds to strengthen the capacity to manage HIV-related activities. We are recommending that the UN Theme Group be approached and requested to fund the workshop and to provide initial resources for the proposed task force. However, the long-term sustenance of the Kenya Business Task Force on AIDS lies with the business sector itself, which should own and run HIV programmes for the good of its own businesses and the nation.

1.1.2. Safeguarding commercial interests and viability within the agro-estate

The findings of the present study clearly indicate that the HIV epidemic is affecting agro-estates through loss of productivity, inability to plan for human resources, high labour costs, and loss of profit. There is a need for companies to address these effects in order to protect the interest of employees, shareholders, and the government. There is an urgent need to arrest the increasing trend of morbidity, mortality and associated costs. This could be achieved through the following actions:

Reduction of direct cost of illness and funerals. It must be emphasised that agro-estates will be forced to reduce operational costs wrought by HIV-induced morbidity and mortality in order to remain productive, profitable and competitive. One solution to decrease funeral costs would be to transport terminally ill employees to their place of birth before a funeral is necessary. However, this option would simply push costs on to the families. More humane options include conducting funerals on weekends rather than weekdays. This would ensure a minimal disruption of the work week and would facilitate attendance by official mourners, who would be off duty. With this option, attendance at funerals would not interfere with normal employment-related duties. All such changes should be closely negotiated with trade unions and burial associations to avoid potential sources of industrial conflict.

Another option is to offer contracts to outside suppliers, who may provide needed services at a lower prices. Positions such as employee gatekeepers, cleaners, and security guards do not need to be agro-estate employees; these positions could easily be outsourced. Since firms would not employ these people directly, they would be able to decrease their accountability for illness and disability benefits. This, of course, would benefit the outsourcing firm and the company. The cost of the service would be shifted to another socio-economic unit. The disadvantage for this option is that, while social and health coverage for employees may decrease, the outsourced employee's exposure to situations of risk may increase.

Almost all employees living with HIV seek medical care in hospitals and health centres, and this is costly for the family and the agro-estates. Only one of the five agro-estates we visited has a home care programme, and this one example had only recently been established. We recommend that agro-estates establish home-care-based programmes for employees living with AIDS. Home care programmes have been found to be effective in terms of costs and quality of care in agro-estates of Zimbabwe (cf. Kay 1997). It would be useful for agro-estates in Kenya to benefit from lessons learned within Kenya and other countries such as Zambia (the Chinkankata Salvation Army Model), Botswana (Bobirwa Home Care Model) and Zimbabwe (Zimbabwe Commercial Farmers Union Model). Appropriate parts of such models could be considered for adoption.

A good home-based care model has the following features:

  1. A person living with AIDS is cared for at home, in a congenial environment.

  2. Nursing support is made available to caregivers for the hygiene, nutrition, emotional, and other needs of the person living with AIDS.

  3. Material and financial support is provided (if there is the need).

Within Kenya there are a number of home care programmes upon which agro-estates could build their programmes. These include Crescent Medical Aid (based in Nairobi) and C.P.K. Kibera, Kikuyu Mission Hospital. These and other home care programmes for people living with AIDS are well known to KANCO and AMREF. Agro-estates, either individually or through the task force, could directly approach these home care programmes or request more information from KANCO and AMREF.

Development of a comprehensive workplace policy on HIV. This study has shown that only one of the five agro-estates interviewed has a workplace policy on HIV that is based on the WHO/ILO 1988 guidelines. This low percentage of Kenyan companies with HIV programmessuggests that the epidemic has not been accorded the attention it deserves. If companies are to avoid fear, low morale, overwork, and low productivity, there is a need to formulate such policies. Workplace HIV programmes should take into account the concerns of employees and employers. Policies and programmes will not be effective if imposed by a top-down approach or if introduced from the outside, without adequately tailoring the program to the individual needs of the estates. Instead, the formation of HIV policies and programmes should result from extensive dialogue and consultation between NGOs, management and employees. Such policies and programmes should cover issues such as:

1.2. Other stakeholders

Analysis has shown that the effect of HIV on agro-estates has implications on the entire economy of Kenya (see Figure 12, page 8). To the extent that the effect of the epidemic is systemic, there is an urgent need for other stakeholders, ranging from the government, bilateral and multilateral agencies to NGOs and civil society, to prevent the consequences of the HIV/AIDS epidemic. The following set of recommendations is intended for these other key players in Kenyan society. Although a focus-in-time perspective has been placed in the following section, all stakeholders should play a crucial role in short-term and long-term action.

1.2.1. Short-term action

Ministries should appoint focal points on AIDS. As has already been stated by the Sessional Paper on AIDS, ministries should appoint one or more of their senior professional staff to serve as focal points on HIV. In order to legitimise efforts to confront the epidemic and to have a focused and co-ordinated approach to the problem, this is highly recommended. Given the focus of this study, focal points should include the ministries responsible for Agriculture, Planning and National Development, Health, Labour, Rural Development, and Women and Child Welfare. The responsibility of a focal point on AIDS is to ensure that there is an integration of HIV and AIDS into the core work of the ministry and to co-ordinate such activities within. These focal points would ensure that ministry concerns are brought to the attention of the National AIDS Council (NAC), a body proposed in the Sessional Paper. The Government of Kenya has certainly seen the importance of having such focal points in different sectors and departments.

Accordingly, the Government states that, Government ministries, parastatals, NGOs, and private sector will create focal points in line with budgets for AIDS control within their organisation (see Parliamentary Sessional Paper of 1997). The key issue is for the focal points to co-ordinate programmes of individual ministries and to network among themselves so as to ensure programmes are consistent and mutually supportive.

Review policies and programmes with the view of internalising the effects of HIV epidemic. Once focal points on AIDS are chosen and the National AIDS Council is established, the immediate task should be to initiate a process to review existing policies and programmes and to internalise the effects of the epidemic at the national level. Tasks for some of the ministries are as follows:

Donor agencies (multilateral and bilateral). There is an urgent need to place HIV assistance at the core of country programmes. Donor agencies have to ensure that programmes and projects are inherently strategic to address the socio-economic issues that make the Kenyan economy vulnerable to HIV and AIDS and susceptible to their impact. The UN system in Kenya already has a Theme Group on AIDS. The theme group should have a constant dialogue with the proposed focal points and the National AIDS Council, in order to implement activities that are a priority to the government.

1.2.2. Medium- and long-term responses to addressing the HIV/AIDS epidemic through appropriate developmental policies

Government of Kenya. In the medium- and long-term perspectives, the Government of Kenya (through its various ministries and key research institutions) should address the socio-economic factors that render the Kenyan society, including those working in agro-estates, vulnerable to HIV infection. This research has identified such factors as food insecurity, poverty, unemployment (especially among the youth), and gender inequality as contributing to the spread of HIV. Through the Social Dimensions of Development, the government needs to focus on policies that would address issues of food insecurity, poverty and unemployment. This could be done through: (1) support to income-generating micro-enterprise programmes, especially those focusing on youth and women; and (2) support for micro-credit programmes to assist those willing to start income-generating, self-employed projects that do not qualify for formal sector financial loans. Some of these issues are discussed below:

Civil society, NGOs and research institutions. Civil society in Kenya has an immense role to play in HIV/AIDS prevention and mitigation programmes. Every effort should be made to mobilise people at the grassroots, so that they participate actively in AIDS activities, in particular, and the development process, in general. To do this, the government, NGOs, and donor agencies have to avoid the conventional top-down approaches of the past. AIDS sensitisation campaigns will have be conducted in a participatory manner; for example, conducting Participatory Rural Appraisals (PRAs) to assess the rates of morbidity, mortality, and impoverishment in the epidemic. This should be followed by needs assessments of local people in terms of information on AIDS and resources needed for the mitigation of impact. PRAs also provide room for facilitators and local people to boost confidence in their ability to act on determinant situations of risk. Social mobilisation should be done through existing institutions and organisations such as women's groups, youth groups, religious groups, village barazas [3], and other village-level groups.

Both modern (print and electronic) as well as traditional (folk dance, drama, etc.) media have a key role to play in the prevention and mitigation of HIV/AIDS. It is recommended that the Government of Kenya, NGOs and other institutions and organisations should mobilise and make good use of the media in disseminating information on HIV and AIDS and spearheading public discussion on strategies to confront the epidemic.

The challenge to the Ministry of Health, NASCOP and other partners - particularly NGOs - is to produce AIDS information in a participatory manner. There should be active involvement of those to whom the information is intended so that it takes into account gender relations and other social and cultural factors within the intended audience.

So far, AIDS education has been largely targeted to adults, because they, being sexually active, are the ones considered at risk. However, this study has yielded evidence to show that teenage children are also at risk because, contrary to expectation, they are sexually active at an early age. Thus, the challenge is to develop information on HIV and AIDS that would be targeted to young age groups, including education about basic life skills, values of society, and responsible citizenship. Perhaps the best place to start is to incorporate such an integrated HIV and sexual health education into the school curricula as early as Standard Four. Education on HIV/AIDS prevention should also be part of the curriculum development in institutions for (agricultural) technical training and general higher education. Contrary to the myth that sex education leads to promiscuity, experience documented in research studies indicates that it encourages responsible sexual behaviour (see Verkuyl, 1998).

Today, little is known, for example, about the impact of AIDS on the orphaned in Kenya. There is no information pertaining to the number and whereabouts of AIDS orphans. Such information is necessary if one has to plan for orphan activities including education, access to health care, etc. Certainly, a good number of orphans are adopted within family networks. However, it is not self evident that extended families have an inexhaustible capacity to absorb the growing numbers. There is urgency for needs assessment and enumeration of orphans, and for a study on the capacity of extended families to absorb them. UNICEF and the Ministry of Education need to make sure this is done soon.

Equally, there is a need for research on the capacity of agricultural research and extension institutions, to respond to the demands imposed by the epidemic on smallholder as well as commercial agriculture, as discussed above. Thus, the Ministry of Agriculture, FAO, and KARI would have to conduct a study to assess the possible technological and extension responses to the epidemic. Research studies on socio-economic determinants of situations of risk need also to be sustained through the support of agencies, such as the UN Theme Group on AIDS in Kenya, bilateral agencies and NGOs.

Finally, all individual recommendations are intended to be integrated into a holistic response to combat the devastating effects of HIV/AIDS on the commercial agricultural sector in Kenya, in order to ensure the welfare of the workforce, as well as to safeguard viable economic interests in the sector. With such an integrated response, further rural development and economic prosperity could take place, given that action is taken early on (see Annex 1 of the Report for a Summary Table of Recommendations).


Notes

1. Chira is an affliction that befalls an individual and/or members of the family because of breaking a taboo. Jinni is being understood as a magical spirit to inflict injuries to one's enemies.

2. Striga hermonthica is a main problem (as a weed) among crops belonging to the grass family (Graminae), which include maize, sorghum, and millet.

3. A baraza is a meeting summoned by a Chief.


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* Essential reading for anyone interested in micro- and macro-economic effects of HIV in Kenya


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