This study was carried out by the National Agricultural Advisory Services of Uganda (NAADS) with the support of FAO's Integrated Support to Sustainable Development and Food Security Programme (IP). It was designed by IP, in conjunction with NAADS, and has the main objective of providing in-depth assessment and analysis of the non-health effects of HIV/AIDS on individuals, households and communities. The study pays particular attention to the disease's impacts on rural livelihoods and food security in the mixed agriculture, fisheries and pastoral subsectors. It also identifies existing and potential coping strategies for mitigating the impacts, and recommends ways of adopting and supporting the most effective of these. It is envisaged that the study's findings can be extrapolated to all parts of Uganda.
Agriculture is the dominant sector in Uganda's economy, supplying 80 percent of employment, 43 percent of gross domestic product (GDP) and 90 percent of foreign exchange earnings. The sector is dominated by food production, and most produce is consumed at the household level.
The study was based on a survey of smallholder agricultural rural households at six sites (agricultural communities) in the Lake Victoria Crescent agro-ecological zone. The six sites were selected with the aim of capturing data that represent each of the mixed, fisheries and pastoral agricultural subsectors. Both qualitative and quantitative data were collected and analysed via a process that involved a questionnaire-based survey of household heads, as well as participatory rural appraisal (PRA) through focus group discussions (FGDs). The 631 households selected included both HIV/AIDS-affected and non-affected ones, as well as a cross-section of different household structures (male-, female-, widow-, widower- or orphan-headed, and households that foster orphans). Overall, about 63 percent of the survey households were affected, and 37 percent non-affected; 73 percent were male-headed, and 20 percent female-headed; and 78 percent were engaged in mixed farming, 11 percent in fisheries, and 11 percent in pastoral production. Households were asked to provide comparative data for the five-year period from 1997 to 2002.
The study assessed the numbers and proportions of people to fall ill or die as a result of HIV/AIDS. It also identified the impacts that HIV/AIDS-related illness and death have on a household, particularly in terms of changes in productive and reproductive activities and the affects of these on income and food security. At the time of the survey, of the 3 879 people in the study population, 328 (9 percent) were ill, 85 of them (26 percent) with HIV/AIDS and related illnesses. A total of 486 people had died over the previous five years, more than half of them (54 percent, or 262 people) from HIV/AIDS and related illnesses.
Most households were found to depend mainly on the sale of household assets to meet the costs of HIV/AIDS-related sickness and death. This was often supported by assistance from relatives and members of the community. Other major impacts were: reduced food consumption, in terms of both quantity and quality; reductions in herd size or in the area of land cropped; the use of fewer crop varieties; the abandonment of specific activities and crops; and the removal, or stripping, of assets by relatives from outside the household. Some affected households shifted from labour-intensive to low labour-input agricultural crops and activities and, in virtually all, surviving members had to assume a wide variety of additional tasks.
The result of these changes is usually a spiral of decreased income and food security, with orphan-headed households being particularly vulnerable to food insecurity. HIV/AIDS-affected households find it difficult to adopt recommended agronomic practices that boost production and the quality of produce, and have less money to invest in farm inputs and implements; they have less time to carry out their productive and reproductive tasks and so often have to rely on hired labour, which needs to be paid for; and they risk losing the assets they put up as collateral for loans that they subsequently cannot repay or service. Other results include: shifting gender roles, as men and women are forced to assume tasks that used be done by the other sex; high school dropout rates, as children abandon their studies in order to help ensure household income and food supply; and changing family sizes, as orphans are fostered or children from vulnerable households are sent to stay with less vulnerable relatives outside their communities.
In assessing households' awareness of the linkages between HIV/AIDS and nutrition, the study found that families in the mixed and fishing communities had high awareness, but were unable to prepare special meals for sick household members because of competing demands over limited financial resources and time. In the pastoral community, however, households appear to have only very limited awareness of HIV/AIDS-nutrition linkages. There is no established food support or aid system in any of the communities surveyed, and it was also found that traditional support systems (where they existed) were falling into disuse as a result of increased demand and decreased resources.
Traditional knowledge and agricultural practices are being lost when experienced member of the community die. The dissemination of new techniques is also being hampered by affected households' difficulties in attending extension seminars, by their short-term planning horizons and by the death of knowledgeable extension staff.
Several institutions have emerged as a result of the pandemic, while others have collapsed. The institutions to emerge deal with HIV/AIDS counselling, nutrition education, and helping sick members to cope with stigma from the general community. Those that collapse usually do so as a result of the death or ill health of founding and other key members. Some self-help rural institutions have emerged, including groups that pool and share their own labour, and funeral banks that help bereaved families with burial costs. In other cases, however, previously established mutual assistance networks, such as those between fish traders and fishmongers, have collapsed as a result of death and disease.
Affected households and communities have devised several coping strategies to counter the effects of death and disease. These strategies can be classified into labour-related, nutrition-related and income-related. However, although they attempt to mitigate the negative impacts, they are often little more than survival strategies and rarely have significantly helpful results. In order to address the impacts of HIV/AIDS, a concerted effort is needed that takes a multisectoral approach and involves stakeholders from all levels - including government, non-governmental organizations (NGOs) and development partners - in finding and supporting ways of combating the disease.