Once a largely urban problem, AIDS has moved to rural areas in developing countries, devastating thousands of farming communities and leaving impoverished survivors scarcely able to feed themselves. The disease is no longer a health problem alone, but is having a measurable impact on food production, household food security and rural people's ability to make a living.

The latest statistical evidence issued by the Joint United Nations Programme on HIV/AIDS (UNAIDS) on sub-Saharan Africa -- the worst-hit region -- confirms the scale of the epidemic's impact on the countryside.

UNAIDS estimates that over half of the 28 million people living with HIV/AIDS in sub-Saharan Africa live in rural areas. In order to estimate such figures, UNAIDS epidemiologists start with data taken from tests done on blood samples from pregnant women attending prenatal clinics. They then extrapolate the figures to estimate infection rates in larger areas. Recent findings point to two of the hardest-hit countries:

  • Zimbabwe, where the 2000 prevalence survey showed that 31.4 percent of pregnant women living in rural areas were HIV positive. Women who listed their residence as "farm" registered a 43.7 percent prevalence rate. Such figures mean that over 1 million people in rural areas have HIV/AIDS in Zimbabwe.

  • Swaziland, whose 2000 surveillance survey showed that 25 percent of the women who listed their occupation as "subsistence farming" were HIV positive. Overall prevalence among pregnant women in rural areas was 32.7 percent. Such figures mean that over 100 000 people in rural areas of this small southern African country, out of a total population of 938 000, have the virus.

"This is a real wake-up call for governments," says Marcela Villarreal, FAO focal point on AIDS. "Policy-makers are guided by evidence. Solid evidence is now coming in and will make governments understand how rural areas are actually more vulnerable to AIDS than urban areas."

Recent reports from other African countries show a similar pattern of rampant rural infection.

In an FAO-supported study commissioned by Uganda's Ministry of Agriculture, Animal Industry and Fisheries, researchers surveyed 300 households in five rural districts in late 2001. The majority of the households (91 percent) had lost a family member in the preceding 10 years, mostly in the 20-35 age bracket. AIDS caused 56 percent of the deaths.

Study author Narathius Asingwire, of Makerere University in Kampala, says that the deaths of so many farmers in the prime of life has far-reaching implications for the country, since agriculture accounts for 43 percent of GDP, 85 percent of export earnings and 80 percent of employment. In addition, 85 percent of Uganda's 22 million people live in rural areas and depend mainly on agriculture.

Asked to comment on the effects of HIV/AIDS in their households, two thirds of households replied that they now grow less food, over two thirds reported producing fewer cash crops and over half said they were eating less. The following statistic spells trouble for the many rural landless who depend on casual farm labour to survive: 85 percent of respondents said they were using less farm labour.

Survey respondent Paulo, 80, supports five young grandchildren orphaned by AIDS. He has a banana plantation, but the biggest part is overgrown with weeds due to lack of labour. There has been a sharp reduction in food consumption among his family members -- they now only get one full meal a day, in the evening, eating just some porridge for lunch.

"Even now when I am still alive, we do not have enough to eat," says Paulo, who is ill and cannot work to augment the family income. Pointing to the youngest grandchild, he says, "You can see that young one is gloomy not because he is sick or has been punished, but because he has not eaten anything since morning."

In Kenya, the latest figures from the Ministry of Agriculture and Rural Development predict that the total number of lost workdays in the agricultural sector due to HIV/AIDS will reach 329 000 person years in 2020, if present trends continue. In 1990 the figure was 45 000 person years.

The district of Bondo in western Kenya has been particularly hard hit by the virus, with about 29 percent of the population infected, according to a 2000 survey, says Kenneth Ayuko, leader of an FAO community support team in Kenya. In some communities, as many as half of the adults are HIV positive.

"We have grandparents having to take care of up to 20 or even 30 orphans, and that takes a very big toll. Therefore, it is probably correct to say that food production under these circumstances of the HIV/AIDS pandemic is not possible," he says. "No wonder that the bulk of the population in Bondo is going hungry."

Poverty underlies the suffering and devastation behind these figures, says Ms Villarreal. "The HIV/AIDS epidemic cannot be addressed without doing something about rural livelihoods: how people make their living, how they get enough food, what strategies they follow in order to survive," she says.

FAO is currently formulating pilot projects that will test labour-saving techniques and low-input agriculture in African and Asian communities hard hit by the epidemic. Other priorities for the FAO HIV/AIDS programme include building up institutions that help rural communities, improving nutrition, addressing gender inequalities in access to productive resources (especially land) and helping decimated communities find a way to pass on farming knowledge to the young.