COMMITTEE ON WORLD FOOD SECURITY
Rome, 28 May - 1 June 2001
THE IMPACT OF HIV/AIDS ON FOOD SECURITY
II. GLOBAL DIMENSIONS OF THE EPIDEMIC
III. HIV/AIDS AND THE DETERIORATION OF FAMILIES AND RURAL COMMUNITIES
IV. EFFECTS ON THE AGRICULTURE SECTOR AND RURAL ECONOMIES
VI. BUILDING EFFECTIVE RESPONSES TO THE HIV/AIDS EPIDEMIC IN SUPPORT OF FOOD SECURITY
A. GUIDING PRINCIPLES FOR RESPONDING TO THE HIV/AIDS CRISIS
B. common constraints to effective action
C. ELEMENTS OF A FRAMEWORK FOR COMBATING HIV/AIDS AND PROTECTING FOR FOOD SECURITY
D. ROLE OF THE FOOD AND AGRICULTURE ORGANIZATION
1. Throughout history, few crises have presented such a threat to human health and to social and economic progress as does the HIV/AIDS1 epidemic. This is even more troubling given the realisation that much of the suffering and destitution caused by the disease could have been prevented. Hopefully, with concerted action lives can still be saved, suffering reduced, and the impoverishment that often accompanies this disease minimised. Still, the global HIV/AIDS epidemic will have widespread adverse effects on social and economic development for years to come. HIV/AIDS can no longer be considered solely as a health problem; sufficient efforts are needed to address its social, economic and institutional consequences. Increasingly, the HIV/AIDS epidemic is having a major impact on nutrition, food security, agricultural production and rural societies in many countries. All dimensions of food security - availability, stability, access and use of food - are affected where the prevalence of HIV/AIDS is high.
2. This paper presents the major challenges confronting individuals, communities and nations. The estimates of the disease prevalence and patterns of the spread of the infection are examined and common coping mechanisms of households and demise of communities affected by HIV/AIDS are described. The implications of this deterioration for agricultural production and the impact on national economies are highlighted. This analysis is followed by a discussion of actions for and constraints to alleviating the situation. Approaches to addressing this urgent problem are suggested and guidance on the role of FAO is sought.
3. Currently it is estimated that some 36 million people worldwide are infected with the HIV virus, 95 percent of whom live in developing countries. The number of people estimated to have been living with the virus by region in 1999 is shown in Table 1. Tragically, the prevalence of the disease is still increasing. Since the disease commonly strikes the most economically productive members of society, HIV/AIDS is a problem of critical importance for agricultural, economic and social development. As illustrated in Figure 1, HIV/AIDS is a truly global epidemic. India with over four million people infected has the largest population living with HIV, but regionally the magnitude of the epidemic is greatest in sub-Saharan Africa where more than 24 million people are infected with the virus.
Table 1: Estimated number of people living with HIV/AIDS worldwide (1999)
|Region||Number infected||Proportion of adults infected
|East Asia & Pacific||530,000||0.06|
|Australia & New Zealand||15,000||0.13|
|South & South-East Asia||5,600,000||0.54|
|Eastern Europe & Central Asia||420,000||0.21|
|North Africa & Middle East||220,000||0.12|
Source: UNAIDS 2000
4. In some instances the rapid spread of the infection is a critical element of the disaster that makes efforts to cope with its effects very difficult. For example, in 1984 less than 1 percent of Botswana's adults were infected, by 2000 the prevalence rate had soared to 35 percent (see Figure 2).
Figure 2. Spread of HIV 1984-1999
5. HIV/AIDS can have devastating effects on household food security2 and nutrition. Nutritional status is determined by various factors, often categorised into household food security, health and care - all are affected by HIV/AIDS. The specific impact of HIV/AIDS is related to the livelihood systems of affected households and will vary according to their productive activities (agricultural and non-agricultural) and the economic and socio-cultural context in which they live.
6. Direct impact on households: Classically, a downward spiral of the family/household's welfare begins when the first adult in a household falls ill. There is increased spending for health care, decreased productivity and higher demands for care. Food production and income drop dramatically as more adults are affected. Once savings are gone, the family seeks support from relatives, borrows money or sells its productive assets. One study in Uganda showed that 65 percent of the AIDS-affected households were obliged to sell property to pay for care. Frequently, children are forced to discontinue schooling, as the family needs help and cannot pay school expenses. Time dedicated to child care, hygiene, food processing and preparation is sacrificed. When the AIDS patient dies, expenditures are incurred for the funeral and the productive capacity of the household is reduced. According to a study in Tanzania, funeral expenses represented about 60 percent of the direct costs associated with an AIDS victim.
7. In the next stage, the partner becomes sick and the downward spiral accelerates. The household is eventually reduced to impoverished elderly people and children. These individuals may have limited decision-making power and access to resources, as well as less knowledge, experience and physical strength which are required to maintain a household. Relatives may be unable to care for children whose parents have died. In some areas, the percentage of orphans ranges from 7 - 11 percent. (in contrast to 2 percent in less affected areas).
8. Gender issues: Women are especially vulnerable in HIV/AIDS-affected households. Usually, they care for the sick and dying in addition to maintaining heavy workloads related to provisioning and feeding the household. Women are more likely to be illiterate, of lower socio-economic status and have fewer legal rights, which combine to limit their access to resources and social services. In some societies, socio-cultural practices, such as a widow not being able to maintain access to or benefit equitably from the property of her deceased husband, may further aggravate problems. Poverty, tradition and social pressure tend to limit women's ability to express their wishes regarding choice of sexual partners and "safer-sex" practices. Low-income, income inequality, and low status of women are associated with high levels of HIV infections. Biologically, females are at greater risk of being infected.
9. Nutrition impact: In households coping with HIV/AIDS, food consumption generally decreases. The family may lack food and the time and the means to prepare some meals, especially when the mother dies. Research in Tanzania showed that per capita food consumption decreased 15 percent in the poorest households when an adult died. A study carried out in Uganda showed that food insecurity and malnutrition were foremost among the immediate problems faced by female-headed AIDS-affected households.
10. For the patient, malnutrition and HIV/AIDS can form a vicious cycle whereby undernutrition increases the susceptibility to infections and consequently worsens the severity of the HIV/AIDS disease, which in turn results in a further deterioration of nutritional status. Even when a person does not yet show disease symptoms, infection with the HIV virus may impair nutritional status. The person may lose their appetite, be unable to absorb nutrients and become wasted.
11. Good nutrition is important for disease-resistance and may improve the quality of life of AIDS patients. The onset of the AIDS itself, along with secondary diseases and death, might be delayed in individuals with good nutritional status. Nutritional care and support may help to prevent the development of nutritional deficiencies, loss of weight and lean body mass, and maintain the patient's strength, comfort, level of functioning and self image.
12. In most countries, AIDS medication and special nutritional supplements are neither widely available nor affordable. While nutritional counselling has an important role in the assisting HIV/AIDS patients, better access to drugs and medical care is also essential. Improving the nutritional status of HIV/AIDS patients can also help improve the effectiveness of treatment if it is available.
13. Breakdown in informal institutions and culture: Informal institutions, customary practices and tradition are affected by HIV/AIDS. When a high proportion of households is affected, the traditional safety mechanisms to care for orphans, the elderly, the infirm and the destitute are overwhelmed. People have no time to devote to community organisations. The effects on informal rural institutions are creating a crisis, particularly among the extended family and kinship systems. This has implications not only for the spread of HIV but for the viability of rural institutions.
14. The widespread loss of active adults affects the entire society's ability to maintain and reproduce itself. Mechanisms for transferring knowledge, values and beliefs from one generation to the next are disrupted, and social organization is undermined. Agricultural skills may be lost since children are unable to observe their parents working. Due to gender divisions, a surviving parent is not always able to teach the skills and knowledge of the deceased partner. Within a rural household, there is a marked difference in impact depending on whether the man or woman is affected first by the HIV virus. In effect, widespread HIV/AIDS can tear the very fabric of a society.
15. Poverty and the disease: HIV/AIDS takes an especially heavy toll on the poor. Affected rural families commonly shift to off-farm income earning activities such as small-scale trading, processing and servicing, which requires access to urban or peri-urban communities. People may migrate in search of employment, or may look for rapid income, which can lead to high-risk behaviours such as drug abuse or involvement in prostitution. The consequences of poverty thus increase the risk of infection, and the disease in turn exacerbates poverty.
16. Whole communities thus become food insecure and impoverished. For instance, in some highly affected communities, there has been an irreversible collapse of the social asset base. It may be difficult to overcome this without assistance. Yet, the epidemic has a significant effect on formal institutions and their abilities to carry out policies and programmes to assist rural households. Institutions may suffer considerable losses in human resources when staff and their families are infected with the HIV virus. Care for sick family members, attendance at funerals and observation of mourning times reduces the work output. Skilled staff are often the first to be affected by the epidemic. The disruption in services further aggravates the difficulties in meeting the needs of an HIV/AIDS affected population.
17. In most of the highly-affected countries, agriculture provides a living for the large majority of the population. Agriculture, particularly food production, is affected in several ways by HIV/AIDS. First, there is a toll on the agricultural labour force. FAO has estimated that in the 27 most affected countries in Africa, 7 million agricultural workers have died from AIDS since 1985, and 16 million more deaths are likely in the next two decades. In the ten most affected African countries, labour force decreases ranging from 10-26 percent are anticipated (see Table 2).
|Table 2: Impact of HIV/AIDS on agricultural labour force
in the most affected African countries
(Projected losses in percentages)
|Central African Rep||6.3||12.6|
18. In Ethiopia, a study found that AIDS-afflicted households spent 50-66 percent less time on agriculture than households that were not afflicted. In Tanzania, researchers found that women spent 60 percent less time on agricultural activities because their husbands were ill. By one estimate approximately 2 person-years of labour are lost by the time one person dies of AIDS, due to their weakening and the time others spend giving care.
19. Second, AIDS affects food production, through sickness and death, in a number of ways:
20. Third, HIV/AIDS can have a detrimental effect on commercial production. On small farms, cash crops may be abandoned because there is not enough labour for both cash and subsistence crops. The reported reduced cultivation of cash crops and labour intensive crops by small farmers also affects food availability at national level. Other effects include:
21. The impact of HIV/AIDS on agricultural production and food availability will be felt in terms of quantity and quality of food. In Zimbabwe, communal agricultural output has decreased 50 percent in a five-year period, largely due to HIV/AIDS. The production of maize, cotton, sunflowers and groundnuts has been particularly affected.
22. The impact of the disease is systemic: HIV/AIDS does not merely affect certain agriculture and rural development sub-sectoral components, leaving others unaffected. If one component of the system is affected, it is likely that others will also be affected, either directly or indirectly.
23. The negative impact of HIV/AIDS on nutrition and food security expands from the household to the community to different parts of the country. The socio-economic deterioration will eventually have a significant impact at the national level. The decrease in the labour force, worker productivity, total outputs, and overall economic growth could lead to a decline in national food supplies and a rise in food prices, including those in urban areas. The breakdown of commercial enterprises may undermine the country's capacity to export and generate foreign exchange.
24. The serious setback in development experienced by some countries may not be captured in Gross Domestic Product (GDP) per capita figures. Yet, the epidemic has a major impact on development because it undermines three of the main determinants of economic growth: physical, human and social capital. For instance, UNDP estimates for South Africa suggest that the Human Development Index could be 15 percent lower in 2010 due to the HIV/AIDS epidemic. Notwithstanding the methodological difficulties involved, the World Bank has estimated that HIV/AIDS has reduced the annual rate of Africa's per caput GDP growth by 0.7 percent.
25. Health and education: The social cost of the epidemic is staggering. Providing drugs for HIV infected individuals has exorbitant costs; these expenditures are beyond the reach of many governments and most individuals. Treatment costs of HIV/AIDS patients are very high and the increased burden on governments will divert funds from productive investments. The cost of treatment of AIDS and related infections is expected to exceed 30 percent of the Ministry of Health budget in Ethiopia by 2014, and 50 percent and 60 percent in Kenya and Zimbabwe, respectively, by 2005. To this must be added the cost of assisting orphans and destitute households.
26. Dealing with the epidemic obliges governments to compromise on the quality of the services they provide. The capabilities of the future labour force are jeopardised by reductions in education. In the first 10 months of 1998, Zambia lost 1 300 teachers due to AIDS -- the equivalent of two-thirds of all new teachers trained annually. Training of primary school teachers had to be reduced from 2 years to 1 year to be able to cope with the loss of teachers.
27. Human resources: Many agricultural and rural development institutions can no longer achieve their planned programme outputs. Ministries and Departments are experiencing delays and disruptions in policy and plan implementation. Without the necessary institutional support services, the agricultural and rural development sectors are failing to realise the forecasted growth rates and planned production targets.
28. HIV/AIDS presents an enormous humanitarian and developmental challenge. However, experience from several countries indicates that this challenge can be met and the epidemic can be reduced. For example, in Uganda, the infection peaked during the early 1990s with an estimated 15 percent of the population affected. Ten years later, levels of infection have been halved following the adoption of appropriate prevention methods and programmes of mitigation. Uganda's National AIDS Control Programme included training community leaders and mobilising the community; innovative communication techniques to change attitudes; reduction in discriminatory practices and involvement of people living with AIDS in care and prevention activities.
29. Similarly, projected infection rates in Thailand for 2000 dropped to 984 000 from 1.4 million projected in 1994. This rapid reversal of the trend has been closely linked to the shift toward a more comprehensive, multi-sectoral development approach in Thailand. The National AIDS Prevention and Alleviation Plan mobilised the society against stigmatisation; used the mass media; encouraged condom use; and incorporated information about HIV/AIDS into community education and services programmes.
30. While actions to respond to HIV/AIDS will vary, experience indicates that several principles underlie successful initiatives to combat the epidemic:
Without the committed support of political and social institutions, the resources required to cope with the epidemic will not be forthcoming. Endorsement at the highest political level for cross-sectoral action is an essential step.
Without halting the spread of the disease, efforts to mitigate its effects will never be sufficient. Each government must decide how its ministries and development partners can contribute to prevention efforts.
The basic goal is to help create the conditions in which both infected and non-infected individuals can live with dignity and security even in highly affected areas. Meeting the immediate food and other basic needs of destitute households is essential. Halting risky sexual and social behaviours, including, for example, the trading of sexual favours for food, goods and services, is crucial to this goal. This particular example is especially important as the poverty arising from HIV/AIDS spreads and creates greater destitution among adolescents and young adults who must then look for ways to survive.
In many ways the problems associated with widespread HIV/AIDS - poverty, food insecurity, discrimination and social marginalisation, time and labour constraints, disability and untimely death - are similar, but more severe, to problems seen in most poor communities. The same basic participatory appraisal and planning approaches for developing and implementing appropriate solutions should be employed.
The need is to ensure that the constraints that HIV/AIDS produces - whether it affects households, communities or nations - are recognised and addressed by policies and programmes in relevant social, economic and agricultural sectors. HIV/AIDS awareness and action need to be mainstreamed into agriculture and development planning, just as food security issues need to be addressed by HIV/AIDS policies and programmes.
31. Often HIV/AIDS is not acknowledged as attitudes and practices related to sexual behaviour are not openly discussed in most cultures. A strong reluctance to recognise and address the real situations that contribute to the spread of HIV/AIDS is common. In both developed and developing countries, high-risk sexual behaviour and intravenous drug abuse are at the heart of the contagion; yet most governments and societies have shied away from dealing effectively with the root causes.
32. It is difficult but necessary to confront many topics, for example, women's vulnerability to high-risk sexual practices; multiple sexual partners outside of marriage or other stable unions; the spread of the disease by people who travel widely; the exploitation and sale of children and women into prostitution and virtual slavery; HIV/AIDS in prison populations; and the destitution and deprivation of AIDS orphans struggling to live on the streets. When these social factors are combined with the great lack of public information on the extent, causes, consequences and means of preventing HIV/AIDS, efforts to deal with the epidemic are seriously constrained.
33. Stigmatisation and marginalisation of people and households living with HIV/AIDS is another constraint. Such discrimination can interfere with the transmission of prevention messages; discourage the adoption of voluntary counselling, testing and access to early care; give the appearance that individual and social denial are legitimate and make it difficult for people living with HIV/AIDS to be involved in mitigation efforts and for people who are not infected to talk about the virus and adopt safer practices.
34. The HIV/AIDS epidemic and strategies for mitigating its impact are often not given specific attention by rural development workers. Projects operating in high-prevalence areas inadvertently bypass the households struck by the epidemic, as those households have neither time nor resources to participate in, and benefit from, project activities. This frequently leads to further marginalisation and destitution of affected households.
35. The lack of adequate health care and social services limit initiatives to combat the epidemic through medical treatment. The high cost and limited availability of drugs to fight both the primary HIV infections and secondary infections and associated opportunistic diseases are serious constraints to effective HIV/AIDS programmes.
36. Given the importance of information and communication, strong advocacy strategies to raise awareness of governments, policy makers, ministries, opinion leaders and the general public about the impact of HIV/AIDS are needed. Society at large must acknowledge the HIV/AIDS problem and accept responsibility for addressing it. The negative impact of HIV/AIDS on individuals and communities calls for immediate action to prevent the transmission of HIV/AIDS and mitigate its effects. Particular support is needed to ensure that destitute children and other AIDS-affected household members can meet their daily food and other basic needs.
37. It is also important to recognise that combating HIV/AIDS is not solely the responsibility of the HIV/AIDS-affected households and the health sector. Concerted action should be undertaken by a broad coalition of actors from affected communities, local and national governments, religious and social institutions, UN agencies, NGOs, the private sector and concerned individuals.
38. In some developing countries, coping with the widespread HIV/AIDS epidemic must become a priority in the policies and programmes of governments, agencies and local institutions working to advance food security and social and economic development. In particular the Ministries concerned with food and agriculture need to be fully involved in efforts to prevent and mitigate the effects of the epidemic.
39. While specific strategies will vary according to the magnitude of the problem, the resources available and the socio-cultural context found in each country, the following should be considered as key elements of national approaches to combat the epidemic:
40. National strategies, based on high political commitment, concerted multi-sectoral action and the effective involvement of all stakeholders, should be implemented with a commitment of adequate resources.
41. The extent and severity of HIV infection needs to be assessed and the likely consequences for food security recognised. Food Security Units should take the lead in monitoring the implications of HIV/AIDS in affected areas and at national level and warning about the impact.
42. The effect of the disease on rural social security systems, assets and other resources needed to sustain rural livelihoods, demographic patterns, gender dynamics and other social and economic processes need to be analysed. Laws and practices concerning access to land and resources should be reviewed to ensure that the livelihoods of widows, orphans, and other poor HIV/AIDS-affected households are protected.
43. Agriculture extension programmes need to promote technologies that meet the changing needs of the rural households. Activities might include reorienting food production, processing and preparation; promoting initiatives for alleviating labour and capital constraints; fostering use of labour-saving tools and crops; introducing more productive agro-technologies and shifting to higher value crops.
44. Agricultural sector staff need to be aware of HIV/AIDS and trained and encouraged to identify and assist affected households, communities and institutions. All government and agency staff should understand both the risk of HIV/AIDS and its means of transmission. Most importantly, ministry staff must be willing and able to protect themselves and their families against the disease.
45. Participatory household food security and community nutrition programmes present a neutral and acceptable way to initiate discussion about HIV/AIDS where the disease generates stigmatisation. This can simultaneously address household food security, health and care while improving the nutritional situation of people living with HIV/AIDS. Collaboration with local male and female leaders needs to be sought.
46. All field staff, in particular agricultural extension workers, need to be informed about the importance of good nutritional status. Nutrition education and communication strategies should include appropriate dietary recommendations for individuals suffering from the disease, taking into account local food sources and production systems.
47. Popular messages to prevent the marginalisation of affected households and to help communities deal with the epidemic must be disseminated. Specific attention should be given to participatory communication. Innovative and successful local responses should be shared among affected communities, local institutions and nationally.
48. Donor countries must assist in preventing the spread of this disease and mitigating its negative impact on food security by providing advice and resources to countries heavily affected by the HIV/AIDS epidemic. Such assistance might include food aid to provide supplementary feeding to households and orphanages.
49. FAO has an important role in global fight against HIV/AIDS. The basic aims of the Organization in this regard are: to encourage high-level awareness of and political commitment for addressing HIV/AIDS; to reduce the impact in terms of increased food insecurity and malnutrition; to promote the reconstruction, maintenance and strengthening of rural livelihoods and social security nets and to mobilise effective multi-sectoral and participatory responses to meet the food security needs of people and countries affected by HIV/AIDS.
50. During the last decade, FAO has undertaken assessments of the impact of HIV/AIDS on agriculture, food security and rural development, and has provided assistance to countries in developing their programmes. For instance, research on the impact of HIV/AIDS on agricultural extension organisations and farm operations was conducted in selected countries of southern Africa. The Organization has assisted the Ministry of Agriculture in Uganda in incorporating HIV/AIDS considerations within its agriculture extension services. In Namibia, the impact of AIDS on livestock was assessed. In Asia, the Farmer Field Schools and Integrated Pest Management innovative participatory methodologies are being successfully applied to HIV/AIDS prevention. In nutrition, guidelines for home-based nutritional care are being developed for use at the community level. FAO will aid southern African countries to develop AIDS-sensitive agricultural policy.
51. In 1999, FAO signed an agreement with UNAIDS to collaborate in developing broad-based responses to HIV/AIDS in relation to agricultural development and food security. An inter-departmental Informal Working Group on HIV/AIDS is being formalised and will develop FAO's normative programme of work on HIV/AIDS, food security and rural development. Guidelines are being prepared to systematically incorporate an HIV/AIDS dimension into all of FAOs relevant field activities and emergency operations in high-prevalence areas.
52. The global HIV/AIDS epidemic presents an enormous humanitarian challenge for all nations. The consequences threaten to inhibit social and economic progress and are a particular threat to food security and nutrition in many countries and in particular in rural communities. Governments are advised to implement strategies and mechanisms for dealing with the epidemic. The international community has a responsibility to assist governments and communities in these endeavours. To this end, the guidance of the CFS is sought for directing FAO's continuing work regarding HIV/AIDS.
53. The Committee is invited to consider and endorse the following:
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1 Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome
2 Household food security exists when households are able to ensure that all people at all times have physical, social and economic access to sufficient, safe and nutritious food to meet their food preferences and dietary needs for an active and healthy life.