Chapter 1 Introduction

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1.1 The purpose of this study
1.2 About the disease
1.3 Global and African epidemics
1.4 The nature of the impact
1.5 A diversity of results
1.6 HIV/AIDS and rural livelihoods in Africa
1.7 Who is vulnerable?

1.1 The purpose of this study

Much has been written about the medical and clinical aspects of HIV/AIDS. There is also an increasing body of work on the impact of the disease on social and economic systems, but relatively little is understood about the effects of the HIV/AIDS epidemic on farming systems and therefore on rural livelihoods.

The purpose of this study is to examine, using information collected from three countries in Africa, Tanzania, Uganda and Zambia, in which relatively high incidences of the disease have been found among their populations, the ways in which morbidity and mortality associated with HIV/AIDS are affecting farming systems and rural livelihoods.

The focus of the present study is not the disease itself but its impact, both actual and potential, on rural populations, their livelihoods and their farming systems. In order to increase understanding of this problem, the Food and Agriculture Organization (FAO) commissioned with the financial support of United Nations Development Programme (UNDP) a series of studies in each of the three countries where the disease is seen at different stages of its evolution.

Following several months of preparation, predominantly involving studies of secondary sources, three national teams, supported by an international consultant and FAO staff, carried out field work in Tanzania, Uganda and Zambia. In each case the fieldwork period was about one to two months. The results of this research are presented in the following chapters.

1.2 About the disease

HIV/AIDS is a viral disease currently without cure or vaccine which is mainly sexually transmitted, although there are other infection paths, perinatal, contaminated syringes, and contaminated blood donations. The disease has a long period of latency during which people who are HIV+ (seropositive) are infectious. The virus affects the body's ability to resist infections. This results in progressive morbidity as people fall prey to a variety of infections in their environment to which they would normally be resistant.

As far as is known HIV/AIDS is always fatal. Depending on a number of factors including the general health status of the population, and the level of infectious agents in the environment, progression from infection to manifestation of symptoms may take anything from a few months to many years. Progression from initial illness to death also varies from a few months to several years.

In healthy well-fed populations in areas of the world where there are fewer opportunistic infections a person who has contracted HIV/AIDS may remain well for several years. In other parts of the world where people are poor and malnourished and where opportunistic infections are more common, the onset of illness will be more rapid. A recent study by the United Kingdom Medical Research Council in Uganda observed 11000 individuals over three years in rural areas. An important finding of this research was that among HIV+ adults there was a mortality rate of 11.6% a year.

Even when no symptoms of the disease are apparent, a person is infectious. This means that by the time that significant numbers of people begin to exhibit illness there are likely to be many more who are infected. For this reason, it may be appropriate to describe the HIV/AIDS epidemic as a "long wave" disaster. By the time that its presence in a population is obvious, it is already widely spread in that population.

HIV/AIDS affects the health of individuals. Development of measures which will cure or protect individuals through vaccination is the business of medical scientists and clinicians. However, as with all serious illness, the effects on the individual have serious implications for others - at the household, community and ultimately the national level.

1.3 Global and African epidemics

With the exception of the epidemic in the United States of America, the disease has reached epidemic proportions earliest in Africa. However, it is important to recognise that Africa is not unique and that much of the attention that it has received stems from a number of causes. These include the fact that Africa was one of the areas where the epidemic was reported first, and this may in part have been due to the readiness of some African governments to make research results available.

Figure 1: Global incidence of HIV/AIDS (number of infected people)

Figure 2: Minimum and maximum HIV prevalence among antenatal attendees in Tanzania, Uganda and Zambia 1992

Figure 2 shows the minimum and maximum infection rates observed among women attending ante-natal clinics in different parts of Tanzania, Uganda and Zambia.

However, it must be clear that HIV/AIDS is not a disease which is restricted to the world's poorest countries. Rather the problem is that in these countries production is often heavily dependent upon human labour power and because of their strained economic circumstances, it is these countries which are least able to confront the long-term economic and social impact of the epidemic. In the world's richest countries, the epidemic is very severe. In the United States, it has been identified as the second largest cause of deaths among young men.

There are indications that HIV/AIDS will rapidly increase in Asia. Data from India suggest that at least 500000 people are currently infected, while in Thailand seroprevalence was estimated at 450000 in a population of 60 million in 1992.

1.4 The nature of the impact

In order to understand the importance of the preceding observations it is necessary to look more closely at the issue of the social and economic impacts of this epidemic as they are manifested in the world's poorer societies.

The key feature of the HIV/AIDS epidemic which makes its social and economic impact so important is that it is mainly a sexually transmitted disease. If we assume that in most societies the years between 15 and 50 are those in which people are most sexually active, then we may also assume that it is this age group which will be most vulnerable to infection. These people also constitute the main body of the labour force in any society. In poor countries as compared to rich countries this fact is of greater significance given that:

- work, particularly farm work, is more labour intensive;
- highly trained and educated individuals are rarer and their training, loss and replacement all result in greater proportional costs.

Accordingly, the epidemic affects both the quantity and quality of labour supply in the economy. This affects output and Gross National Product (GNP). In practice this means that there may be fewer teachers, fewer skilled artisans, and fewer farmers. The situation is in fact worse than the preceding statement might suggest as the economic idea of GNP conventionally used in national accounting (the value of output resulting from the use of resources - land, labour, capital - owned by national members of a society) takes no account of the unpaid labour contributed by family members. In particular this excludes both the domestic work of women in maintaining households as well as their agricultural work producing non-marketed, usually staple, crops.

A more subtle but equally serious consequence of the epidemic on the effective labour supply is that rising adult mortality adversely affects the transmission of acquired skills and knowledge both within an age cohort and from generation to generation.

However, perhaps the most important finding of this work is that the main costs to a society are not the direct costs of medical care and prevention. Rather they are other costs resulting from the loss of output plus the more complex and less easily estimated social as well as economic costs associated with the burden of looking after orphans, care of the elderly, and costs of increasing social disorder associated with the disruption of the socialisation and education of the young.

Between consideration of the micro-level impact as in the preceding example and the macro impacts predicted by econometric modelling, there lies the complexity of the links between the local and national levels of analysis. There are many ways in which the epidemic impact on the individual, local community and nation, link together to confront politicians, administrators and ordinary people with major development problems, most of them issues of social and economic policy but some inevitably with environmental implications.

1.5 A diversity of results

As will be discussed in Chapter 2 which deals with the method used to carry out these studies, the results have proved to be quite diverse, not only between countries but between different agricultural systems in the same country. For example, in studying the farming systems in Tanzania, Uganda and Zambia, account had to be taken of the dynamic endogenous impact of HIV/AIDS. There are always many variables at work within a system and the effects of changes in these variables - cropping patterns, consumption preferences, availability and prices of inputs, rainfall levels, market demand - are often difficult to distinguish from the exogenous impact of HIV/AIDS. This problem has to be borne in mind when considering the detailed data reported below.

The very diversity of the results which were obtained in this study illustrate how difficult it is to understand the impact of a disaster such as an epidemic on farming systems. Nonetheless, this complexity is itself of use in increasing our understanding of the complex inter-relations which make up a "farming system". The effects which were observed are significant enough, be they on the small farm economy, or rural households, especially on those headed by women, to be taken into account in future research on the subject, and in development work generally in countries where HIV/AIDS is present or threatening.

1.6 HIV/AIDS and rural livelihoods in Africa

Since the mid-1980s, rural communities in East and Central Africa have been increasingly affected by HIV/AIDS. At the national level, where the economies of the countries concerned are substantially or largely dependent on labour intensive agriculture for subsistence and cash crop production, this effect is becoming progressively more pronounced. Table l shows that of the three countries discussed in this study, both Tanzania and Uganda are heavily dependent upon agriculture. While Zambia appears to be an exception to this rule, agriculture still remains of great importance. Because of the role of minerals in the Zambian economy, cheap locally-produced grain is important in supporting urban purchasing power. Thus, there is a link between rural production, urban wage rates, urban purchasing power, mineral production and urban social order particularly in the mining regions.

Table 1: Agriculture as a percentage of GDP and exports (1991)

Source: The World Bank, 1993

African subsistence agriculture is labour intensive and, in most cases, is heavily dependent upon women's work. Farms are small and use limited quantities of inputs such as mineral fertilisers, pesticides, herbicides and mechanisation. Table 2 indicates that the majority of the population in the selected countries (except Zambia) live in rural areas and derive their livelihoods from these activities. While population growth was long seen as the problem in Africa, in some rural communities HIV/AIDS is now resulting in labour shortages for both farm and domestic work. Seasonal labour constraints are not new. There are many reasons why this is so: farm incomes are low and adults have often spent part of the year away from the farm in search of cash incomes; in some regions rainfall distribution means . that labour has to be mobilised intensively in brief periods; and daily life requires substantial amounts of labour for non-farm work associated with maintaining the household. Water and fuel collection may occupy as much as eight hours a day - tasks usually done by women and young girls.

Table 2: Percentage of the population living in rural areas (1991)

Source: Op. Cit., 1993

1.7 Who is vulnerable?

Within a systems' hierarchy, AIDS is first seen at the farm household level, because it is affecting human beings . The effects of AIDS are spreading to the subordinate level, the crop/livestock system as well as on superior levels up to the national system. However, this study will concentrate on the effects on the farming system, the farm-household system and the crop/livestock system.

At the farming systems level, the study observed features relating to different kinds of farming systems which appeared to make some more or less vulnerable than others. Variables include location and climate of the system, types of crop and or livestock produced, presence of sufficient labour, etc. A system with plentiful and well distributed rainfall, fertile soil and a wide range of crops will be less sensitive to labour loss than one having limited rainfall, poor soils and a small range of crops.

Despite the appearance of excess population, subsistence agriculture often operates on the margin-labour may be in short supply at certain times and for specific tasks. This margin is rapidly disturbed when communities are affected by HIV/AIDS. The precise effect of the epidemic depends upon the particular combination of climate, soils, crops, and involvement in labour migration. Thus it is possible to describe different farming systems and their associated communities as more or less sensitive to the loss of labour.

At the farm household level in an existing farming system, the study also observed certain factors which make households - be they wealthy or poor - more or less susceptible to the effects of the disease. For example, a relatively wealthy household whose members are more mobile and who have more contact with, in particular urban centres, was sometimes found to be particularly susceptible to exposure and to contracting HIV/AIDS. As household members become ill and die, the family's resources are progressively strained and it may experience a severe fall in the standard of living. Similarly, a household which is already at or near subsistence level, is also vulnerable given that it has fewer resources to fall back on.

The loss of labour, the loss of household members to care for the very young and the elderly, increased numbers of dependent children, restriction of the range of crops grown, continue the downward spiral in living standards. In the households' efforts to cope, children may eat less well, receive less care, be withdrawn from school particularly in the case of young women who can fetch water and firewood, care for the younger children or the sick as well as work on the farm.

Figure 3: AIDS in the systems' hierarchy

Nowhere is this more so than in the case of women who are widowed. When a man dies, the ownership or cultivation rights to his land may be disputed by the wider family, leaving his widow and children landless and having to move away from the area. In a continent where few cultures accord women independent rights to land, their social and economic insecurity may be exacerbated by the impact of the epidemic.

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