ARC/02/5

Table of Contents

I. INTRODUCTION

II. DIMENSIONS OF THE EPIDEMIC

III. HIV/AIDS AND DETERIORATION OF FAMILIES AND RURAL COMMUNITIES

IV. CROSSCUTTING ISSUES: POVERTY, GENDER, HUMAN RIGHTS

V. EFFECTS ON THE AGRICULTURE SECTOR AND RURAL ECONOMIES

VI. IMPACT AT NATIONAL LEVEL

VII. 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 through Agricultural policy
D. Role of the Food and Agriculture Organization

THE IMPACT OF HIV/AIDS ON FOOD SECURITY IN AFRICA

I. INTRODUCTION

Throughout African history, few crises have presented such a threat to public health and to social and economic progress as does the HIV/AIDS epidemic. This is even more troubling given the fact 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 accompanies this disease minimised. Still, the HIV/AIDS epidemic is likely to have widespread adverse effects on social and economic development for many years to come.

HIV/AIDS can no longer be considered solely as a health problem. Because of AIDS, decades of development have been lost in Africa, and the countries' efforts to reduce poverty and enhance living standards have been greatly undermined. Vigorous action is needed to address the social, economic and institutional consequences of the epidemic. Increasingly, HIV/AIDS is having a major impact on nutrition, food security, agricultural production and rural societies throughout the African continent. All dimensions of food security - availability, stability, access to, and utilisation of food - are affected where the prevalence of HIV/AIDS is high, posing a threat to whole nations.

This paper presents the major challenges confronting African countries. The estimates of the HIV/AIDS prevalence and patterns of the spread of the infection are sketched 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 is followed by a discussion of actions for and constraints to alleviating the situation. Approaches to addressing this urgent problem are suggested.

II. DIMENSIONS OF THE EPIDEMIC

Currently it is estimated that some 36 million people globally are infected with the HIV virus. More than 25 million (about 70 percent) of those live in sub-Saharan Africa, making the region the worst affected area in the world. Since the disease strikes mainly people aged 15-49 years, that is the economically most productive members of society, HIV/AIDS is a problem of critical importance for economic and social development. Because populations of the worst affected countries are predominantly rural, the agricultural sector is particularly strongly affected by the epidemic.

Inter-country differences in levels of the HIV/AIDS epidemic are significant. Available estimates for the year 1999 indicate that adult prevalence rates range from less than 1 percent in parts of Northern Africa and some island states in the Indian Ocean, to more than 25 percent in Zimbabwe, Swaziland and Botswana (see Figure 1). Overall, countries in Eastern and Southern Africa have been hit hardest by the epidemic, and prevalence is soaring in parts of Western Africa. However, it needs to be stressed that in many parts of the African continent, particularly in the small island countries, there is considerable scope for increased data collection on the prevalence of HIV/AIDS.

Source: UNAIDS

AIDS affects different population segments with different intensities. For instance, studies conducted in sub-Saharan Africa have revealed that due to a combination of biological, socio-economic and cultural factors, women become infected at younger ages than men. Consequently, about two million more women than men carry HIV in sub-Saharan Africa. Children are suffering disproportionately the consequences of the epidemic, with an estimated 13.2 million children orphaned by AIDS. This number is expected to more than double by 2010.

Geographic differences within countries are also important. The AIDS epidemic spreads through channels such as truck routes which greatly facilitate population movement, thus increasing the risks of AIDS infection in villages along such routes. AIDS-related problems in rural communities are further intensified through migration, as many HIV-infected urban dwellers tend to return to their rural homes when they fall ill. Because access to information and health services is much poorer in rural areas than in cities, rural people are less likely to know how to protect themselves against HIV, and if they fall ill they are also less likely to receive adequate care. Due to such factors, AIDS is now becoming an even greater threat in rural areas than in cities.

Tragically, the prevalence of the disease is still increasing throughout much of the African continent. In some countries, the rapidity of the epidemic represents 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, whereas by 1999 the national prevalence rate had soared to 35 percent. But even in regions where the impact of AIDS is thought to be lower, such as in West Africa, the epidemic is spreading fast; for instance, in Cameroon the HIV-prevalence rate rose about 20-fold during the last decade. North Africa is the only part of the continent where levels of AIDS continue to be relatively low.

III. HIV/AIDS AND THE DETERIORATION OF FAMILIES AND RURAL COMMUNITIES

HIV/AIDS has devastating effects on rural households and communities. In particular, the disease poses a serious threat to the food security of the millions who are infected and their families, both in terms of their capacity to produce and to purchase their food. 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.

Impact on household food security: HIV/AIDS diminishes the household's ability to produce food because it takes its death toll mostly among productive adults. In fact, the impact on the agricultural labour force, which makes up most of the labour force of the affected countries, has been enormous. HIV/AIDS also affects food security by impoverishing affected families and hence reducing their ability to produce and buy food. A study in Ethiopia revealed that the cost of caring for an AIDS patient, and meeting the subsequent funeral expenses, exceeded the average annual farm income. As a result, poor rural households sell their productive assets, including their livestock, to care for the sick or pay the funeral expenses, and with those assets go their only savings, compromising their future livelihoods. One study in Uganda showed that 65 percent of the AIDS-affected households were obliged to sell property to pay for care. Traditional safety nets, which contribute to food security in times of need, are breaking down in the worst affected communities, where families and neighbours become too overburdened to help each other with food, loans, a hand in the fields, or care of orphans.

Direct impact on households: Studies have shown that labour-intensive farming systems with a low level of mechanization and agricultural input are particularly vulnerable to HIV/AIDS. The pandemic creates a significant shortage of labour supply among working age people, decrease productivity, increase production costs and promote new migratory movements. Morbidity and mortality due to HIV/AIDS significantly raise the rural households' expenditures such as medical and funeral costs. In addition, it affects rural life indirectly through the loss of valuable skills and experience. Those afflicted with AIDS become unable to carry out their usual farm work. Healthy family members must care for the sick, dedicating less time to tending crops. Important farm tasks are left undone, and fields become unproductive. Children are frequently forced to discontinue schooling to help the family to cope, which also isolates this vulnerable group from useful information and jeopardizes their future. Farm families earn less and less income precisely at a time they need it most. Once savings are gone, the household seeks support from relatives, borrows money or sells its productive assets. Declining incomes can force members of farm households to look for work in cities, and this rural-urban migration further perpetuates the epidemic. Poverty can also drive people into behavioural patterns that increase the risk of infection, such as involvement in the commercial sex industry. Eventually, the household may be reduced to impoverished elderly people and children. Especially the latter may have limited decision-making power and access to resources, as well as less knowledge and experience; and both age groups often lack the physical strength to maintain a household. Relatives may be unable to care for children whose parents have died, and many orphans are thus left to fend for themselves. In some areas, the percentage of orphans ranges from 7 to 11 percent. Not surprisingly, severe food insecurity among orphans is already reported in the worst affected areas.

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 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.

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 appetite, be unable to absorb nutrients and become wasted.

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.

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 of 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.

IV. CROSSCUTTING ISSUES: POVERTY, GENDER, HUMAN RIGHTS

Poverty and the AIDS epidemic: AIDS affects people of all income and education levels. However, the poor are more vulnerable to its consequences. They are less likely to recover from the shock that the loss of a productive adult and the loss of the resources to take care of him or her cause to the household. Poverty creates a risk environment that contributes to the transmission of HIV, for it is linked to low levels of human capital, limited productive assets and gender inequality in access to resources. These are conducive to sexual transactions to satisfy food and other needs. The epidemic in turn exacerbates rural poverty. This vicious circle is of particular concern in the rural areas, where most of Africa's poor live. Whole communities thus become food insecure and impoverished. The epidemic may have a significant effect on formal institutions and their ability 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. The disruption in services further aggravates the difficulties in reducing poverty in AIDS-affected populations.

HIV/AIDS and gender: Gender inequality is one of the driving forces behind the spread of HIV. Access to productive resources including land, credit, knowledge, training and technology, is strongly determined along gender lines, with men frequently having more access to all of these than women. With the death of her husband, a wife may be left without the access she had gained through him or his clan, and her livelihood and that of her children is immediately threatened. AIDS is thus worsening existing gender imbalances. Biological and social factors make women more vulnerable to HIV, especially in youth and adolescence. In many places HIV infection rates are three to five times higher among young women than young men. Effective interventions to mitigate the spread of the epidemic must therefore target both men and women, based on a gender perspective that seeks to understand the complex set of socially ascribed roles and relations between them.

HIV/AIDS and human rights: HIV/AIDS-affected household and communities often face considerable difficulties when adapting themselves to the devastating effects of the epidemic. Extended families are generally better able to cope with AIDS-related morbidity and mortality due to the presence of more productive adults to offset the loss of adult labour. However, coping strategies are largely dictated by the availability of and access to key assets (land, income, technology, know-how, etc.), and secondly on the availability of such resources as extended families or a community security net. Access to these assets and resources depends partly on factors such as gender, socio-economic status, age, marital status, and life-cycle stage, among others. For example, in patrilineal rural African societies, AIDS widows (many of whom are likely to be infected with HIV) may have no legal rights to land and property after their husband's death, due to customary or even formal inheritance laws. Impoverishment may force them to send some of their children away (who also might be infected with HIV), engage in occasional sex for money, or earn a living as commercial sex workers. Moreover, the stigma associated with HIV/AIDS may not enable an infected person to disclose this information without facing social exclusion, thus deterring any attempt to cope with the consequences of the disease. The access and availability factors that affect the capacity of rural households to cope with HIV/AIDS are thus intrinsically linked with the question of human rights. Therefore, in order to support productive adaptations of affected households and communities to the consequences of HIV/AIDS, the human rights dimension of the epidemic must be recognized and addressed.

V. EFFETS ON THE AGRICULTURAL SECTOR AND RURAL ECONOMIES

In most of the highly affected countries, agriculture provides a living for the large majority of the population and represents an important source of the gross national product. Agriculture, particularly food production, is affected in several ways by HIV/AIDS. The impact of AIDS is observable at various levels of social organization (individuals, households, communities, etc.), and is felt along various time scales (short, medium and long-term).

First, there is a toll on the agricultural labour force. FAO has estimated that in the 25 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 1).

Source: FAO/SDWP

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.

Second, AIDS affects food production, through sickness and death, in a number of ways:

Reduction in area of land under cultivation. The sickness and death of an adult results in the inability of the household to cultivate all the land at its disposal. Tending for the sick takes a considerable amount of time, which is no longer available for agriculture. More remote fields thus tend to be left fallow and the total output of the agricultural unit consequently declines.

Declining yields. Yields decline as a result of delays or poor timing in essential farming operations. Delays occur because of sickness or dependency on outside labour which is not always available when needed. The fertility of the soil is also negatively affected owing to the priority given to immediate survival concerns over longer-term land conservation measures.

Decline in crop variety and changes in cropping patterns. Cash crops are abandoned due to the inability to maintain enough labour for both cash and subsistence crops. Switching from labour-intensive crops, to less labour-intensive ones, often containing lower nutritional values, is observed. This is having a direct impact on the nutritional quality of the diet and on poverty.

Decline in livestock production. Livestock serves multiple functions and frequently represents also a form of savings. Animal husbandry practices deteriorate through the impact of AIDS on labour force, particularly on child labour availability as this group is often primarily responsible for animal care. The medical costs incurred by those affected by HIV/AIDS often require the sale, gift or sacrifice of livestock as payment for traditional forms of medicine, and funeral rites may include slaughtering of animals.

Decline in post-production operations. Food storage and processing are impaired, thus increasing food insecurity between harvests and availability of raw materials such as seed for subsequent crops.

Loss of agricultural skills. In many areas, the usual way for children to learn the required agricultural skills is by working with their parents. Given the AIDS epidemic, this is no longer possible. A study in Kenya showed that only 7 percent of agricultural households headed by orphans had adequate knowledge for the most basic agricultural tasks. Furthermore, owing to the gender division of labour and knowledge, the surviving parent is not always able to transfer the skills of the deceased one.

Shifts in the structure of household expenditures. Credit for agricultural production is diverted for the medical care of sick relatives, funeral expenses and food. The resulting reduction in crop yields and loss of income cause families to default on loan repayments or sell assets.
Breakdown of support services. As staff fall ill, management capacity, transport, and extension services are disrupted, further aggravating the plight of rural households.

Third, HIV/AIDS can have a detrimental effect on commercial production. On small farms, cash crops are 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:

• Loss of seasonal workers can compromise plantation farming.
• Protracted morbidity and mortality of employees have high financial and social costs for businesses, especially as skilled and experienced employees are lost.
• The fall in productivity and competitiveness results in decreased employment opportunities and local economic spin-offs. Thus, HIV/AIDS affects also healthy people, as some economic activities may no longer be viable.

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.

VI. IMPACT AT NATIONAL LEVEL

The impact of the disease is systemic: HIV/AIDS does not merely affect certain social or economic sectors, leaving others unaffected. If one component of the society is affected, it is likely that others will also be affected, either directly or indirectly.

Economic growth: The negative effect of HIV/AIDS expands from the household to the community to different parts of the country. The economic deterioration will eventually have a significant impact at the national level. The epidemic undermines three of the main determinants of economic growth: physical, human and social capital, and thus has a major impact on development. 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. The World Bank has estimated that HIV/AIDS has reduced the annual rate of Africa's per caput GDP growth by 0.7 percent.

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. The increased burden on governments diverts 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. Dealing with the epidemic increasingly 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.

Human resources: Because of HIV/AIDS, Ministries and Departments are losing large numbers of their staff, leading to delays and disruptions in policy and plan implementation. In Kenya's Ministry of Agriculture, an estimated 58 per cent of all staff deaths are caused by AIDS, while some 16 per cent of staff in Malawi's Ministry of Agriculture and Irrigation are living with the disease. Without the necessary institutional support services, many agricultural and rural development institutions can no longer achieve their planned programme outputs and production targets.

Food security: The decrease in the agricultural 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 to import food when needed. Many of the worst affected countries are low-income food-deficit countries (LIFDC), and many are also highly indebted poor countries (HIPC). HIV/AIDS is exacerbating their difficulties in providing food for their peoples.

Rural development: HIV/AIDS is rapidly spreading to rural areas, where more than two thirds of the population of the 25 most affected African countries live. Rural communities bear a higher share of the cost of HIV/AIDS, as many urban dwellers and migrant labourers usually return to their home villages when they become sick. Thus, at the same time as remittances from these former migrant members of the household dry up, expenditures to meet medical bills and funeral expenses rise. As the number of productive family members declines, the number of dependants grows. Poverty, widespread in rural areas, leads to poor nutrition and poor health, which make people more vulnerable to HIV infection. Poor nutrition can also shorten the incubation period of the virus, causing symptoms to appear sooner. This situation is especially severe for the rural poor, who have the least access to medical care. Armed conflict, typically fought in rural areas, also increases vulnerability to HIV/AIDS because of sexual violence, displacement of people and destitution.

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. 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. AIDS can tear the very fabric of a society and in fact, in many parts of rural Africa, it has generated an irreversible collapse of the social asset base.

VII. BUILDING EFFECTIVE RESPONSES TO THE HIV/AIDS EPIDEMIC IN SUPPORT OF FOOD SECURITY

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, the level of infection has been halved following the adoption of appropriate prevention and mitigation programmes that enjoyed a high degree of political commitment and participation of stakeholders. 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.

A. Guiding principles for responding to the HIV/AIDS crisis

While actions to respond to HIV/AIDS will vary from country to country depending on local circumstances, experience indicates that several general principles underlie successful initiatives to combat the epidemic:

Dynamic leadership, political commitment and integrated multi-sectoral action at all levels are imperative for effective measures to halt the HIV/AIDS epidemic and mitigate its effects.

Preventing the spread of the HIV infection is of paramount importance. Prevention of HIV/AIDS in poor communities can only be accomplished if immediate assistance and development initiatives are also carried out.

A people-centred, gender-sensitive, multi-sectoral, community-based approach to development is fundamental for creating and sustaining the conditions in which HIV/AIDS can be prevented and its impact addressed most effectively.

Linking HIV/AIDS and food security initiatives can be accomplished by the reciprocal incorporation of HIV/AIDS considerations into food security initiatives and nutrition, and the incorporation of food security objectives into HIV/AIDS programmes.

Because agriculture employs up to 80 percent of the workforce in many African countries, Ministries of Agriculture and other bodies dealing with agriculture and rural development, both national and international, have a particularly important role to play in translating these general principles into concrete policy interventions.

B. Common constraints to effective action

Responses to the HIV/AIDS epidemic have shown African countries and the international community at both their best and their worst. Some of the typical obstacles to effectively dealing with the effects of AIDS on agriculture and rural development include:
denial of the problems brought about by AIDS, reluctance to recognise and address the situations that contribute to the spread of the virus;
victim-blaming, stigmatisation and marginalisation of people and households living with HIV/AIDS;
lack of adequate resources, health care and social services in rural areas;
lack of information on the impact of AIDS on the agricultural sector, which often leads to the false conclusion that the sector has no role to play in fighting the epidemic.

C. Elements of a framework for combating HIV/AIDS through agricultural policy interventions

Although agricultural policies are not usually designed with HIV/AIDS in mind, they can indirectly affect the spread of the epidemic and lessen its effects on farm households and farming systems. By explicitly taking the HIV/AIDS factor into account, agricultural policies can attempt not only to achieve their usual objectives (increase in yield, commercial crop outputs, etc.), but also to reduce vulnerability to HIV by modifying the socio-economic, demographic and cultural factors that are related to risk behaviour (poverty, loss of employment, food insecurity, migration, etc.). Although policies to reduce vulnerability cannot replace policies to reduce risk, they can create positive synergies.

Many agricultural/rural development institutions may feel that they do not have the know-how or the resources to implement HIV vulnerability reduction strategies. However, there might be certain measures in their normal sphere of competence that could be used to contribute to the national effort in combating the pandemic. Specifically, the agriculture sector can help to influence the environment and the vulnerability context in which the pandemic takes place, thereby also modifying some of the factors that shape its course and impact.

What policy instruments could be effective in the field of agriculture? It can be observed that the agriculture sector already has several types of macro-level instruments at its disposal, each of which can have a generic impact on vulnerability to HIV/AIDS:

Market-related instruments, such as minimum wages, interest rates, floor/ceiling prices, and many others. A number of these could be relevant. For example, a minimum wage or floor price for a product can guarantee a minimum income to a household; this, in turn, could limit the need for economically motivated seasonal migrations, or improve the conditions under which such migrations take place, and thus reduce the spread of HIV/AIDS from area to area. A complementary policy strategy could be to use tax cuts in order to promote lucrative agricultural activities and thus to ensure better revenue, particularly to vulnerable segments in society (for instance, households headed by women or orphans).

Resource base-related instruments, such as infrastructure facilities for storage or development of human capital through training, could also reduce vulnerability. The storage of crops so that sale could be better timed in relation to market changes would have a favourable impact on the day-to-day availability of income and reduce seasonal vulnerability between crops. Training and the provision of survival skills are essential for orphans and other vulnerable groups, in order to protect them from exploitation and abuse. There is also a need for national policies to protect rural institutions from losing their staff and their expertise. At the same time, there may be opportunities to introduce positive changes in agricultural techniques and/or to promote technologies that better meet the changing needs of rural households.

Institution-related instruments, such as promoting the participation of stakeholders in decision-making or improving legislation on property rights, could reinforce existing efforts through empowerment processes. These, in turn, could have positive spin-off effects on the pandemic. Forming partnerships with donor countries and the private sector, whether commercial or non-profit, would be an essential dimension here. Assistance obtained through such partnerships might include food aid to provide supplementary feeding to orphanages or affected households.

Identifying policy tools that can be used in reducing the negative effects of HIV/AIDS is just one element in responding to the epidemic. Effective policies also demand greater insight into the dynamics of the HIV/AIDS epidemic in rural areas. Although the disease can affect all parts of the rural sector, two types of rural areas appear to be particularly vulnerable so far: those situated along truck routes; and those that are sources of migrant labour, whether on a long-term basis or on a temporary basis (during the agricultural off-season). Traditional subsistence regions with low mobility are perceived to be less vulnerable to HIV. As a rule, people whose livelihoods depend on leaving their families/communities over longer periods (such as nomadic pastoralists or fishermen) are at increased risk of contracting HIV due to increased exposure, relative marginalisation and limited access to social services, and may spread the disease upon their return. Women remaining on farms with seasonal migrant husbands are also vulnerable to HIV infection if their husbands bring the disease back with them. Such population sub-groups need to become the priority targets of strategies to mitigate the negative effects of AIDS. However, the impact of HIV/AIDS is determined by a combination of socio-cultural and economic factors which may vary from one situation to the next, and policies will therefore need to be based on a good understanding of the local context and to be tailored accordingly.

D. Role of the Food and Agriculture Organization

FAO has an important role in the 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 the impact of HIV/AIDS on food security, rural development and rural poverty; to contribute 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, gender sensitive and participatory responses to meet the food security needs of people and countries affected by HIV/AIDS from a human rights perspective. In recent years, FAO's role in helping to combat AIDS has become even more critical due to the fact that the epidemic creates a significant institutional capacity gap in the affected countries, especially as regards agricultural extension and service organizations, national agricultural research organizations and institutions in higher education and training.

Since 1988, 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. Policy-oriented research on the effects of the epidemic on farming systems was conducted in both East and West 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 nutrition, guidelines for home-based nutritional care are being developed for use by local service providers. FAO will aid southern African countries to develop AIDS-sensitive agricultural policy.

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 FAO's relevant field activities and emergency operations in high-prevalence areas. FAO is introducing an AIDS lens in all of its Investment Center projects and is developing a field programme in coordination with WFP and IFAD to mitigate the impact of the epidemic on the agricultural sector and on food security in the most affected countries. Collaboration with other UN agencies such as UNESCO, WHO and ILO is being enhanced.