"HIV/AIDS is a disease of poverty in that poverty pushes
men into single-sex migration, women into prostitution
and children into undernutrition…"
--Rural Poverty Report, p. 31

THEME: Rural development programmes can help slow the spread of HIV/AIDS by empowering women and decreasing the out-migration of men.

The IFAD Rural Poverty Report 2001 points out that some 34 million people are now infected with HIV/AIDS. About two thirds are in Africa. Initially HIV/AIDS was a problem of the urban non-poor. Now, in the developing world, the epidemic increasingly affects the rural poor. In countries such as India, the disease is spreading faster in some rural areas than in the cities. In many African countries, the rural and urban prevalence is more or less the same. The IFAD report highlights several gender dimensions that are useful for understanding the spread and impact of the epidemic in rural areas.

HIV/AIDS and poverty are closely intertwined in cause and effect. The report points out that in rural areas in developing countries, HIV exposure originates with male migration and female prostitution. Since these result largely from rural poverty, poverty is therefore a facilitating factor.

• Countries with the highest HIV/AIDS incidence, which are mainly in southern Africa, have a history of massive male migration to work in mines.
• Poverty in some Asian countries forces families to send young village girls to cities to become sex workers to support their families. When the girls become infected, they frequently return to their villages to die.
• Other IFAD experience observes that the influx of labourers on large infrastructure projects such as dams, railways or roads, can also increase incidence in the villages that house the workers. While education of local populations and of workers may be attempted, it never works perfectly.

Cultural practices and values that discriminate against women or use women are also factors in the spread of the disease. The common African practice of marrying a widow to the deceased husband's brother also spreads the disease when the husband has died of HIV/AIDS and the wife is infected. The belief in Africa and Asia that sleeping with a virgin will act as a cure for an infected man is a cause of infection in many young girls. Sexual initiation practices with prostitutes for young boys still persist in some Asian countries, as well as elsewhere, and result in the infection of young boys.

The report notes that the risk of infection is higher among women, rising with female circumcision, failure to use barrier contraceptives and the presence of lesions from prior untreated venereal disease. In Africa, women's chances of contracting HIV/AIDS are about double that of men's.

While poverty is the underlying cause of much of rural infection, poverty is also aggravated by the impact of HIV/AIDS. In essence, the disease "sabotages poverty reduction" by increasing the number of dependents to workers. The IFAD report and other studies point out that HIV/AIDS:

• reduces the availability of able-bodied labour of both victims and those who have to take care of them (with special difficulties in hoe agriculture, which is often heavily reliant on women's work);
• reduces the productivity of labour, particularly in heavy field work;
• places a greater work burden on women, if they are not infected, since they are the ones who usually care for those who are;
• consumes family resources resulting from the costs of health care;
• leaves children motherless and fatherless (with deaths in Africa particularly affecting women aged 15 -30, who are most likely to have younger children); and
• shifts more of domestic and farm labour to children, whose schooling and health often suffer as a result.

The IFAD report, as well as other United Nations reports on the subject, suggest that women's empowerment may help reduce new infections by making women more courageous in negotiating safe sex. Stemming the tide of male out-migration would also help. This argues for greater promotion of small rural industry and microenterprise, not just for women, but also for men.

Adapted from:

IFAD. 2001. Rural Poverty Report 2001: The Challenge of Ending Rural Poverty. Oxford University Press. February.