I issued a call to action against HIV/AIDS, with five clear objectives:

  • First, to ensure that people everywhere, particularly young people, know what to do to avoid infection;
  • Second, to stop perhaps the most tragic form of HIV transmission, which is from mother to child;
  • Third, to provide care and treatment for all those infected;
  • Fourth, to redouble the search both for a vaccine and for a cure;
  • And fifth, to care for all those whose lives have been devastated by AIDS, particularly the orphans. There are an estimated 13 million of them in the world today, and their numbers are growing.

To achieve those five objectives we need two things: leadership and resources…

Address by Kofi Annan, Secretary-General of the United Nations to the World Health Assembly (Geneva, May 2001)

Lennart Båge, President of IFAD on:

IFAD, the Rural Poor and HIV/AIDS

Uganda - Regina Nankabirwa, 40, a widow for over a decade, has lost many relatives to AIDS. She has 18 children under her care, ten of which are orphans. Regina joined UWESO in 1997 and received her first loan to start a small business. She owns a retail shop in the town of Kitante, near Masaka. IFAD/Robert Grossman IFAD is a specialized agency with a specific mandate to address rural poverty. Why should it address HIV/AIDS?

IFAD's mandate is to work with the rural poor - and approximately three quarters of the world's poor live in rural areas. The rural environment is generally characterized by poor social services, poor access to information and livelihood insecurity. To overcome these inequities, men migrate in search of better incomes for their families - and, partly as a result, we now have the challenge of HIV/AIDS. The epidemic affects every segment of the population, the institutions that are meant to serve the people, and, in the worst-hit regions, every sector of the economy. Poor people have to use up their savings and liquidate their already meagre assets in order to care for their sick while supporting themselves and their families.

The new survival conditions created by HIV/AIDS are changing the shape of rural poverty - and a new generation of ultra-poor is emerging. This is particularly so in sub-Saharan Africa where approximately 25.3 million people are living with HIV/AIDS and 17 million have already died. In absolute numbers, most of those infected and affected by the epidemic are found in rural areas of Africa and also in Asia.

We cannot continue business as usual: we, like all other development agencies, must adjust our current models of development to respond to this changing profile -or all the resources that are being invested in development aid will be meaningless. If we ignore HIV/AIDS, the consequences will eventually be felt across entire nations and around the world. And unless we act now, we will not be able to maintain the global commitment reached at the United Nations Millennium Summit in September 2000 to halve the proportion of the world's population living in extreme poverty by 2015.

What comparative advantage does IFAD have in relation to HIV/AIDS, given that the epidemic has long been perceived as predominantly a health concern?

Although HIV/AIDS is certainly a medical problem, it also has important socio-economic dimensions, which cannot be addressed through medical interventions alone. A multisectoral and development-based approach is also essential to halt the spread of HIV.

IFAD's comparative advantage lies in it ability to reach rural areas and help poor rural women and men to attain sustainable livelihoods and to influence and control institutions. Given the many links between poverty and HIV/AIDS, we must concentrate our efforts on providing rural populations with the tools they need to achieve sustainable livelihoods - including access to assets, technology and markets. We must also help them to avoid high-risk situations, reduce their vulnerability to HIV/AIDS, and mitigate its impact once it has taken hold in their households and communities. I should underline that achieving this also means adjusting our operations - both our programming and our policies.

How does IFAD intend to achieve this 'new' task of integrating and implementing HIV/AIDS-related initiatives into its portfolio?

The socio-economic and medical dynamics of HIV/AIDS require a highly coordinated response from different institutions that have traditionally not worked together. In reorienting our ongoing programmes/portfolio to integrate HIV/AIDS concerns, we will need to establish partnerships with other actors based on their areas of competence. As a first step, we have already entered into a partnership with the Secretariat of the Joint United Nations Programme on HIV/AIDS (UNAIDS) in order to facilitate access by IFAD and its borrowing partners to technical backstopping and information on HIV/AIDS. I should like to emphasize that IFAD is well placed to work with governments, donors, civil society and other stakeholders, particularly since traditionally it is our clients who implement the programmes that we support. And, in fact, in the case of HIV/AIDS, it is the national institutions, rural communities and households that must be in the driver's seat.

Achieving a tangible impact with regard to prevention and mitigation will require not only partnerships but also resources. IFAD will thus be seeking to mobilize additional [grant] resources to be channelled to the rural poor in support of their livelihoods. To guide this process, we already have a strategy for East and Southern Africa, and should soon have an overall framework outlining the main thrust for all IFAD activities connected to HIV/AIDS.

Is IFAD currently supporting any HIV/AIDS-related initiatives?

IFAD's experience related to HIV/AIDS is in microfinance as one form of social safety net support. In a programme in Uganda, implemented in collaboration with the Belgium Survival Fund, we are channelling support through a local non-governmental organization, the Uganda Women's Effort to Save Orphans (UWESO), to orphans and their foster families for the financing of small-scale business initiatives and for the vocational training of orphans. We are also in the process of piloting a smaller replication of this programme in Tanzania, using grant financing from the Japanese Government. Other programmes in Kenya, Mozambique, Rwanda, Swaziland and the United Republic of Tanzania are investing in strengthening local prevention capacities.

As we approach World AIDS Day on 1 December 2001, I would like to stress that WE CARE. Our way of stating our commitment is to work with poor rural women and men, paying special attention to empowering them economically and socially in order to reduce their vulnerability to HIV/AIDS and to mitigate the impact of this epidemic.

IFAD and HIV/AIDS

In the words of staff and beneficiaries of IFAD-financed programmes

Who do you train when farmers spend all their time attending funerals or looking after sick people?

The loss of any key persons in the farm extension chain leaves a vacuum for project activities. These [activities] often have to come to a standstill until replacements are made, which is usually not easy.

Extension staff, Kolomozd District, Southern Province Household Food Security Programme, Zambia.

Access to markets by AIDS-affected families is not easy because markets are fragmented and distant. Markets require personal contact, good health and energy.

Community leaders, District Development Support Programme, Uganda

AIDS is leading to loss of experience, and knowledge transfer is more difficult. When coupled with the loss of farmers and experienced family managers, household productivity is negatively affected. Moreover, the people dying are young adults, thereby leaving a vacuum.

District and camp agricultural extension staff, Southern Province Household Food Security Programme, Zambia.

 

IFAD has recognized that the human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) is no longer exclusively a health issue. It is also a development issue affecting all social and economic sectors of developing countries. The Fund is therefore seeking to approach the issue of HIV/AIDS systematically and as an integral part of its agriculture and rural development investment programmes. This is particularly so for its programmes in sub-Saharan Africa, where 25.3 million of the 36.1 million people living with HIV/AIDS in the world can be found.1

The Fund has three levels of HIV/AIDS-related activities: policy and strategy development, operations and partnership building.

Policy/strategy development

IFAD has recently developed a draft strategy for East and Southern Africa aimed at guiding and strengthening its operations in the region as they relate to HIV/AIDS. It is also assessing the HIV/AIDS situation in West and Central Africa, with a view to formulating an appropriate strategy for intervention in that region. Regional strategies will be the basis for developing a corporate HIV/AIDS strategy for Africa, which will define IFAD's key priorities and approaches, including the partnerships it will need to foster with other development actors.

Operations

IFAD is increasingly integrating HIV/AIDS mitigation activities into its projects in Africa. Specifically, it is using ongoing projects as platforms for launching HIV/AIDS-related activities, taking advantage of the fact that IFAD-financed projects are designed to reach and involve rural poor community groups and households at the grass-roots level.

In West and Central Africa, IFAD has incorporated HIV/AIDS-related activities into the extension components of a number of projects. One example is the National Agricultural Research and Extension Programmes Support Project in Cameroon, which provides training to extension staff on HIV/AIDS awareness raising. IFAD is also involved - albeit indirectly - in HIV/AIDS mitigation activities in countries such Guinea and Nigeria within the framework of projects cofinanced with the World Bank. As a future direction in West and Central Africa, the Fund intends to integrate HIV/AIDS components into its projects, introducing activities to mitigate the negative economic impact of HIV/AIDS on rural households.

In East and Southern Africa, IFAD has supported and/or designed a number of projects with activities aimed at combating HIV/AIDS, including:

HIV/AIDS and development: 'ABC Africa'

HIV/AIDS is found almost everywhere, but mainly in Africa. In Africa it is found everywhere, but mainly in the countryside. It affects all classes, but mainly the poor. As film director Abbas Kiarostami observes in the film 'A. B. C. Africa', HIV/AIDS is not transmitted by mosquitoes: it is a social disease, the deadliest of them all. It is a complex disease, medically. It is a disease for which there is no known cure - and for which existing treatments are economically and organizationally beyond the reach of most of those who suffer from it - especially in Africa where hundreds of millions of people live below the recognized 'lines' of extreme poverty.

The social causes of the epidemic and its effects are much better understood. As a social disease, it reflects social conditions: the fragility of rural economies and women's lack of social power. It reflects the high levels of male migration, driven by the crisis in agriculture and rural development. It reflects the spread of prostitution as a means of survival. And it reflects the fact that poor women in rural societies have little social power to control their own sexuality (see Women on the front-line).

The social consequences of the epidemic are also well understood, both for those living with HIV or AIDS and the much greater number who are not seropositive, but whose lives are taking new and more threatening shapes all the same: deepening rural poverty as families sell their possessions and their tools to care for the sick and compensate for lost income; disorganization of families; intolerable strains on families and communities; and a crisis in the care and education of the young. The effects on the future development of Africa and the fight against rural poverty are incalculable.

None of this is inevitable. While the race for better treatment and, ultimately, cure continues, the epidemic can be reduced through attacking some of the most important social bases of vulnerability: the local and global crisis of the African peasant economy; and the position of women and girls in rural society. Prevention can work, and it can reduce the medical burden dramatically. Mitigation can work. Communities and families can be effectively helped to regain their strength to deal with the challenge posed by orphans and the loss of the young and able-bodied. The answer to the social challenge of HIV/AIDS in rural Africa will need to be grounded in the initiative and optimism of Africans themselves. That is what is shown in A. B. C. Africa: the willingness of women, children and men to engage and fight . While we spend billions on the medical solution, we should also be thinking about the social problem and the social solution. And about re-engaging in assistance to social and economic development in rural Africa - without which the prospects for improving the lives of the majority of the poor and controlling HIV/AIDS continentally and globally are dim indeed.

Gary Howe, Director, Eastern and Southern Africa, International Fund for Agricultural Development
(g.howe@ifad.org)

  

Ugandan Women's Effort to Save Orphans (UWESO) Development Project. The project, supported by IFAD since 1995 through a grant from the Belgian Survival Fund (BSF) Joint Programme, aims to strengthen UWESO's capacity to empower two groups particularly affected by the epidemic: foster families (the majority of whom are women-headed) and orphans. To achieve this objective, it is emphasizing skills development, the provision of access to rural financial services and the promotion of social cohesion. Specifically, the project provides training to foster families in skills such as business and micro-project management and the management of savings and credit accounts. It also carries out complementary activities such as training in food and nutrition security, and HIV/AIDS care and counselling.

Uganda - Mrs Elizabeth Sentango's son helping his mother to gather ground nuts that she will sell in the local market in Masaka, Uganda. She has received loans to pay for insecticide spray, maize and bean seeds, a sewing machine, and her three children's' school fees. IFAD/Radhika Chalasani
To empower families economically and make it easier for them to apply the skills they have learned, the project provides access to microcredit for investment in income-generating activities. It also provides out-of-school orphans with vocational training and apprenticeship opportunities, typically bicycle or radio repair, carpentry and tailoring. By combining capacity-building and microcredit provision, the project has enabled beneficiaries to engage in more secure and sustainable livelihoods, thereby increasing their household incomes significantly. The UWESO initiative has become a key example of how community resilience and coping mechanisms can be strengthened using technical training and microcredit as tools.

Kenya - Farmers hoeing weeds in a carrot field intercropped with maize in Narumoru Agothi, Kieni East Division. The project aims to increase farmers groups' self-reliance and their ability to sustain the benefits of the project's investments. Outstanding results have been achieved by the project in terms of poverty alleviation, improvements in household food security and community mobilization and commitment. IFAD/Giacomo Pirozzi
Central Kenya Dry Area Smallholder and Community Services Development Project. The project, financed by an IFAD loan and a BSF Joint Programme grant during 1991-99, had as its main objectives the reduction of mortality and morbidity and the improvement of the overall well-being of the rural poor in the Keinei District of Kenya. It focused principally on health, nutrition and sanitation; agriculture and irrigation development; institutional support; and group development and participation. Carrying out activities targeting HIV/AIDS under the health, nutrition and sanitation component of social services development, the project provided training for district and community health workers in home-based care and counselling of people living with HIV or AIDS.

 

Tanzania - Health workers going over record books at the health centre in Majeleko village. IFAD/Christine Nesbitt
Rural Financial Services Programme in the United Republic of Tanzania. The main goal of this programme, approved by the IFAD Executive Board in December 2000, is the sustainable increase in income, assets and food security of poor rural households. Its purpose is to enhance the capacity of the rural poor to mobilize savings and invest in income-generating activities through the development of viable rural financial systems. The programme seeks to ensure, without exclusion, beneficiaries' access to and use of financial products and services. It will offer insurance through a fund covering, among other things, loan defaults due to incapacitation or death as a result of HIV/AIDS. Insured clients will pay 50% of insurance premiums and the programme will contribute the remaining 50%.

Partnership building

Recognizing that any effective response to HIV/AIDS must involve a broad coalition of actors, IFAD is actively seeking partnerships with key stakeholders (including United Nations organizations, governments, bilateral organizations, non-governmental organizations and project clients). In this connection, in September 2001 IFAD and the Joint United Nations Programme on HIV/AIDS (UNAIDS) established a cooperation framework to facilitate joint action against HIV/AIDS. The mission of UNAIDS is to lead, strengthen and support an expanded response to the HIV/AIDS epidemic that will prevent the spread of HIV, provide care and support for people who are ill with AIDS, reduce the vulnerability of individuals and communities to HIV/AIDS, and alleviate the socio-economic and human impact of the epidemic.

Areas earmarked for IFAD-UNAIDS collaboration include: identification and promotion of best practices for the prevention and mitigation of HIV/AIDS in rural communities; exchange of information on HIV/AIDS-related rural and agricultural development initiatives; and technical assistance by UNAIDS to IFAD in the area of impact alleviation and reduction of vulnerability to HIV/AIDS.

This is the first of a series of partnerships that IFAD will be fostering with various actors, and particularly with civil-society organizations, in order to assure a joint effort towards HIV/AIDS prevention and the mitigation of its impact on the livelihoods of the rural poor.

Women on the front-line

Uganda - Lehama Hajati working in her dry goods store in Masaka, Uganda. She has received two loans from the project to stock her store. IFAD/Radhika Chalasani
  • Women whose husbands are migrant workers are especially vulnerable to HIV/AIDS, as their spouses may have other sexual partners. Women who engage in transactional sex in exchange for money or other commodities in times of economic insecurity are also vulnerable.
  • In rural areas, as in cities, the epidemic adds to the already formidable burdens women bear-as workers, caregivers, educators and mothers. At the same time, in some countries, their legal, social and political status make them more vulnerable to HIV/AIDS.
  • In some cases, traditions meant to ensure widows access to land can contribute to the spread of HIV. An example is the custom that obliges a man to marry his brother's widow. Unfortunately, initiatives to stop these practices, while effective in slowing the transmission of HIV, may also leave widows without access to land and food.

Studies in several countries have found that some rural women whose husbands have died of AIDS have resorted to commercial sex as a means of survival, because they had no legal rights of inheritance to their husbands' property.

Source: United Nations Special Session on HIV/AIDS, June 2001

Twenty years of HIV/AIDS

In June 1981, scientists in the United States reported the first clinical evidence of a disease that would become known as Acquired Immunodeficiency Syndrome or AIDS. Twenty years later, the AIDS epidemic has spread to every corner of the world. Almost 22 million people have lost their lives to the disease, and over 36 million people are today living with HIV, the virus that causes AIDS. But two decades of struggle to control the epidemic have also yielded a growing arsenal of breakthroughs.

For a detailed timeline, visit the UNAIDS1 website

1/ UNAIDS, AIDS Epidemic Update, Joint United Nations Programme on HIV/AIDS and World Health Organization, Geneva, December 2000.

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