IFAD strategy paper on HIV/AIDS for East and Southern Africa

Section I - Introduction

1. Initially, the human immunodeficiency virus (HIV) and the acquired immune deficiency syndrome (AIDS) were perceived as a public health crisis. Over the last decade, however, the HIV epidemic in East and Southern Africa has assumed such proportions that it poses a threat to socio-economic development. In 1991, it was projected that nine million people in sub-Saharan Africa would be infected with HIV by 2000, and five million would die of AIDS. This was a roughly a threefold underestimation: by late 2000, it was estimated that more than 25 million people in sub-Saharan Africa had become infected with HIV and over 17 million had died of AIDS. The magnitude of the epidemic and its systemic impact are affecting every sector (including industry, transport, tourism, education, health and agriculture). For this reason, a number of countries in the region have declared HIV/AIDS a national disaster.

2. Unprecedented rates of HIV morbidity and AIDS mortality among young adults are reversing hard-won gains in life expectancy by 20 to 40% in countries such as Botswana, Kenya, South Africa, Uganda, Zambia and Zimbabwe. Life expectancy at birth is now only 37 years in Zambia and 39 years in Botswana, whereas without AIDS it would be 59 and 70 years respectively1. Infant mortality is rising: in Zambia and Zimbabwe, 25% more infants are dying than would have been the case without HIV.2


3. AIDS has orphaned nearly 13 million children in sub-Saharan Africa.3 In Uganda alone, a country with a population of 21 million, 1.7 million children are orphans. The social cost of the epidemic in terms of human suffering, orphanhood and dislocation is incalculable. Further, HIV/AIDS is eroding the social fabric of African societies by unravelling socio-economic safety nets, exacerbating gender inequities and fragmenting or dissolving a growing number of households.

4. HIV/AIDS-induced mortality is altering population structures, with 'chimneys' replacing pyramids in the hardest-hit countries. A case in point is Botswana, where more than a third of the adult population is infected with HIV. The impact that AIDS is predicted to have on Botswana's population structure by 2020, as shown is Figure 1, is dramatic. The implications of this unprecedented demographic trend on socio-economic development are difficult to predict. What is clear, however, is that an increasingly smaller number of young adults (many of whom will be living with HIV/AIDS) will have to support large numbers of young and old people.


5. In East and Southern Africa, the epidemic is no longer affecting only isolated households. Young adult morbidity and mortality have an impact on virtually all households, either directly or indirectly (Box 1).

 

Box 1: HIV - Not Just a Virus

Hardly a home along the Kibos River in Kenya is unaffected by HIV/AIDS. Neighbours can no longer help neighbours, overwhelmed by their own misfortunes. "It isn't just the virus, or the absence of drugs," said a despondent community worker. "People are dying from hunger and poverty. This isn't some disease. It's a disaster."

Source: IFRC, 2000, p. 53

Tanzania - Students are learning how to grow coffee in Koreri village, Mugumu town. In the area, 37 schools have coffee plots like this one. They soon expect to sell their first full 50-kilo sack of coffee using the profits for school projects and sporting equipment. IFAD Photo by Robert GrossmanHIV/AIDS affects a household directly when: (a) a household member is living with HIV/AIDS; (b) the household has recently lost a young adult to AIDS; or (c) it is fostering an AIDS orphan. HIV/AIDS has an indirect effect when households have to assist sick relatives with labour, food, cash or other contributions on an intermittent or continuous basis; help neighbours with occasional labour; or fulfil their obligations towards the community with contributions to funerals.

Figure 1: Projected Population Structure With and Without the AIDS Epidemic, Botswana, 2020

Source: U.S. Bureau of the Census, World Population Profile, 2000, in UNAIDS, 2000a.

6. The causes and consequences of the epidemic are closely associated with wider challenges to development, such as poverty and food and livelihood insecurity. The HIV epidemic tends to exacerbate these problems through its systemic impact (Box 2). As a long-wave disaster, HIV/AIDS not only increases the depth and extent of rural poverty, but it also changes its profile. An alarming number of households today are headed by young widows, elderly grandmothers and orphans; and, in some countries, nearly a quarter of households are fostering orphans. For many households, HIV/AIDS triggers impoverishment and hunger. In fact, the shock that the epidemic inflicts is such that many households are unable to reverse the process of impoverishment.

 

Box 2: The Systemic Impact of HIV/AIDS
Agriculture and rural development do not merely consist of the total of various isolated subsectors (infrastructure, employment, education, health, etc). They are dynamic, integrated and interdependent systems of productive and other components, operating through a network of interrelated subsectors, institutions and rural households with links at every level of activity. The efficiency and effectiveness of each subsector, institution and household depends, to a large extent, on the capacity in other parts of the system. If this capacity is eroded through HIV/AIDS, then the system's ability to function will be diminished.

Thus, HIV/AIDS does not merely impact on certain agricultural and rural development subsectoral 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. In other words, the impact of HIV/AIDS is not only cross-sectoral, but, more importantly, systemic. If the linkages between subsectors, institutions and households are not identified and addressed as such, then the analysis of the impact of HIV/AIDS will be incomplete and programme responses will be inadequate.

Source: Topouzis, 1998. 		 

7. This strategy paper delineates IFAD's role in helping to stem the spread of the epidemic and in addressing its effects on the rural poor and on agricultural and rural development. It describes the approach the Fund will use to achieve these objectives, which consists of: (a) adapting existing agricultural and rural development strategies and programmes to the challenges posed by the epidemic, and (b) introducing new components that address HIV/AIDS-specific concerns.

8. The strategy paper is divided into six sections. Section II reviews in detail why IFAD should be concerned with HIV/AIDS, focusing on the linkages between HIV, poverty and gender. Section III proposes elements of a framework for HIV/AIDS impact analysis and for the identification of mitigation responses. This framework and suggested approach are relevant not only for IFAD but also for other donors and organizations engaged in HIV/AIDS mitigation work. Section III further highlights sector-specific impacts of HIV/AIDS and outlines their implications for IFAD-supported development projects. Section IV identifies key focus areas of IFAD's response to the epidemic and analyses how HIV/AIDS can be integrated into the IFAD project cycle. Section V outlines potential strategic partnerships with non-governmental organizations (NGOs), national bodies and networks, other United Nations (UN) agencies and bilateral donors. Section VI summarizes potential activities at project, country and headquarters level through which IFAD can address HIV/AIDS concerns in its work.

1/ U.S. Bureau of the Census, Zambia and Botswana Country Profiles, 2000, at http://www.census.gov.

2/ UNAIDS cited in World Bank, 1999.

3/ According to UNAIDS, an orphan is a child under 15 years of age who has lost his or her mother or both parents to AIDS.

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