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

Executive Summary

1. The human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) is emerging as a key cross-sectoral issue for IFAD-supported projects in East and Southern Africa in view of three factors:

(a) the magnitude of the epidemic in the region. East and Southern Africa are at the epicentre of the HIV epidemic, with the fastest-growing HIV infection rates in the world and with rural areas increasingly affected;

(b) the disproportionate impact of HIV/AIDS on the agricultural sector relative to other sectors. The epidemic has caused the decimation of skilled and unskilled agricultural labour; a steep reduction in smallholder agricultural production; a decline in commercial agriculture; the loss of indigenous farming methods, inter-generational knowledge and specialized skills and practices; and capacity erosion and disruption in the service delivery of formal and informal rural institutions resulting from the scale of staff morbidity and mortality; and

(c) the close association of HIV/AIDS with poverty, poor nutrition and household food and livelihood insecurity, thus directly impinging upon IFAD's mandate of economic empowerment of the rural poor.

2. The IFAD's poverty alleviation strategy focuses on the economic empowerment and development of the rural poor through organizational and institutional development, and through the facilitation of access to resources and their efficient use. HIV/AIDS directly undermines this strategy in East and Southern Africa. This is largely because poverty is the driving force of HIV epidemics. At the same time, HIV/AIDS increases the depth and extent of rural poverty, and changes its profile through demographic and socio-economic impacts - thus making the environment even more conducive to the spread of the epidemic. Given the strong links between rural poverty and HIV/AIDS, this strategy paper recommends that IFAD's poverty alleviation strategy and agricultural investment projects and programmes in the region address the developmental impacts of the epidemic and the ways in which these may affect the Fund's operations.

3. The paper examines four areas of HIV/AIDS relevance to IFAD-supported projects:

(a) the vulnerability of IFAD target groups to HIV infection and to the impact of AIDS, requiring a focus on HIV prevention, with a special emphasis on addressing the co-factors of vulnerability to the infection;

(b) the vulnerability of staff of IFAD-supported projects and of their collaborating partners, and their families, to HIV infection and to the impact of AIDS;

(c) project implementation capacity, including diminished service delivery (in terms of reduced staff productivity; increased staff turnover, project expenditures and workload of project staff; and loss of knowledge, skills and expertise among staff); inability of project staff to address the impact of AIDS on target populations; and reduced district-level revenue base and thus IFAD counterpart funding; and

(d) the continued relevance of IFAD-supported project objectives, strategies and interventions in view of the impact of HIV/AIDS (including not only its impact on project objectives and activities, but also the potential inadvertent impact of IFAD-supported projects on the HIV epidemic).

4. Effective responses to the epidemic require an in-depth understanding of the phases and dynamics of HIV/AIDS prevalence and impact. This strategy paper proposes an HIV/AIDS vulnerability and mitigation matrix as a planning tool with which to identify focus areas of response to the epidemic, using concepts from disaster management. Response measures are identified on the basis of HIV/AIDS adult prevalence rates and AIDS impact levels.

5. Four indicators are presented for measuring AIDS impact levels: (a) percentage of single orphans (children who have lost one parent) and double orphans (children who have lost both parents); (b) percentage of households fostering orphans; (c) percentage of household income spent on health-related expenditures; and (d) percentage of households with access to health care. With the assistance of the Joint United Nations Programme on HIV/AIDS (UNAIDS) and other institutions, thresholds for low and high rates of HIV/AIDS adult prevalence and impact levels can be established in order to assist project and programme staff in identifying epidemic phases and appropriate responses.

6. An analysis of the sector-specific impacts of HIV/AIDS (for instance, on crop production and livestock projects; irrigation projects; financial services programmes; area development programmes; research, extension and training projects; and post-conflict reconstruction and rehabilitation projects) shows that HIV/AIDS affects every technical area in which IFAD is involved. For this reason, an HIV and development lens is required and should be applied across sectors and sectoral project components within an overall multisectoral framework of response to the epidemic.

7. Five key areas of IFAD's response to the HIV epidemic are examined:

(a) HIV/AIDS information, education and communication (IEC) programmes for HIV prevention and AIDS mitigation among IFAD target groups;

(b) poverty alleviation and livelihood security programmes adapted to the conditions created by HIV/AIDS, including income-generating programmes, microfinance projects and functional adult literacy (FAL) programmes;

(c) food security and nutrition-related innovations or adaptation of existing practices, such as: the introduction of high-yielding, weed/pest resistant plant varieties that require little labour; the rehabilitation of certain staple food crops; improved agricultural practices to save labour and capital; and nutritional gardens;

(d) socio-economic safety nets, with special emphasis on support to orphans and households fostering orphans. The IFAD-supported Uganda Women's Effort to Save Orphans (UWESO) Development Programme is presented as a case study of how development measures, rather than relief initiatives, can effectively strengthen socio-economic safety nets; and

(e) integrated HIV/AIDS workplace programmes for IFAD-supported projects, featuring: IEC campaigns on HIV prevention, AIDS care and support; a review and adjustment of working conditions, human resource policies and administrative procedures; and capacity-building and training in the technical aspects of the impact of AIDS.

8. The strategy paper underscores that breaking down the stigma of HIV/AIDS must be a key objective of all measures taken in response to the epidemic.

9. Further, the paper emphasizes that HIV/AIDS needs to be incorporated in the IFAD project cycle, going beyond problem analysis to the identification of concrete entry points and response measures. In project areas severely affected by HIV/AIDS, further conceptual and operational adjustments may be necessary. Such a process needs to run through the entire project cycle from design to implementation. The paper give examples of how HIV/AIDS concerns can be integrated into each stage of design and implementation, highlighting the specific conceptual and operational adjustments required.

10. Given the magnitude of the epidemic and its far-reaching cross-sectoral impacts, the strategy paper emphasizes the need for strategic partnerships with national bodies and networks, bilateral donors, other United Nations agencies and non-governmental organizations (NGOs). It discusses the potential partnerships between IFAD and other organizations in the area of cofinancing, advocacy, operations, research and knowledge dissemination.

11. To build institutional capacity to address HIV/AIDS concerns, the strategy paper proposes a series of activities that IFAD can undertake at project, country and headquarters levels.

12. At project level, brief consultancies for each IFAD-supported project can help assess the impact of the epidemic on the project; enable projects to mainstream HIV/AIDS in core activities; specify operational and procedural adjustments needed to address the impact of AIDS on project staff and target groups; and identify key entry points for the integration of HIV/AIDS in ongoing project interventions.

13. At country level, workshops can be held bringing together staff from IFAD-supported projects to brainstorm on the impact of HIV/AIDS on their projects and to establish a networking mechanism among projects to ensure exchange of information and experience in addressing HIV/AIDS.

14. At headquarters level, proposed measures include:

(a) raising awareness of IFAD staff on the links between HIV/AIDS and the technical areas of the Fund's work;
(b) capacity development to build HIV/AIDS in project design, implementation, monitoring and evaluation;
(c) raising awareness of the staff of cooperating institutions (the United Nations Office for Project Services (UNOPS), the African Development Bank and the World Bank) and cofinancing partners of the developmental effects of HIV/AIDS on IFAD-supported projects; and
(d) the establishment of a database on HIV/AIDS and rural development.