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Sustainable Livelihoods Approaches and the HIV/AIDS
epidemic. A preliminary resource paper
Janet Seeley and Colin Pringle
Abstract
With 40 million people worldwide living with HIV/AIDS, no development initiative can afford
to ignore the epidemic now and in the longer term. While the literature on HIV/AIDS
continues to grow rapidly, much of the non-medical literature repeats lessons already
highlighted over the last decade. The examples cited in this paper and referenced in the
appendices show that what has worked in arresting the HIV/AIDS epidemic and mitigating its
impact has often been local responses rather than global initiatives or grand strategies. What
needs to be done is to support such local responses and to share the learning across sectors,
regions and organisations. Sustainable livelihoods approaches, which bridge sectoral divides,
are well placed to provide a vehicle for this. A livelihoods approach to the HIV/AIDS epidemic
offers the chance to mitigate its impact on the poor by looking at their circumstances `in the round’,
looking at the connections between different livelihood assets and taking into account the fact that an
intervention in one area will impact on other areas of people’s lives. Impact mitigation needs to be seen
as an urgent task, independent of, but related to, the health-led HIV/AIDS initiatives but of equal
importance for funding. Drugs and vaccines will not rebuild the communities of those devastated by the
epidemic. The biggest challenge facing us is to build on the strengths of what is already known, what is
already tried and tested, and to support and encourage people as they reconstruct livelihoods to enable
them and their families to live with and counter the impact of HIV/AIDS.
“Throughout history, few crises have presented such a threat to human health and
social and economic progress as does the HIV/AIDS epidemic” FAO report for the
27th Session of the Committee on World Food Security, 2001
At the end of 2001, 40 million people worldwide are living with HIV/AIDS, 90 per
cent in developing countries and 75 per cent in Sub-Saharan Africa.1 In 2001 there
were 3 million AIDS-related deaths. Sub-Saharan Africa is frequently viewed as the
‘hot spot’ of the epidemic, but the impact is global and cross sectoral. Significant
epidemics occur in SE Asia, the Indian Subcontinent, Latin America, North America
and the Caribbean and Eastern and Central Europe. The importance of addressing
the impact on development of HIV/AIDS has been highlighted in the Millennium
Development Goals where Target 6 is to `have halted by 2015 and begun to
reverse the spread of HIV/AIDS’.
The purpose of this paper is to help with initial thinking on Sustainable Livelihoods
Approaches and the HIV/AIDS epidemic, setting out in the annexes some of the
resources available on the impact of the epidemic on peoples’ livelihoods. This is
part of a process by which the Sustainable Livelihoods Support Office of DFID aims
to engage with a range of people to look at HIV/AIDS as a `livelihoods issue’
impacting on many different aspects of peoples’ lives.
1
UN Special Session on HIV/AIDS August 2001, Declaration of Commitment on HIV/AIDS
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`HIV/AIDS is not only a health issue that demands prevention and care for the sick;
it is also a livelihoods issue, since, if AIDS-depleted households are not the target of
particular support, the precarious livelihoods of survivors are likely to collapse under
the impact of the epidemic’.2
The examples cited in this paper and referenced in the appendices show that what
has worked in arresting the HIV/AIDS epidemic and mitigating its impact have been
local responses, not global initiatives or grand strategies. What needs to be done is
to support such local responses and to share the learning across sectors, regions
and organisations. Sustainable livelihoods approaches, which bridge sectoral
divides, are well placed to provide a vehicle for this.
Background
The HIV/AIDS epidemic is not, of course, new nor is the acknowledgement that
HIV/AIDS is having an impact on development a novel idea. Fifteen year olds
growing up in Kampala, Uganda, do not know of a world without HIV/AIDS
messages and slogans, their lives and livelihoods have been and will continue to be
profoundly affected by the epidemic. There is a vast, and growing, literature on the
medical and social aspects of HIV/AIDS. But in the course of reviewing the
literature for this paper, it was apparent that much of the non-medical literature
(particularly that in the social sciences) reiterates observations made in the early
1990s, and does little to take forward our understanding of the impact of HIV/AIDS
and how that impact might be mitigated. And much excellent work remains
unpublished or only available in academic journals not readily accessible in the
public domain, or readily translatable into action.
While White and Robinson3 may be correct to say that HIV/AIDS has `become a
matter of concern beyond the fields of biomedicine and preventive and curative
health’ and has become increasingly understood as a development issue, much of
the thinking remains sectorally-focused and the work that is `livelihoods’-related’
tends to focus on particular occupational groups or sectors such as `agriculturebased’ livelihoods in Africa. We found no long-term in-depth research that looked at
the impact on `joined-up livelihoods’; that explored the ways people adapt their
livelihoods, often taking risks or seemingly -to the outsider - irrational decisions in an
effort to cope. Attention to the personal cost of HIV/AIDS, which is an important
influence on how people respond and what decisions are taken, often appears in
anecdotes or as quotes in case studies, but seldom seems to be fed into the literature
providing guidelines and toolkits for development practitioners. Despite the large
volume of publications, web-sources and anecdotal evidence on the impact of
HIV/AIDS and the necessary response, the `literature on the social, economic and
2
Appleton, Judith (2000) `“At my age I should be sitting under that tree”’: the impact of AIDS on
Tanzanian lakeshore communities’ Gender and Development 8 (2) 19-27
Joanna White and Elizabeth Robinson (2000) HIV/AIDS and Rural Livelihoods in SubSaharan Africa, Policy Series 6, NRI, p. 5
3
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demographic impact of the epidemic is comparatively small and limited to a few
authors (unlike the medical literature).’4
One of the reasons why the social science has not kept pace with the medical
research is undoubtedly funding, but there is also the sense that the solution to the
epidemic must be medical: through drugs or vaccine and therefore efforts need to
be focused to support that work. Therefore, much of the non-medical funding has
been for behavioural research, in support of medical solutions. Too little funding
has gone for research on prevention and, importantly, on impact mitigation. For
much of the world, interventions are coming too late to prevent the epidemic from
spreading, even if the Millennium Development Goal Target 6 is attained and the
epidemic arrested, we still need research and development that builds on people’s
strengths to cope with the wide-ranging impact, of which medical interventions will
only be a small part.
The situation in South Africa feels so urgent. Personally I have two cousins living with AIDS
right now. The Oxfams’ have talked about treating HIV as an emergency situation, but how
long can you have a crisis for? We were calling it a crisis in 1982. We need to think longer
term: nothing we do now will show major change for another five years.
Dawn Cavanagh, `The Right to Equity’: the South African joint Oxfam HIV/AIDS program
www.caa.org.au/horizons/february_2001/aids.html
There is, therefore, plenty of room for innovation in finding ways forward and there
are many, often small-scale and localised, examples of good practice to share and
from which to learn.
UMN, an international development organisation based in Nepal and supported by various
donors (including DFID) produce 'Pipal Pustaks', a series of books for Non Formal Education
that have won international literacy awards. They are based on true stories and are usually
written by newly literate people and are published for their peers.
Recognising the need for HIV/AIDS materials for NGOs in Nepal, a Pipal Pustak on
Care and Support, and one on raising awareness/advocacy for HIV/AIDS were produced. They
are now used within rural and urban development projects in UMN (and beyond) as well as in
education and health programmes.
(source: Andrew Furber, DFID supported HIV adviser, UMN pers. comm. )
Amambisi and communities like it are fighting back against the disease with the few weapons
at their disposal. "You are a journalist, don't say we are helpless against this scourge, we are
doing a lot," Chief Lingazwe told IRIN. The endless funerals have also brought the reality of
HIV/AIDS home to Amambisi. Sister Nogzima's classes and a new outreach programme
means the safe sex message is finally getting through and communal structures are managing
to absorb the growing number of AIDS orphans. "Our close networks mean people are talking
and learning and behaviour is, I think changing," said Lingazwe. "We'll see many more
funerals, but we're not just lying down and letting this thing eat us, we need government
support and international help, and we need it now," he added. (source IRIN-SA, IRIN-
AIDS Weekly 2001, email: AIDS@irin.org.za)
4
Barnett and Whiteside (2000) The Social and Economic Impact of HIV/AIDS in Poor Countries: a
review of studies and lessons UNAIDS p.14.
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The impact on HIV/AIDS on livelihoods
Livelihoods approaches offer an holistic way of addressing the HIV/AIDS epidemic
which promote joined up thinking across sectors and disciplines, that can look not
just at the impact on health but also at the impact on social support, finances,
housing, land-use and land tenure. After all, a person living with AIDS does not
stop being a family or community member, a land holder or a house tenant, a
carpenter or a share cropper, or for that matter an educated or literate person.
HIV/AIDS may alter access to work and financial assets, to family and community,
but a person with HIV/AIDS is still a person; a fact that has often been undermined
by the use of labels like `AIDS victim’ and `AIDS patient’. Medical conditions often
rob a person of their status as a person, and AIDS, particularly with the stigma
associated with the condition, is no exception.
Individuals, households, industry and government machinery are adapting to the
long-term impact of HIV/AIDS in many different ways. HIV/AIDS is a `long wave
event’, not a short sharp shock,5 life-styles may change but people continue to need
to earn a living, raise children, and cope with day to day crises. While the age
group most likely to be affected by HIV in any population is those between 15-40
years old, who tend to constitute the most economically active section of the
population, the old and the very young also feel the impact on their lives.6
The head of Amambisi Tribal Authority, Chief David Lingazwe said the epidemic had
taken everyone in the area by surprise. "We thought it was a town thing, we didn't
know it would kill our families like this," he said. HIV/AIDS has also brought new
social problems to Lingazwe's community, including crime. "Stock theft and stealing
generally have increased, I'm told people are desperate for money to pay for
treatment," he said. Local police confirmed the trend and said they were often in a
dilemma over prosecuting sick people. (from a report on Daliwonga clinic, Eastern
Cape, S. Africa -source IRIN-SA, IRIN-AIDS Weekly 2001, email: AIDS@irin.org.za)
5
`The HIV/AIDS epidemic is a long wave event when compared to a volcanic eruption, a flood or a
famine. In many sub-Saharan African countries the demographic impact, signalled by changes in
population structure and life expectancy, will be felt for many decades’. Tony Barnett (1999)
`HIV/AIDS: Long Wave Event, Short Wave Event: Identity, Gender, Agriculture and Policy in Uganda
and Elsewhere’ American Anthropological Association Annual Meeting Chicago 1999.
6
HelpAge International has been active in recent years in highlighting the impact of the epidemic on
older people. See `HIV/AIDS: why strategies must include older people’ in Ageing and Development
Issue 8, May 2001.
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Agro-industry in Kenya is severely affected by HIV/AIDS epidemic. The commercial agricultural
sector of Kenya is facing a severe social and economic crisis due to the impact of HIV and
AIDS. Protracted morbidity and mortality have profound financial, economic, and social costs
for industry. The loss of skilled and experienced labour to the epidemic continues to be a
serious concern. If agro-estates are to remain viable businesses, it will be necessary and
urgent to approach the epidemic with the seriousness it deserves. This includes wellelaborated prevention programmes and concerted mitigation strategies at the company level,
in collaboration with other sectors of the economy including the government, NGOs, and civil
society.
(Source: HIV/AIDS and the commercial agricultural sector of Kenya: Impact, vulnerability,
susceptibility and coping strategies: Gabriel Rugalema Institute of Social Studies, The Hague,
Netherlands with Silke Weigang (FAO/SDRE) and James Mbwika, Consultant)
Incapacity or loss of the 15-40 year old age group has significant repercussions at
the level of both the household and community, but also beyond in terms of macrolevel social and economic development. For example, a significant loss of skilled or
semi-skilled labour within the transport sector can have serious consequences for
the safe transport of people and goods throughout and beyond a country. Hospitals
may be over-stretched and already scarce resources diverted to treating AIDSrelated infections to the detriment of the treatment provision for other infections or
injuries. High levels of HIV infection among teachers may eventually cause
significant disruption to schooling and jeopardise education for large numbers of
children. Loss of agricultural labour may in turn lead to children being removed from
school in order to contribute to the household economy and may lead to significant
(and detrimental) changes in traditional agricultural practice.7
An impact assessment conducted by the Ministry of Agriculture and Irrigation of Malawi
found that among MoA male staff, drivers, supervisors, middle and top managers were most
vulnerable to HIV infection. Among female staff, messengers and secretaries were
perceived to be most vulnerable. Reasons given for this increased vulnerability included: i)
the fact that these jobs required frequent travel to the field, which separated employees
from their spouses for prolonged periods of time; ii) better-off male staff were more likely to
have more than one sexual partners; iii) worse-off female staff were more likely to offer sex
for money.
`Addressing the impact of HIV/AIDS on Ministries of Agriculture: Focus on Eastern and
Southern Africa’ by Daphne Topouzis. FAO/UNAIDS Discussion Paper. 2001 p. 11
What are the implications of SLAs on our approach to HIV/AIDS?
Sustainable livelihoods approaches place people at the centre of development,
rather than focusing on the resources they use or a single activity. If we start with
the person in the context of the HIV/AIDS epidemic we look beyond and around the
epidemic, the clinical condition, or the medical solution, and through livelihoods
analysis take into account the other things going on now and in the past in their life,
or the life of the household, community or region. Livelihood diversification has
7
The impact of the epidemic on agriculture, particularly in Africa, is perhaps the best served by
research and documentation. See www.fao.org/Focus/aids1-e.htm for a recent update.
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always been important as a coping strategy for poor people faced with an uncertain
world: harvests fail, market prices fall, factories close, and the informal economy is
constrained by legislation. People adapt. The hardship inflicted by HIV/AIDS,
through the loss of family members, the costs of care; the loss of workers etc.
highlights the need for support for different livelihood strategies at times of crisis
and beyond.
We need to take a dynamic approach; HIV/AIDS does not often kill a person
quickly. Nor does the epidemic have an instant impact on a community or
nation, unlike a flood or earthquake. If we think about it in terms of the SL
framework’s `vulnerability context’ it is not a sharp shock. HIV/AIDS erodes
communities. People LIVE with HIV/AIDS and grow older with HIV/AIDS, and
their livelihood fortunes change over that time. Households, communities and
regions may experience subtle shifts and changes rather than dramatic
change as people adjust to the impact of the epidemic. Livelihoods
approaches encourage us, therefore, to look at the depth as well as the
breadth of peoples’ lives. What this should mean is that policies, projects and
programmes which seek to arrest the spread of HIV/AIDS and mitigate the
impact of the epidemic, do so by recognising the affect of the epidemic on all
aspects of peoples lives, not just health, and seek to identify areas where
support will have a positive impact.
To do this the livelihoods analysis will demand holistic analysis, but with the
subsequent intervention, in most cases, being specifically targeted within that
wider understanding. Our analysis may ask: what income-generating options
exist for a household suffering from a labour shortage? Is the stigma
associated with the condition affecting access to non-health services
(agricultural extension or education, perhaps)? What support exists for
carers, are they cut off from their own social networks because of the burden
of care? In industry or services where a large number of people have died or
are sick, how might capacity be enhanced to meet demand? And, in order to
provide an effective approach, `we’ will look for partners and build on existing
strengths: who else is working here who may provide the service? Share the
knowledge? Who might we support to help them do what they are already
doing more effectively?
Along Route 5, the country’s superhighway that links Thailand to Viet Nam, a growing number
of farmers are learning the essentials of how to prevent HIV/AIDS infection. The “Farmers for
Life School (FLS)” project was established by the Food and Agriculture Organisation to
promote more ecologically friendly cultivation methods. The pilot programme, to run until
2001, was funded (and with technical support) by UNDP South East Asia HIV and
Development Project.
Sin Chhit Na, a Core Trainer at the FLS, noted that since its inception earlier this year,
114 farmers, among them 42 women, have enrolled in the school.
For 16 weeks during the planting and harvesting seasons, members of the FLS
regularly attended a weekly class, each lasting half a day. Here, they learned not only the
science and technique of keeping pests under control in a way that does not harm the
environment, but also how to avoid AIDS.
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As the farmers developed the ability to critically analyse the ecology of rice fields, they also
became more adept at assessing the threats and constraints on their livelihood, as well as
weighing options available to them.
(Source: `Mae Chan Workshop on integrated community mobilisation towards effective
multisectoral HIV/AIDS prevention and care’ compiled by: HOLLERTZ UNDP South East Asia
HIV and Development Project May 2001)
"FAO has come a long way since it first addressed the issue of AIDS and agriculture at a time
when the epidemic was still considered essentially an urban problem. One of the lessons we
have learned over the past years is that institutional collaboration is imperative for effective
action to take place." Statement by Mr. Henri Carsalade, Assistant Director-General Sustainable
Development Department, FAO (1999) (from Michiels 2001, Strategic approaches to HIV
prevention and AIDS mitigation in rural communities and households in Sub-Saharan Africa,
FAO)
Through holistic analysis one may find that the obvious entry point is not the
only one or even the best one. Access to treatment and medical support for
the sick person may be important. But ensuring that carers, particularly
where they may be de facto rather than de jure household heads (and
therefore not on `official lists’), are aware of their rights and obligations and
can access what they require to maintain their own and their households wellbeing, may be more important in sustaining the household in the longer term.
This may be particularly the case if the episodes of AIDS-related illness go on
for many years and, if a number of people in the household die, because the
impact will be felt by the family for years to come. And it is essential to stress
that people living with HIV/AIDS do not stop being decision makers, they are
still a part of the `target group’ for development initiatives, with valuable
knowledge and understanding. Ensuring their participation often requires
challenging the stigma and fear surrounding HIV/AIDS.
Agricultural extension in Zimbabwe in the face of HIV/AIDS: an NGO view
Conventional agricultural development in Zimbabwe has been largely based on top-down
research & extension, mostly promoting higher input technologies to male smallholders. This
process has marginalised women farmers.
This conventional approach to agricultural research is fast becoming irrelevant in the face of
the HIV/AIDS pandemic, as the majority of AIDS survivors in Zimbabwe’s rural areas are likely
to be middle-aged widows, often caring for 6 or more children. These women, left destitute
after paying funeral expenses, are unable to afford inputs and thus require low-risk survival
strategies that can assure household food security, as well as a cash income to pay for school
fees and other basic necessities
The development of appropriate survival strategies for female smallholders will require a
substantial paradigm shift on the part of research and extension. The new paradigm would be
concerned with the promotion of low input, labour-extensive sustainable agriculture and
involve farmers in both the planning & implementation of the supporting research
(source: “Towards a New agricultural research agenda” paper presented at the International
Conference on AIDS, Livelihood & Social Change in Africa, Wageningen Agricultural University
1999, quoted in Daphne Topouzis and Jacques du Guerny “Sustainable Agricultural/Rural
development and vulnerability to the AIDS epidemic” FAO/UNAIDS 1999)
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An example was given by Hans Binswanger (World Bank) of fishing/farming communities
around Lake Victoria. Here many AIDS orphans are cared for within the community by
members of extended family. However most of these children are from urban families - they
have no farming/fishing knowledge, and so are unable to make a living. The society is so
damaged by HIV that there is no teaching or sharing of indigenous knowledge within the
community.
(Source: DFID-IFPRI Consultation on HIV/AIDS & Rural Livelihoods, IFPRI, January 2001
reported by Pringle, JSIUK Meeting Notes 2001)
Socio-economic vulnerability may lead to the adoption of survival strategies
that enhance the risk of HIV transmission. For example children orphaned
through HIV often migrate from rural to urban areas where they may join the
ranks of the so-called ‘street children’, sometimes exchanging sex for food,
money or protection. In these circumstances the relative powerlessness of
children increases their vulnerability to acquiring infection. The complexity of
local circumstances is illustrated where the reverse migration of HIV orphans
occurs from urban areas (where the parents went in search of employment)
back to the rural ‘homeland’ on the death of the parents. These children often
lack the skills to produce or earn food in the traditional setting, leading to
considerable local impact on society.
In a Uganda study, 65% of AIDS-affected households were obliged to sell property to pay for
care (source FAO report for the 27th Session of the Committee on World Food Security, 2001)
Another phenomenon, unheard of in the area, is also taking hold. "Young girls are
prostituting themselves, often to get cash for themselves or infected family
members, of course this is just spreading AIDS," Tolly Xigau, a rural social worker in
nearby Bizana, told IRIN. She added that desperate women often forsake condoms if
it means making more money. "It's really sad because often the girls will do anything
to get money for food, drugs or transport to urban areas where better treatment is
available," she said. (from a report on Daliwonga clinic, Eastern Cape, S. Africa -
source IRIN-SA, IRIN-AIDS Weekly 2001, email: AIDS@irin.org.za)
Some impact may be more subtle, it may even be hidden, and therefore an
intervention to alleviate the impact may be required that is less obvious than
attempting to provide an alternative means of making a livelihood. Death and
illness, sorrow and grieving take their toll. Add to that the fact that HIV/AIDS can
be spread through the very act of reproduction that should be associated with a
sense of fulfilment and well-being, and one can understand that people may lose a
sense of purpose, the very will to hold their livelihoods together. Development
seldom confronts such emotional issues, and few people working in development
are equipped to cope with the impact on themselves, let alone on the people they
work with.
A 1996 study of 12 to 20 year olds in three schools in Malawi found a high sense of
hopelessness and fatalism particularly among poorer adolescents in rural areas. Their
knowledge about AIDS was high, and this contributed to their sense of pessimism about the
future. More than 40% of the rural youth believed they would die young as did 17% of the
more affluent urban students interviewed.
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"The life experiences of poorer rural students in Malawi appear to lead to a serious level of
despondency and low self-esteem, likely to reduce capacity to prevent HIV infection. Young
people can be presumed to be less likely to practice abstinence or safer sex if they truly believe
that they will be dying within the next few years regardless of what they do" (Source: SaFAIDS
News, Dec. 1998, via John Williamson, Senior Technical Advisor, Displaced Children and
Orphans Fund of USAID, 2001)
A thirty year old woman often complained […] that she was lonely. Her sister who had been
the household head had died in 1990 and she was left with her sister’s two children and child
of her brother to care for. […] a cousin came to stay in order to help her organise a New
Year’s Party. The interviewer commented “Regina was so excited and in the happiest mood I
have ever seen because she had a visitor of her own age” ’ Source: Janet Seeley (1993)
`Searching for indicators of vulnerability: a study of household coping strategies in rural South
West Uganda’ MRC/ODA report, p. 58
The mitigation of the impact of the epidemic needs to include activities and
interventions that build social capital, that bring pleasure, that build a sense of
purpose. That may come from reconstructing livelihoods around a new economic
activity, but we also need activities and interventions that enable people to cultivate
their social and cultural capital.
Prevention efforts targeting youth should promote a sense of capacity and the vision of better
future. Simply telling them "AIDS kills" makes matters worse.
(source: John Williamson, Senior Technical Advisor, Displaced Children and Orphans Fund of
USAID, 2001)
So, the response to the epidemic must increasingly look beyond `education about the
disease’ and medical interventions, not only in places where rates of infection are high
but also in places, such as India, where the impact of the epidemic is just beginning
to be acknowledged. Coping with the impact of the disease and promoting
prevention strategies as well as supporting coping strategies requires a broad-based
approach. In terms of project and programme design, this is more than adding an
annex or a paragraph to a project document talking of the impact of HIV/AIDS on the
project stakeholders, or noting it as a risk in the log-frame.
On a recent visit to Andhra Pradesh, India, in a remote tribal village, we learned that
three families, in a community of less than a hundred households, had members with
AIDS-related illnesses. HIV/AIDS is not just an issue for sub-Saharan Africa: all
development programmes and projects, new and on-going, need to think seriously
about what `mainstreaming HIV/AIDS’ really means – and respond appropriately.8
Barnett and Blaikie9 provided a definition of three distinct categories in
relation to the impact of HIV/AIDS on households. They defined AIDSafflicted households as those where a member of the household is ill or has
died from HIV/AIDS. AIDS-affected households are those where household
8
In the course of this review we were surprised to find that development and research projects (which
are not specifically targeted at HIV/AIDS treatment or prevention initiatives) which acknowledge the
presence of HIV/AIDS in the target community and include a strategy for taking account of the epidemic
in the approach, are still the exception rather than the rule, even in Sub-Saharan Africa. The recently
published DFID HIV/AIDS Strategy provides a framework for mainstreaming HIV into all DFID’s activities
(see Appendix B of this document. Full text of the Strategy is available on www.dfid.gov.uk ).
9
Barnett, Tony and P. Blaikie (1992) AIDS in Africa – the present and future impact Belhaven Press,
London
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members are not infected, but have been affected by HIV/AIDS. Unaffected
households are those in which no member is ill or has died from AIDS and is
not affected by illness or death in a related household. As we enter 2002
there are few `unaffected’ households if one includes all those who worry
about their own or their children’s exposure through unsafe-sex, who
recognise the cost the epidemic to development in the country or region or
join in the debate on access to anti-retrovirals.
The HIV/AIDS epidemic is a fact of life for everyone, and as such it is one
factor among many that development needs to take into account. Given that
livelihoods approaches encourage us to take an holistic look at people’s lives,
an exclusive focus on the impact of HIV/AIDS may miss other factors
influencing poverty that may not be directly the result of the epidemic: global
recession that results in closure of factories and the loss of poor people’s jobs
or a fall in agricultural prices, for example. The HIV/AIDS epidemic may
make the situation far worse for a household in southern India, or South
Africa, but even without the impact of the epidemic the prospects for finding
a path out of poverty may be bleak. Again, this reminds us that we need to
have a joined up approach to looking at development initiatives to support
peoples’ livelihoods. Much of the literature, as shown in appendix E, has
focused on particular livelihood groups or target groups, and much of that
learning still needs to shared and links made. A seasonal migrant is a part of
a larger family who may undertake agricultural activities and petty trading as
well as take part in a savings and credit group.
Once largely an urban problem, HIV/AIDS has moved to rural areas: more than two
thirds of the population of the 25 most-affected African countries live in the
countryside […] Rural communities also bear a higher burden of the cost of
HIV/AIDS as many urban dwellers and migrant labourers return to their villages
when they become sick.
`HIV/AIDS, food security and rural livelihoods’. FAO Fact Sheet, 2000, p. 1
In the course of the HIV/AIDS epidemic it has seldom been very helpful for
the individuals or groups involved to label them `at risk’: Gays, Haitians, Sex
workers, `people who have lived in Africa’, Migrants and Truckers are among
those who have been so labelled. Driving a truck may bring a relatively
lucrative income, more controversially perhaps commercial sex work may be
the mainstay of a household’s income. They are livelihood options and
unlikely to be given up unless viable alternatives exist (that may not just
mean viable in the sense of economic viability but viable in terms of life style
and status too), so the most important thing may be to ensure that people
are `safe’ to pursue their work, something that a number of programmes with
drug users, sex workers and truckers have sought to do. Addressing issues to
do with the hidden livelihoods of the poor, particularly where the activity is
deemed illegal is a challenge for livelihoods analysis as well as meaningful
interventions.
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Without further investment in focused research, linked to practical uptakes, it is
unlikely that the knowledge base in this field will move any further forward.10
What might we do differently?
The first thing we might do is to support the implementation of recommendations
that already exist, such as those from the 1998 Harare Conference, Responding to
HIV/AIDS: Technology Development Needs of African Smallholder Agriculture (quoted
in White and Robinson 2000:46) and the 2001 Technical Meeting in Rome Mitigating
the Impact of HIV/AIDS on Food Security and Rural Poverty (see Appendix D for a
table of these recommendations). There is no need to `reinvent the wheel’ we need
to look for ways in which such ideas can be mainstreamed. New research in some
areas is required to build on such recommendations by taking a more holistic
approach, recognizing that agricultural livelihoods often depend on urban remittances,
for example, and that for many people in the world there is no neat divide between
`urban and `rural’ livelihoods. There is also a need to recognise that livelihoods
change over time as the domestic group changes and fortunes change. Support is
required for programmes and research that examine ways to replicate successful
initiatives, to test ideas in other regions and to promote learning across different
regions and from micro to macro levels within countries and regions. As White and
Robinson (2000: 45) note there is still an urgent need for `approaches for developing
effective communication pathways for sharing local experiences and practical
livelihood innovations that are emerging to tackle the impact of HIV/AIDS’ and
bridging the gap between the policy makers and the grassroots practitioners.
What needs to be done is for impact mitigation to be seen as an urgent task,
independent of the health-led HIV/AIDS initiatives but of equal importance for
funding. Drugs and vaccines will not rebuild the communities of those devastated by
the epidemic now and in the future. This is a task for cross-sectoral development.
A livelihoods approach to the HIV/AIDS epidemic offers the chance to mitigate its
impact on the poor by looking at their circumstances `in the round’, looking at the
connections between different livelihood assets and taking into account the fact that
an intervention in one area will impact on other areas of people’s lives. It demands
that the fact of HIV/AIDS in people’s lives is seen as one factor among many and that
`arresting HIV/AIDS’ may not be top priority to people who are hungry or have
insecure living conditions. Women in Uganda once pointed out to one of the current
authors that the fever their babies suffer from today is much more important NOW
than the possibility of a long-term illness sometime in the future, they wanted help
with the fever, not HIV/AIDS education messages. This does not mean that
HIV/AIDS is not important in their lives in the longer term, nor that we might ignore
HIV/AIDS in that context, it means we adopt a people-centred approach and
support their way of seeing the threat of the epidemic and work with them from that
stand point.
Tony Barnett, cited in Joanna White and Elizabeth Robinson (2000) HIV/AIDS and Rural
Livelihoods in Sub-Saharan Africa, Policy Series 6, NRI, p. 45
10
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“HIV is about people. We are demanded to walk an extra mile every day….and we
are having to walk many extra miles” Cedric Fernandes, Sahara Center for
Residential Care & Rehabilitation, India – quoted in ‘Expanding community action on
HIV/AIDS, International HIV Alliance, 2001
If we work in that way, the principle of a responsive and participatory approach is
a necessity. This challenges a traditional medical approach to the epidemic where
outsiders or even insider medical professionals and those associated with them, have
through research and development been seen as bringing answers, promoting
changed behaviour and generally seeking participation in and compliance with their
ideas. Some of the more successful HIV/AIDS programmes such as the OXFAM
HIV/AIDS programme in South Africa have focused on HIV/AIDS as a development
issue: addressing illiteracy, education, poverty etc. through a multi-layered
programme rather than viewing HIV/AIDS in isolation. There are many, often small
scale, examples of best practice in this area: ideas need to be shared and best
practice disseminated beyond those who work in the so-called `HIV/AIDS field’.
A multi-layered and responsive approach requires interventions not just at the
household level but supporting strategies for sustainable livelihoods that
influence policy. Thus the SL principle of working at various levels,
recognising macro-micro linkages, is central to any strategy to mainstream
HIV/AIDS. Sometimes local NGO initiatives do not have the voice or presence
to influence policy or institutions that may affect the people they work with.
A livelihoods approach based on livelihoods analysis conducted with such
partners may be able to link such grass-roots initiatives to others who can
take on the macro agenda. This doesn’t call for a dramatic new approach, it
supports and builds with those engaged in existing initiatives.
Thus the SL approach stresses the need to work with partners. The DFID
HIV/AIDS Strategy similarly stresses the need to work in partnership through among
other things: building political leadership, building national capacity and maximising
the contribution of all sectors. In order to be able to respond to communities in a
genuinely holistic way we must be prepared to confront the challenges that HIV
presents at a personal level or a professional level.
Jeremy Stickings minuted earlier this year that our understanding of the impact of
HIV/AIDS, and of the most effective mitigating interventions `is limited by the
somewhat random and scattered studies so far undertaken. Whilst appreciating the
need for more and better studies, the participants [of a consultation meeting] were
also cognisant of the need to do something now in the face of the huge tragedy
currently unfolding. It was pointed out that many of the issues raised and
recommendations made now had been the same five years ago, and that we did not
want to be meeting again in another five years’ time still discussing the same
questions.’11 If talk is to be put into action this requires leadership from non-medical
sectors, it needs mainstreaming HIV/AIDS to be taken seriously in DFID and in
international organizations. It needs HIV/AIDS impact mitigation to be accepted as a
key part of any strategy for the epidemic, and to be appropriately funded.
DFID-IFPRI consultation on HIV/AIDS and rural livelihoods IFPRI January 2001, Back-to-Office Report
by Jeremy Stickings, ASSC Manager, NRIL, also see Appendix F of this document.
11
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But we should not forget that much is already happening, as participants representing
Governments and civil society in Sub-Saharan Africa frequently reminded other
participants at the recent Technical Meeting in Rome.
An NGO representative from Malawi commented, with some exasperation, during one session
that people in affected countries have not been sitting idle, “just because `you’ don’t know
about it, doesn’t mean nothing is happening”, she told one northern participant.
Mitigating the Impact of HIV/AIDS on food security and Rural Poverty, Technical Meeting FAO,
Rome 5-7 December 2001 (taken from Janet Seeley’s notes of the meeting)
The truth is many small NGOs and local government workers, as well as practitioners
in donor funded projects, have been so busy `doing’ that they have not been
monitoring or evaluating their programmes, let alone publicising their stories.
Yes, there are gaps, yes there is much to learn, but perhaps the biggest challenge
facing us is to build on the strengths of what is already known, what is already tried
and tested. Using a `livelihoods lens’ which enables us to look `cross-sectorally’ we
should be able to recognise with the HIV/AIDS epidemic, as with many other aspects
of life, that it is inappropriate to look at urban or rural areas in isolation or divide
people up by risk group. We can and must learn with people who have
`mainstreamed HIV/AIDS’ in their own lives out of necessity, and have developed
successful ways to mitigate the impact of the epidemic. That is a strength on which
to build, and a challenge to rise to.
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Appendix A: The DFID HIV/AIDS Strategy
Appendix B: Some general sources of HIV/AIDS information relevant to
sustainable livelihoods
Appendix C: Who’s doing what in HIV & sustainable livelihoods in 2001
Appendix D: Mitigating the Impact of HIV/AIDS on Food Security and Rural
Poverty: a framework for the agricultural sector. Technical Meeting
December 2001, brief report on the meeting.
Appendix E: webliography of recent research and findings relevant to
sustainable livelihoods & HIV/AIDS.
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Appendix A: The DFID HIV/AIDS Strategy
“The DFID HIV/AIDS strategy notes that poverty; insecure livelihoods and lack of social
protection can increase the likelihood of risky behaviour and undermine capacities to
cope with the consequences of the disease. It goes on to note that the epidemic
contributes to skill shortages and affects the productivity and profitability of businesses
and enterprises as people take time off because they are sick, to care for relatives and
to attend funerals. As such it has a profound affect on people’s lives and people’s
livelihoods often far beyond the impact on work and material assets.
Acknowledging the urgency of the issue DFID already invests a large amount of
financial and technical support to assist the prevention of HIV and the care of those
already infected in those countries worst hit by AIDS.
DFID supports the principle of UNAIDS and donor collaboration” (from DFID comment
on ILO Resolution, JSIUK 2001)
The recent DFID HIV Strategy outlines the DFID commitment to responding effectively
to HIV. This is reflected in the significant and growing activities from the health sector;
in inputs to global level policy and strategy activity; in support to UNAIDS and other key
organisations; in support to key international programmes such as the International
Partnership against AIDS in Africa.
In addition, DFID programmes and projects cross-sectorally are incorporating HIV into
planning and design. DFID has also begun the process of mainstreaming HIV into all
of its development work, with the aim of increasing awareness of DFID staff globally as
to how HIV affects them, and what they can do. There are two major components to
mainstreaming:
1. Ensuring all staff have the same understanding
2. Helping planners and decision makers think more creatively of how they can
contribute to the fight against HIV/AIDS, and how existing instruments can be used in
this (e.g. PRSPs, CSPs)
(Advisors et al interested in more information should contact the DFID Sexual 7
reproductive Health Resource Centre)
Mainstreaming HIV means:
Addressing HIV as a development issue across all sectors
Building organisational capacity to respond to the epidemic/policies/strategies and
guidelines
Establishing HIV as an integral part of all programmes: responses to follow the trend of
the epidemic
Building close institutional links with other partners (internal & external)
Building capacity of all staff to respond to HIV
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Matrix showing strategies for different epidemics
(from DFID HIV Strategy 2001, developed by Kate Butcher JSIUK)
Low prevalence: <5%
Interventio
n Targeting
Approach
Prevention
Strategies
Targeting to most vulnerable groups (e g
, CSW, IDUs, MSM, transport workers and
migrant workers) and their partners















Care
Strategies
Mitigation
Strategies
Political Leadership mobilisation
Stigma reduction
Functional national HIV strategy in place
Effective surveillance system in operation
Data about activities/epidemic collated and
available
Population aware of STIs & HIV and how
to avoid them, especially sub-populations
with high incidences
Condoms available, affordable and
accessible
Blood screening
HIV & sexual health integrated into school
curricula
Operations research to understand
transmission patterns and impact of
interventions
STI treatments and diagnosis available and
accessible for women & men
Private sector involved through social
marketing
Infection Prevention and Quality Assurance
guidelines in place and observed
Capacity building of NGOs
All DFID projects to assess impact of HIV
Planning for VCT
Basic health care delivery for Ois
None
Concentrated >5%
subpopulations
Targeting to most vulnerable
groups and their partners
Same package as low
prevalence/nascent, with:
 Effective outreach for atrisk sub-populations
 All DFID projects to
include HIV/AIDS
considerations and/or
prevention interventions
 Expanded training of
health care workers
Same package as low
prevalence/nascent, with:
 Implementation of VCT
 Health systems
development to support
care
 Expanded training of
health care workers
 Planning for expanded
social service delivery
 Economic impact of
HIV/AIDS assessment
 Planning for the impact of
HIV/AIDS on all sectors
Generalised >1% ANC
Targeting to most
vulnerable groups and their
partners and to general
population
Same package as
concentrated epidemic
with:

Expanded
commodity security and
distribution

Expanded
involvement of youth

IEC campaign to
address national
epidemic
Same package as concentrated
epidemic with:

Voluntary testing &
counselling

Syndromic treatment &
diagnosis of STIs
Antiretrovirals for
pregnant women

Effective care & support
strategies
 Health systems
development to support
care
Same package as concentrated
epidemic with:

Interventions to care for
increased number of
orphans

Expanded business &
labour sector involvement

Active multisectoral
involvement

Increase legal protections
 Coping strategies for
families & communities

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FINAL. 29th December 2001
Appendix B: Some general sources of HIV/AIDS information
relevant to sustainable livelihoods
UNAIDS – www.unaids.org is the main focal point for global development
work and HIV/AIDS. Many useful multi-sectoral materials are here, though
finding them can be confusing. Relevant UNAIDS materials are mentioned
under appropriate categories in the listing below.
UNAIDS leads, strengthens and supports an expanded response aimed at
preventing the transmission of HIV, providing care and support, reducing the
vulnerability of individuals and communities to HIV/AIDS, and alleviating the
impact of the epidemic.
SDdimensions – Sustainable Development Department (SD), Food &
Agriculture Organisation of the United Nations (FAO). FAO were quick to
respond to the HIV pandemic, and were the first UN agency to initiate
detailed sectoral analysis of the socio-economic impact of HIV on rural
communities as a development – rather than just a health- issue. A number of
relevant and recent resources are available at www.fao.org/sd
European Union HIV/AIDS Programme in Developing Countries. A
little dated in material available, but there is the very useful ‘Considering
HIV/AIDS in Development Assistance: A Toolkit’, which includes a sectoral
checklist; HIV/AIDS & the Transport Sector; HIV/AIDS & Rural Development:
an Action Plan; Guidelines for including HIV/AIDS in Project Cycle
Management which can be useful when incorporating HIV/AIDS into
project/programme planning. Their website has the broad aim of raising
global awareness of HIV/AIDS issues in developing countries and acting as an
information exchange http://europa.eu.int/comm/development/aids
HPD Centre for Health Information/JSIUK/DFID Sexual &
Reproductive Health Resource Centre HIV updates and HIV
mainstreaming database; plus other HIV/AIDS materials specifically
relevant to DFID. http://healthdatabases.org/virtualteams/azure/index.htm
(password protected, contact CHI for info – F-power@dfid.gov.uk)
AIDS Information Dissemination Site, Southern Africa. This site has an
extensive list of AIDS-related links in southern Africa and around the world. It
also includes a discussion forum to which anyone can freely subscribe.
http://www2.wn.apc.org/sahivaids
HEARD – Health Economics & HIV/AIDS Research Division. Based at
University of Natal, SA. AIDS briefs and toolkits relevant to a number of
sectors and themes can be found on their website
http://www.und.ac.za/und/heard/publications/publications.htm
Including:
HIV & Agriculture Brief
http://www.und.ac.za/und/heard/toolkits/Agriculture.pdf
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HIV/AIDS & Labour http://www.und.ac.za/und/heard/toolkits/Labour.pdf
HIV/AIDS & Subsistence Agriculture
http://www.und.ac.za/und/heard/AidsBriefs/sec/SubsistAgric.pdf
UNDP have a range of SL materials, some with an HIV focus, as well as
materials co-produced with UNAIDS at
http://www.undp.org/sl/Documents/documents.htm
The UNDP HIV and Development Programme website contains a large
number of papers, publications and reports on the socio-economic
determinants and consequences of the HIV epidemic.
http://www.undp.org/hiv
AEGIS is the largest HIV/AIDS Web site in the world. It contains a large,
searchable database of news stories, newsletter articles, community materials
and AIDS abstracts from journals and conferences. http://www.aegis.org
ELDIS, a Gateway to Information Sources on Development and the
Environment, http://www.ids.ac.uk/eldis
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Appendix C: Who’s doing what in HIV & sustainable livelihoods in
2001.
Natural Resources Institute, NRI
NRI are in the process of collecting case studies from various countries in
sub-Saharan Africa on responses to the impact of AIDS on local livelihoods
(eg adaptation of farmer field school training programmes, new micro-credit
policies, the introduction of home garden programmes). This is expected to
be ready in Spring 2002.
NRI are also preparing a short piece outlining the importance of addressing
the impact of AIDS in the design of poverty reduction programmes, including
the basic principles underpinning "good practice" in impact mitigation.
Extracts from NRI notes from meeting with donor representatives to
discuss AIDS-related interventions. Rome 2-4 May 2001
FAO
Key areas: policy development, strategic research, technical
assistance,
Contact: Marcella Villarreal, Chief, Population Programme Service
FAO's high-profile research work on AIDS in the early-mid 1990s was
pioneered by Jacques de Guerny and it is widely felt that this work is still
relevant to policy makers today. Mr de Guerny has subsequently retired and
been replaced by Ms Villarreal. Her role is to ensure that all of FAO's
emerging programmes are AIDS sensitive. It is hoped that FAO will eventually
provide greater resources to carry out this task although there appear to be
problems in securing funds. It was suggested that the APOS scheme might
have a role to play here in providing staff.
FAO is interested in seeing AIDS as an emergency issue, though not in the
same way as donors such as WFP who respond with emergency food aid etc.
Instead, the impact of AIDS should be tackled through targeted rural
reconstruction activities.
Recent activities:
1. Research on potential response for those affected by AIDS, as defined by
different agro-ecological zones (hypothesis being that safety net
thresholds can be different).
2. Lobbying for AIDS component in the Donors Initiative on the Horn of
Africa
3. Commissioning of new research, e.g. impact of AIDS on livestock sector in
Namibia. FAO is also one of the collaborators on a research proposal which
has emerged from the CG-wide SWIHA, led by ISNAR, which aims to
review the impact of AIDS on a range of areas, including food security and
rural institutions. This work will be carried out in close collaboration with
national bodies in several countries. This work has received some seed
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FINAL. 29th December 2001
4.
5.
6.
7.
funds from IDRC and SIDA (NB. there may be a request to DFID for
funding).
Adaptation of FAO's IPM Farmer Field Schools to build capacity amongst
communities for awareness-raising and problem solving concerning HIV
prevention and mitigation of AIDS impact. A pilot project in Cambodia has
proven to be successful and is likely to be replicated elsewhere.
Exploring methods for supporting the transmission of 'genetic resources',
i.e. the handing down of indigenous knowledge between generations in
AIDS-affected communities.
FAO to have HIV/AIDS post in Investment Centre to influence the
allocation of funds and ensure that all proposals are HIV/AIDS-sensitive.
Working to find ways of influencing land rights policies, particularly those
which disenfranchise widows and orphans.
IFAD
Key areas: Supporting rural development projects, particularly in the
areas of agriculture, markets and rural finance
Contacts: Gary Howe (Director, Africa Division), Sean Kennedy
(Public Health Specialist)
Previously IFAD has focused mainly on HIV prevention work but the
organisation is now keen to move towards addressing the impact of the
epidemic. It is clear that the profile of rural poverty is changing but a question
remains about what should be done to tackle this change. One issue which
the organisation is grappling with is the need for tools to analyse the impact
of AIDS in order to plan mitigation activities more effectively. More modelling
work may be needed on types and chronologies of impact.
IFAD staff were keen to emphasise that their involvement in AIDS work is
limited to the rural poverty dimension. They do not have the resources to be
a main player and take a lead role. Fears were expressed that too much of
the work on AIDS is driven by donors and reflects the donors' agenda rather
than the needs as expressed by communities affected by the epidemic.
Recent Activities
1. IFAD has recently commissioned an AIDS strategy paper for East and
Southern Africa which is in the process of being finalised. The aim of this
paper is to provide a framework for integrating an AIDS dimension into all
of IFAD's work (the organisation is keen not to have a separate AIDS
programme). The strategy paper is based on an examination of successful
interventions of supporting work on household food and nutrition security
and the strengthening of social and economic networks in countries such
as Zambia and Uganda. It is hoped that by developing a strategy in close
consultation with country managers in African then IFAD staff will be
brought on board and equipped to tackle the issue of AIDS. Daphne
Topouzis, a freelance consultant with considerable experience in the field
of HIV/AIDS impact, has been commissioned to produce the strategy.
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FINAL. 29th December 2001
WFP
Key areas - Food aid, emergency programmes
Contact: Robin Jackson
WFP has been moving swiftly to integrate HIV/AIDS into its existing work.
However, it has pre-conditions to its work as it has a mandate to work where
groups are food insecure and where there is a logistical system which can
support food aid. The organisation is currently involved in defining principles
of involvement and devising an effective strategy for targeting
households/communities who are food secure and/or affected by HIV/AIDS
(these two groups are not necessarily the same in every case).
Recent Activities
1.
WFP has commissioned a series of country case studies in Kenya,
Uganda, Zambia, Ethiopia and Cambodia to explore what has been
happening at field level and where WFP can most usefully fit in. Initial
findings have revealed that a lot of prevention work is going on, and
some care programmes in place, but very little mitigation work has
been undertaken. The case studies are being used as background to
the development of pilot projects in each country.
2.
Since October 2000 WFP has been working to integrate AIDS and its
impacts into their “Vulnerability and Mapping system” (VAM) which is
used to analyse relative vulnerability to food insecurity. This has
involved exploring new indicators such as numbers of orphans
attending school, and changes in household expenditure on health.
The new system is being piloted in Kenya.
3.
Staff guidelines on HIV/AIDS have been developed.
4.
Methods are being explored for integrating HIV prevention activities
into ongoing work, e.g. linking education and prevention services to
local transport providers, including health information messages with
food aid deliveries.
General Issues
Areas of common interest
-
-
All of the donor representatives we interviewed expressed interest in the
adaptation of existing interventions such as Farmer Field School
Programmes to include "life skills". This includes training in the analysis of
the contextual factors which contribute to the spread of HIV and can lead
to empowerment as participants develop strategies for protection and
impact mitigation.
There was consistent interest in the need to enhance PLWA's
nutritional status to prolong life.
UNAIDS
UNAIDS operates various "think tanks" on AIDS issues which do not purely
focus on health, e.g there is a Reference Group on Economics (of which
Daphne Topouzis is a member). This group has recently been debating the
use of macro-economic impact modelling and has suggested a shift in
emphasis to a poverty dimension. The Reference Group feels that the links
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FINAL. 29th December 2001
between AIDS and poverty are under explored and are recommending that
new data collection is needed, e.g. when gathering data in ante-natal clinics,
socio-economic data could also be collected as part of a monitoring system
concerning who is most affected by AIDS. Ways need to be found for
adapting the current development agenda on poverty in order to integrate the
contextual causes and impacts of AIDS.
World Bank MAP projects
The donor staff we met with were generally pretty wary of the World Bank's
approach and there is some confusion about whether MAP constitutes a loan
or has some grant-making powers. MAP is a multi-sectoral approach which
will be initiated in 11 countries. Ethiopia was the first country where MAP was
implemented, and activities began there over 1 1/2 years ago. Project
Implementation Documents (PIDs) and operation manuals are still being
prepared for each country. The initial aim of MAP was to fund local agencies
communities directly, but the World Bank has faced severe opposition from
central governments for attempting to by-pass central government funding
mechanisms. The result of this is that there has had to be some
compromises. This means that in effect that only around 20% may be
released directly at a local level.
There are concerns that the mitigation and capacity building component of
the MAPs do not receive enough emphasis and components such as
agriculture have not been thought through. Also, tools need to be developed
for impact assessment.
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Appendix D
Mitigating the Impact of HIV/AIDS on Food Security and Rural
Poverty’
A Technical Meeting co-hosted by FAO, IFAD, WFP and UNAIDS
Held at FAO, Rome 5-7 December 2001
Janet Seeley
Background
As a follow-up of the recommendations of the Declaration of Commitment on
HIV/AIDS (United Nations General Assembly Special Session on HIV/AIDS,
New York, 27 June 2001) this technical meeting was held to launch a
collaborative effort to mitigate the impact of HIV/AIDS on agriculture, food
security and rural poverty.
Seventy people attended, drawn from Ministries of Agriculture/Government
(Zimbabwe, Ethiopia, Uganda, South Africa, Kenya, Tanzania, China and
Cambodia), NGOs (ActionAid and OXFAM Malawi, SHDEPHA Tanzania,
Zimbabwe, CARE, World Vision and Institute for Food and Development Policy
USA, Health and Development Networks Thailand, Anglican Church of Kenya,
SCF UK Zimbabwe, TASO Uganda, Zambia Sugar, National Land Committee
South Africa, Internal Federation of Agricultural Producers Italy) DFID, ISNAR,
International Project on the Right to Food in Development, Akershus
University College, Norway, University of East Anglia, NRI, UNAIDS, WFP,
IFAD and FAO.
The Objectives of the Meeting
1. Develop a common understanding of the impact of HIV/AIDS on rural
livelihoods
2. Based on current practices, evidence and lessons learned, identify
innovative, gender sensitive and participatory approaches to mitigate
the impact of HIV/AIDS on agriculture, food security and rural poverty.
3. Devise ways of incorporating an HIV/AIDS dimension into on-going
initiatives related to agriculture, food security and sustainable
livelihoods at national and district levels.
4. Identify interventions to reduce vulnerability and improve rural
livelihoods with special attention to the emerging needs of groups such
as the ultra-poor and the AIDS orphans, rendered especially vulnerable
by the epidemic.
The intention was to discuss these issues and `reach a consensus on practical
steps and concrete actions to be taken’.
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The Programme
The first day was spent in plenary with presentations and discussion in the
following sessions:
 Impact of HIV/AIDS on food security and Rural poverty: an Overview
 Implications of HIV/AIDS for the development of strategies and
programmes
 Sharing country experiences and perspectives (presentations from
some of the country representatives present)
On the second day we began with presentations
 Mitigation strategies for the Agricultural Sector: a global perspective
 Agricultural Research Initiatives
This was followed by working groups on `Ultra Poor and Vulnerable Groups’,
Food and Livelihood Security through Skills and Capital’ `Food and Livelihood
Security through Agriculture’, `Nutrition’, `Conflict and Post-Conflict
Programmes’, `Capacity-building/decentralisation’. The intention was for the
working groups to suggest `what should be done, how it should be done and
when and who should do it’ for each topic. The working group
recommendations fed into the discussion on the final day. The day ended with
two more presentations:
 Vision for the development of the National Strategic Plan in Cambodia
 The World Bank’s Multi-Country Programme: mobilising resources
On the final day the programme was modified from what had been planned,
with the morning given over to listening to `southern voices’ since it was felt
that delegates from Africa, in particular, had not been given enough time to
share their ideas and views. In the afternoon we discussed the way forward
with Marcela Villarreal of FAO presenting a summary of the issues we had
discussed during the three days in order to agree a strategy. A presentation
was also made on `information networks’, which gave helpful ideas of how
delegates might stay in touch and share ideas (using a model that had proved
successful following another international meeting).
The `process framework’ that was discussed appears below:
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FINAL. 29th December 2001
Priority issues agreed at the final session of `Mitigating the Impact of
HIV/AIDS on Food Security and Rural Poverty’ Technical Meeting FAO, Rome
5-7 December 2001
Issue
Knowledge systems are
undermined
Labour becomes scarce
Food insecurity
Unequal access to land
exacerbated
Impact varies with context
Poverty increases mobility and
vulnerability
Capacities of rural institutions
weakened
Investment in agriculture and
rural areas low
Low understanding of the
agricultural sector’s role in
mitigating HIV/AIDS
Vulnerability among the poorest
increased
Much has been done but it is not
well known
Not enough knowledge of impact
Strategy
Extension services:
 Strengthen and adapt to new situation caused by AIDS
 Technology transfer
Sore knowledge at community level:
 Plant diversity
 Farming systems
 Soil fertility
South-South cooperation and networking
Labour saving technology both at farm and domestic level.
Low input technologies
Post-harvest loss cut
Tap into stock of existing knowledge
Promote relevant research (for example into low input varieties)
Kitchen gardens
Strategies to secure food availability
Increase access though income increase
Rights
Gender and age issues
Improve nutrition and nutrition information
Food security is one form of prevention
Gender equality and age
 Consideration in inheritance and access rights
 Advocacy
Land reform
 Advocacy and sensitisation
Policy analysis
Kitchen gardens
Cultural context
Specificity in all interventions
Mapping the stage of the epidemic (to work out which interventions,
and where)
Address mobility issues explicitly in policies
Strengthen capacities
Advocate for increased investment
Develop innovative investments for AIDS affected areas
National/district level activities
Awareness raising
Strategy development
Innovative credit schemes, including insurance against default
Improving information sharing between regional ministries
Networking
Monitoring and evaluation
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FINAL. 29th December 2001
interventions
Multisectoral interventions
needed
Improve synergies with health and other sectors
During discussion the following areas were agreed as `need to be added’:
1. Include PLWHA and partners. Change agents
2. Food security as a form of care and support
a. Role of food aid in complex emergencies
3. Links to on-going orphans projects
4. Investments often cut out ordinary people, flag that investment needs
to be participatory
5. Commercial sector role
6. Water as a separate item: key importance of access to clean water
7. Mainstreaming HIV/AIDS issues
8. Nutrition highlighted
9. HIV/AIDS training for agricultural staff at all levels – for their own
sakes
10. Rural radio
11. Cultural considerations: acceptable food stuffs etc.
12. Work place issues in agricultural ministries
Next steps



The Technical meeting secretariat will prepare and share the
proceedings of the meeting.
A smaller meeting will be held to agree who is doing what from the
table of `issues’.
An email `sharing group’ will be established to carry on the discussion
as broadly as possible among those who attended the meeting
What I did and shall do



I produced a short note on `gender issues raised at the meeting’,
which I had been requested to `watch for’ by Marcela Villarreal. This
is Annex 1.
I commented on a `Collaborative framework for the development of
mitigation responses to HIV/AIDS in the area of food security: an
FAO/IFAD/WFP working document’ produced by Daphne Topouzis. The
original version appears in Annex 2.
I shall produce a short paper constructed around the livelihoods
framework describing different scenarios for people’s lives with the
HIV/AIDS epidemic.
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December 2001
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Appendix E: webliography of recent research and findings relevant
to sustainable livelihoods & HIV/AIDS
Despite some path breaking work in the early 1990s (Barnett and Blaikie) - and
initiatives from the FAO, UNDP and the EU that have sought to look at the impact of
HIV on various aspects of development - most research has been small-scale and
focused on the impact on rural communities.
Additionally much published work and on-going research focuses on the health issues
rather than thinking about the broader livelihoods focus: Policies and priorities in all
aspects of livelihoods need to factor in the impact of HIV/AIDS, and support strategies
for coping with the epidemic.
HIV/AIDS is also frequently perceived as an ‘African’ problem. We have included some
references that illustrate the impact of HIV more globally, and illustrate approaches that
are relevant to the wider HIV epidemic.
It is impossible – given the huge amount of available material and the high rate of web
publishing – to be exhaustive, so we have focused on key and relevant, recent material.
Some Key HIV Themes, and key information sources
Age -related
Rural population ageing in poorer countries: possible implications for rural
development (includes comment on impact of HIV/AIDS on labour supply and
effects on the aged): 2001; FAO
http://www.fao.org./sd/wpdirect/pe0501a_en.htm
AIDS and older people www.unaids.org/bestpractice/digest/files/older.html
Youth/Children
Rural children living in Farm Systems Affected by HIV/AIDS: some issues for
the rights of the child on the basis of FAO studies in Africa: 1998; du Guerny
FAO http://www.fao.org./sd/wpdirect/wpan0026.htm
In Focus: Focus on Young Adults January 2001
www.pathfind.org/IN%20FOCUS/jan_2001.htm (10 pages)
This article examines the potential of efforts to improve the economic
circumstances of youth through a groups of activities known as the `youth
livelihoods approach’ to help stem the spread of HIV/AIDs. The youth
livelihoods approach comprises a broad and interrelated set of programmes
and policies that include:
Giving youth salaried jobs and other opportunities to earn an income
Providing credit, savings and other financial services and related training in
job and business skills
Developing institutions, alliances and networks for oyuth to advance their
economic interests; and
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FINAL. 29th December 2001
Promoting policy and social changes that improve young people’s livelihood
prospects.
The United Nation’s Children’s Fund (UNICEF) tracks global issues facing
children, including the effects of AIDS on young children
http://www.unicef.org/
Community-based response
Many case studies will be found on NGO/GO websites, such as OXFAM, Save
the Children Fund, CARE and ActionAid, as well as among the `best practice’
cases given on the UNAIDS website and the various email listings of HIV/AIDS
information.
Nurturing a community-based response: 1999; ActionAid
Mae Chan Workshop on Integrated Community mobilisation towards effective
multisectoral HIV/AIDS prevention and care: 2001; UNDP South East Asia HIV
& Development Project http://www.hiv-development.org/publications/MaeChan-Workshop.asp
Communication/ Information Technology
Forthcoming JSIUK/DFID Sexual & Reproductive Health Resource Centre
Guidance Note email:info@jsiuk.com
FAO Communication for development initiative – many resources and
materials at www.fao.org/sd
New Challenges and Opportunities? Communication for HIV and Development
Jacques du Guerny, Lee-Nah Hsu -UNDP South-East Asia HIV and
Development Project, February 2001
Gender
Forthcoming DFID Social Development Department/JSIUK/DFID Sexual &
Reproductive Health Resource Centre Guidance Note: email:info@jsiuk.com
Gender, HIV & Human Rights – A Training Manual: Bala Nath 2000;
UNFPA/UNIFEM/UNAIDS
Gender Issues & women at work- a comprehensive guide to new and recent
books, research and resources: 2001 ILO www.ilo.org/publns
Population & Gender in rural societies from the perspective of FAO’s
Population Programme: 2000; FAO
http://www.fao.org./sd/wpdirect/wpre0128.htm
The gender paradigm shift: 2000; EU HIV/AIDS Programme in Developing
Countries, http://europe.eu.int/comm/development/aids/html/n10601.htm
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Human Rights
Opinion: HIV/AIDS rights are human rights: Koch 2000: EU HIV/AIDS
Programme in Developing Countries,
http://europe.eu.int/comm/development/aids/html/n10603.htm
Labour /Employment
HIV/AIDS: A threat to decent work, productivity and development: 2000;
International Labour Office, Geneva http:// www.ilo.org/
HIV/AIDS and employment: N’Daba & Hodges 1998; ILO
The Business Response to HIV/AIDS: Innovation & Partnership: 1997;
UNAIDS Best Practice Collection http://www.unaids.org/
AIDS devastating rural labour force in Africa: 2001 AEGIS
http://www.hivnet.ch:8000/africa/af-aids/viewR?1027
`Impact of HIV/AIDS on the African Labour Force’ ILO East African
Multidisciplinary Advisory Team African Employment Report 1995
www.ilo.org/public/english/region/afpro/addisabba/papers/1997/aer/ch3.htm
This report reviews the ramifications of HIV/AIDS for the workforce in the
formal and informal sectors of urban economies as well as rural locations.
Includes sections on `women’s economic vulnerability’ and `HIV/AIDS and
labour migration’. The report comments on complexity of many people’s
livelihoods, split between rural and urban settings as well as informal and
formal employment.
This site contains information regarding the International Labour Organisation
(ILO) discussion of HIV/AIDS and the world of work
http://www.ilo.org/public/english/protection/trav/aids/index.htm
The International AIDS Economic Network (IAEN) provides data, tools and
analysis on the economics of HIV/AIDS prevention and treatment in
developing countries, for compassionate, cost-effective responses to the
global epidemic http://www.iaen.org/
The Policy Project has prepared a set of studies on the economic impact of
AIDS in 23 African countries as well as an overview paper for Africa. You can
download any of these studies by clicking on the appropriate name in
http://www.tfgi.com
Migration
The International Organisation for Migration has been established since 1951
and is the leading international migration organisation. http://www.iom.int
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Navigate through 'service areas', then 'migration health', then 'key
documents' (http://www.iom.int/sa/entry.htm). This includes a brochure
prepared for the UN general assembly on AIDS, sketches IOM's current
involvement in HIV/AIDS activities.
IOM has also been very closely involved in the production of two key relevant
documents, the technical update 'Population Mobility and AIDS' (2001) and a
paper entitled 'Migrants’ right to Health'. Another good UNAIDS reference is
'Migrant Populations and HIV/AIDS'. All of these are available from the
UNAIDS net site.
MIGRATION, a website supported by The Fondation du Present includes
information from people working on migration related issues, including
HIV/AIDS. www.hivnet.ch:8000/topics/migration
Population Movement in Asia
www.unaids.org/bestpractice/digest/files/populationmvmt.html. Eleven
UNAIDS papers which focus on HIV vulnerability in mobile populations. They
provide experiences and knowledge gained during the conduct of HIV action
programmes in selected countries of the Asia region.
HIV prevention for mobile and displaced populations in Africa, Anthony
Bennett www.aidsnet.ch
(www.unaids.org/bestpractice/digest/files/mobile.html)
AIDS & Mobility – Literature and Materials: 2000; European Commission
(DGV)/ The Netherland AIDS Fund
UNDP-SEAHIV – The UNDP South East Asia HIV & Development Project
focuses on the interrelations between mobility and HIV vulnerability
http://www.hiv-development.org
Repatriation of orphans & vulnerable children to rural areas: AF-AIDS
Discussion Thread http://www.hivnet.ch:8000/africa/af-aids/viewR?1036
`Panel on Poverty, Livelihoods, Migration and HIV/AIDS at the 5th ICAAP,
Kuala Lumpur, October 1999.
www.aidsouthasia.undp.org.in/publicatn/symposium/Symp_detail.htm.
Includes discussion on the consequences of trafficking in the South Asia
region as well as general commentary on the mobile population in the region:
migrant workers from Bangladesh, India, Pakistan, Nepal and Sri Lanka,
refugees from Afghanistan, and large mobile armies and para-militaries.
`Mobility and migration are not in themselves risk factors for HIV, but can
create conditions in which people are more vulnerable. Separation from
spouse, family, socio-cultural norms, together with isolation and loneliness,
and a sense of anonymity, can lead to situations which make migrants and
mobile workers more susceptible to exposure to HIV’.
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‘Foreign Labour Migration & the remittance economy of Nepal (1999) Seddon,
Adhikari & Gurung, ODG http://www.uea.ac.uk/
Migration of orphans & vulnerable children – This article stresses that most
available evidence regarding this theme is only anecdotal
http://www.hivnet.ch:8000/africa/af-aids/viewR?1034
Monitoring & Evaluation
National AIDS Programmes – A Guide to monitoring & evaluation: 2000;
UNAIDS
Nutrition
HIV/AIDS and nutrition: helping families and communities cope
www.fao.org/docrep/x4390t/x4390t04.htm
ACC/SCN 28th Session: Symposium on Nutrition and HIV/AIDS
www.acc.unsystem.org/scn/Publications/AnnualMeeting/SCN28/28th_session_
report.htm
Food and Nutrition Technical Assistance (FANTA), (2001). HIV/AIDS: A guide
for nutrition, care and support www.fantaproject.org
People Living with HIV/AIDS (PLWHA)
Care and Support for PLWHA in Resource-poor settings: Gilks et al 1998;
DFID
UNAIDS Research into the participation of People Living with HIV/AIDS
(PLHA) in community-based organisations extracted from Research Summary
August 1999 – Positive, Engaged, Involved: PLHA Participation in Communitybased organisations, Population Council/Horizons Communications Division.
www.unaids.org/bestpractice/digest/files/plah.html, mentions the value of
involvement in CBOs for PLHA sense of well-being because of better
integration into community.
Poverty Elimination
‘HIV/AIDS Implications for Poverty Reduction, UNDP Policy Paper 2001
What Good Can Debt Relief and PRSP DO? The Case of Zambia. Bread for
the World April 2001
www.bread.org/whoweare/bfwi/debtanddevelopment/dossier5.html includes a
section on `The Social Impact of Adjustment and HIV/AIDS’.
‘Africa: HIV/AIDS and Failed Development’ APIC Document
www.africapolicy.org/docs00/rau0010.htm this is an analysis of the two way
connection between HIV/AIDS and `failed development’, taken from a longer
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FINAL. 29th December 2001
paper by Joe Collins and Bill Rau (www.unrisd.org). This paper highlights the
importance of understanding and designing prevention programmes which
take into account the social and economic contexts within which people live,
including the movement of people between rural and urban areas.
The World Development Report 2000/1, HIV/AIDS and Development: Barnett
& Whiteside 2001 Journal of International Development
The consequences of the evolving HIV/AIDS epidemic have not been properly
considered by any agency. Existing development indicators do not pick up the
impact of AIDS nor do they measure the complex adverse consequences the
disease may have in the decades ahead. Incomplete and conflicting
demographic and health indicators compound the problem. This epidemic is a
"long wave" event and its effects will be seen in Africa and elsewhere for
many decades ahead. The result is that development targets may be
unattainable and the way development is carried out may need to be
rethought.
http://www.uea.ac.uk/dev/publink/aidabst.shtml - the world
AIDS in Africa: Socio-economic determinants and development impact:
Barnett & Whiteside 1998. AIDS (IAS supplement) March: 5-15
An initial account of the relationship between social cohesion, income
inequality and susceptibility and vulnerability to HIV/AIDS
http://www.uea.ac.uk/dev/publink/aidabst.shtml#aids in
The HIV/AIDS Epidemic in Ukraine: Its Potential Social and Economic Impact:
Barnett, Whiteside, Kruglov, Steshenko, Khodakevich , 2000, Social Science
and Medicine 51 (9): 1387-1403. ISSN 0277 9536
The research reported here was undertaken in 1997-8 and describes the
potential medium to long term social and economic impact of an HIV/AIDS
epidemic in Ukraine. Using the concepts of risk environment, susceptibility
and vulnerability, it reports the problems which might be expected to develop
in relation to care of excess orphans, the elderly, vulnerable households and
regions as well as among those working in the “third sector”, a social sector
upon which exponents of the importance of developing sound “civil society” in
“transitional economies” place heavy emphasis.
http://www.uea.ac.uk/dev/publink/aidabst.shtml - the hiv/aids epidemic in
ukraine
The Social and Economic Impact of HIV/AIDS in Poor Countries: a review of
studies and lessons, Barnett, Whiteside & Desmond 2001 Progress in
Development Studies 1 (2): 23-48
This review of the literature on the social and economic impact of HIV/AIDS
falls into three parts:
an account of the different theoretical approaches to studying impact;
history of the study of impact over the last decade;
main disciplinary approaches of existing impact studies: demographic
modelling, economic modelling of macro-economic effects and of effects on
the various sectors, particularly on the health sector.
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All of these are seen to be useful but limited in enabling a full understanding
of impact. The review argues that social scientists other than economists and
demographers need to make their contribution to understanding of impact
issues.
http://www.uea.ac.uk/dev/publink/aidabst.shtml#the social and
economic impact
HIV/AIDS in Africa: Implications for "development" and major policy
implications
Barnett & Whiteside: presented at the Annual Conference of the United
Kingdom Standing Committee on African Studies, 1999
This paper begins by describing the history of the HIV/AIDS epidemic in Africa
together with a survey of its known epidemiology and a consideration of the
problems of data construction and reliability. It argues that HIV/AIDS is a long
wave event. Such events have particular implications for policy making. In
particular there are issues to do with the cultural and political construction of
HIV/AIDS as a problem to be addressed by policy makers in all fields.
http://www.uea.ac.uk/dev/publink/aidabst.shtml#hiv/aids in
Religion/ culture
Sermons based on Buddhist Precepts- a response to HIV/AIDS: 2001; UNDP-
SEAHIV http://www.hiv-development.org/publications/Sermons.asp
A cultural approach to AIDS in Africa: 2001 AFAIDS Discussion Thread
http://hivnet.ch:8000/africa/af-aids/viewR?989
Resource-poor settings/ Environmental Degradation
Care and Support for PLWHA in Resource-poor settings: Gilks et al 1998;
DFID
Links between environmental degradation and AIDS: 1999; AF-AIDS
Discussion Thread http://hivnet.ch:8000/africa/af-aids/viewR?231
Health and Environmental Crisis in India, a five part series of HIVNET postings
by Rajan Gupta (email:rajan@gita.lanl.gov) on:
A. Intro & Health & Environmental Crisis in India: The Track Record
B. Why is HIV/AIDS different? Is something really being done in SEA?
C. Why is the industrialised world concerned about HIV/AIDS?
D. Is the West doing enough to help the developing world?
E. What is missing & suggestions on what needs to be done
http://www.hivnet.ch:8000/asia/sea-aids/threadR?2345:0
`Risk’ and vulnerability
The Jaipur Paradigm: a conceptual framework for understanding social
susceptibility and vulnerability to HIV : Barnett, Whiteside & Decosas 2000
South African Medical Journal 90: 1098-1101
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FINAL. 29th December 2001
http://www.uea.ac.uk/dev/publink/aidabst.shtml#the jaipur
Rural/ Urban development
Follow-up to the recommendations of the International Conference on
Population and Development: Health and mortality – linkages to
development: Statement by FAO www.fao.org/sd/wpdirect/wpre0069.htm
`Impact of HIV/AIDS on Sustainable Livelihoods’, E. Mede, was presented at
UNDP’s SADC Regional Workshop on Sustainable Livelihoods (July 1998)
www.undp.org/sl/Documents/Workshops/sadc/proceedings_from_sadc.htm
While the text of Ms Mede’s paper is not given, the Proceedings does include
some discussion of how a `sustainable livelihoods approach’ might lessen
peoples vulnerability to infection.
Sustainable Agricultural/Rural development & vulnerability to the AIDS
Epidemic: Topouzis & de Guerny 1999; FAO/UNAIDS Best Practice Collection
AIDS & Agriculture in Africa: can agricultural policy make a difference?: 2000;
du Guerny, FAO http://www.fao.org./sd/wpdirect/wpan0048.htm
HIV/AIDS and agriculture: an FAO perspective by Jacques du Guerny
www.unaids.org/bestpratice/digest/files/fao.html
Impact of HIV/AIDS on smallholder agricultural production in Gweru,
Zimbabwe, summarised from a paper by N.M. Ncube in AIDS and African
Smallholder Agriculture 1999 Edited by Gladys Mutangadura, Helen Jackson
and Duduzile Mukurazita.
www.unaids.org/bestpractice/digest/files/impactgweru.html (includes mention
that the extension workers are expected to attend funerals which is disruptive
for their work… and they lose the salary for those days, which is
approximately 10% of the monthly salary)
HIV/AIDS in Namibia: The impact on the livestock sector: 2000; FAO
http://www.fao.org./sd/wpdirect/wpan0046.htm
HIV/AIDS & Rural Development: What can we do?: SNRD Workshop, April
2001, Harare, Zimbabwe; GTZ
HIV/AIDS and the commercial agricultural sector of Kenya: Impact,
vulnerability, susceptibility and coping strategies: Rugalema 1999; FAO
http://www.fao.org/sd/exdirect/exre0026.htm
HIV/AIDS and agriculture: an FAO perspective: 2000, FAO
http://fao.org/sd/wpdirect/wpre0129.htm
Strategic approaches to HIV prevention and AIDS mitigation in rural
communities and households in Sub-Saharan Africa: Michiels 2001 FAO. This
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is a draft paper for discussion that aims to provide a framework of action for
FAO’s engagement in HIV/AIDS prevention & mitigation in Sub-Saharan
Africa, that presents a list of potential activities.
http://www.fao.org/sd/2001/kn0402_en.htm
`The Implications of HIV/AIDS for Rural Development Policy and
Programming: Focus on Sub-Saharan Africa’ by Daphne Topouzis (July 1998)
www.fao.org/waicent/faoinfo/sustdev/Wpdirect/Wpre0074.htm This paper
examines the implications of the HIV epidemic for rural development policies
and programmes in Sub-Saharan Africa.
HIV/AIDS and the African Agrarian Crisis; Which Way Forward? - a paper by
Tony Barnett www.unaids.org/bestpractice/digest/files/aids1.html
AIDS and African Smallholder Agriculture
Summarised from the paper by T.Barnett in AIDS and African Smallholder
Agriculture 1999. Edited by Gladys Mutangadura, Helen Jackson, Duduzile
Mukurazita. SAfAIDS.
’The critical issue for subsistence agriculture, as for other areas of the
economy, is that HIV/AIDS affects primarily the age range that constitutes the
main labour force, between 15 and 50’
Security/ Disaster Relief
HIV/AIDS and Security: Carballo et al 2001; WHO/International Centre for
Migration and Health/DFID
HIV Subverts National Security: Lee-Nah Hsu- UNDP South East Asia HIV and
Development Project, August 2001
This paper examines both the causes and effects of the rapid spread of the
HIV/AIDS epidemic in South East Asia. It also recommends possible
strategies to avert the HIV threats to national security through a combined
health and development approach
Civil War looms unless poor countries get relief from AIDS: 2001 AF-AIDS
Discussion Thread; http://www.hivnet.ch:8000/africa/af-aids/viewR?1037
‘The HIV/AIDS Epidemic and Food Security ‘ Barnett & Rugalema, 2001
International Food Policy Research Institute
http://www.uea.ac.uk/dev/publink/aidabst.shtml#aids has
Stigma/ Discrimination
‘UNAIDS Compendium on Discrimination, Stigmatisation and Denial’ 2001, a
set of new reports using case studies from India and Uganda to explore
discrimination and stigma related to HIV/AIDS http://www.unaids.org/
Transport sector
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FINAL. 29th December 2001
Since 1998 UNDP-SEAHIV has been advocating the potential contributions by
the transport sector to HIV vulnerability reduction in the following relevant
publications:
•
Reduction of HIV Vulnerability within the Land Transport Sector:
Towards a Public Policy Framework for Addressing HIV/AIDS in the Transport
Sector, May 2000.
•
Land Transport & HIV Vulnerability: A Development Challenge, April
2001.
•
HIV Policy Formulation and Strategic Planning for the Transport Sector
in Vientiane, Lao People’s Democratic Republic, August 2001 http://www.hivdevelopment.org/
38