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Mitigating the effects of HIV/AIDS on food security and agriculture in Eastern and Southern Africa

Wendy P Munn, Emma Sylvester Bradley

Conference Summary Report

Maputo, Mozambique, 3 - 7 November 2003

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Introduction: HIV/AIDS, agriculture and food security

Because of the increased mortality the HIV/AIDS pandemic causes it has become increasingly obvious that HIV/AIDS can no longer be considered solely as a health issue, as the pandemic has wide ranging socio-economic impacts on all sectors, in particular on agriculture. Because of HIV/AIDS, decades of development have been lost in Africa, as efforts to reduce poverty and enhance living standards have been greatly undermined.

Eastern and southern Africa is currently at the epicentre of the HIV/AIDS pandemic, with the fastest growing HIV infection rates in the world and with rural areas increasingly affected. In some countries HIV prevalence rates have risen higher than thought possible, exceeding 30%: Botswana (38.8%), Lesotho (31%), Swaziland (33.4%) and Zimbabwe (33.7%).1 HIV/AIDS is now the leading cause of death in sub-Saharan Africa accounting for a quarter of all mortality: in comparison malaria accounts for less than one tenth. To put the impact into perspective, southern Africa is home to about 30% of people living with HIV/AIDS, yet the region has less than two per cent of the global population.

The countries most affected by the HIV/AIDS pandemic are also the most heavily reliant on agriculture with over 70% of their populations dependent on small-scale agriculture for food and their livelihoods. Many rural communities in Eastern and Southern Africa faced with high prevalence rates of HIV/AIDS are already suffering from high morbidity and mortality rates among the most productive members of their communities. Examples from all the African countries represented at the conference indicate that the pandemic is disproportionately affecting the agricultural sector and developing into a serious problem that will affect or is already affecting the agricultural productivity, nutrition and food security of rural households.

Agricultural productivity is affected through the loss of skilled and unskilled agricultural labour; reduction in smallholder agricultural production; a decline in marketing surplus production; the loss of indigenous farming methods; decreased inter-generational transfer of knowledge; and specialised skills & practices. Income and food reserves are severely reduced and savings & assets depleted to meet health care, living and funeral costs. Furthermore the high number of people needing care and the high death rate is stretching traditional systems of mutual assistance to their limits. Formal and informal rural institutions are affected by the loss of human capital resulting from the rising scale of staff morbidity and mortality. All dimensions of food security – availability, stability, access and utilisation of food, are affected where HIV/AIDS prevalence is high, posing a threat to entire nations.

In addition, the effects of the pandemic are compounded through the close association of HIV/AIDS with poverty, poor nutrition and food insecurity: HIV/AIDS increases the depth and extent of rural and urban poverty. The current food crisis in southern Africa highlights the dynamic interplay between HIV/AIDS and other crises. Due to drought and poverty people leave the rural areas and their families to procure an income in the cities and to send food home. Once there many have to rely on risky livelihood strategies that expose them to HIV infection. In the mean time, urban people who become ill because of AIDS can no longer send either money or goods to their families and have to return to their rural homes to receive care. These effects of the pandemic are exacerbated by the ongoing food crisis, which has led not only to further increases in food insecurity and vulnerability of households to HIV, but also to an increase in poverty. The vicious cycle of poverty, food insecurity and HIV/AIDS is in full swing in the region and showing no signs of abating.

As a result many feel that the HIV/AIDS pandemic should be considered an emergency with different impacts to those of say man made or natural disasters like civil war or drought. This is due to the impact the pandemic has on labour structure and household composition.

Despite the fact that almost 80% of the people in the most affected countries are dependent on agriculture for their subsistence, nearly all the response to the pandemic has been channelled through the health sector. Most governments, NGOs and international organisations have concentrated their actions on prevention (particularly on improving the control of transmission and the alleviation of health impacts), through awareness campaigns among their staff and among beneficiary communities, to prevent new infections and arrest the spread of the disease.

Responses to mitigating the social and economic impacts of the pandemic in rural areas have not received as much attention or funding. Some institutions have started actions to mitigate the effects but the majority of these are active in urban areas. Associations of people living with HIV/AIDS (PLWHA) usually start among the better-informed and more affluent urban communities and tend to concentrate their activities in these areas. Community based organisations (CBOs), faith based organisations (FBOs) and other grassroots organisations who work at the cutting edge of the pandemic have also tended to concentrate on prevention and care as opposed to mitigation. Until now, very few organisations have initiated activities to mitigate the wide-ranging socio-economic effects of HIV/AIDS in rural areas.

In the face of the potentially devastating impacts the HIV/AIDS pandemic can and will have on the agriculture sector, governments and their international partners (e.g. UN) need to ask themselves what they can do to mitigate the impact of the spreading pandemic. Which agricultural policies and programmes can be used to effectively combat the wide-ranging socioeconomic impacts? The agricultural sector is best placed to implement and develop activities to address growing food insecurity and to maintain/increase agricultural production taking into account the effect of HIV/AIDS on farming communities, and to implement strategies to overcome the upsurge in young adult morbidity/mortality.

All those involved however, will have to take into account the demographic implications the pandemic has on rural household composition as community infrastructures weaken and as beneficiaries might be destitute families, child-headed or elderly-headed households. To effectively assist these beneficiaries will require innovative approaches to project design and implementation. Providing equipment or inputs on credit for example, is not feasible when working with the destitute or households with large numbers of orphans.

One approach would be to use what we already know – there is a wealth of experience in improving food security, poverty alleviation and development activities. The challenge is not only to use what we already know to mitigate the effects of HIV/AIDS, but also to integrate or mainstream HIV/AIDS into national poverty alleviation & development strategies and to utilise a multisectoral approach in policy and programme formulation and when implementing interventions to mitigate the effects of HIV/AIDS.

However, in order to be able to effectively address the effects of the pandemic through appropriate mitigation strategies there is a need for some form of impact assessment framework (similar to environmental impact assessments (EIA) for example) in order to determine their success or failure. Each country will need to develop their own according to the scope of their interventions, the socio-economic & political environment within which it will be implemented.

The importance of mitigating the effects of the HIV/AIDS pandemic cannot be underestimated, because the human and socio-economic impacts of the pandemic will persist long into the future regardless of the success of any prevention messages, increased access to antiretroviral drugs, or even the development of an effective vaccine. The burden of the pandemic increases over time because it takes, on average, seven to ten years post infection before falling ill and, if there is no treatment, before dying. Even if by some miracle the spread of the disease were halted, people would still become ill and die (eventually) and we would still need to address the effects of the pandemic and associated mortality for generations to come.

We are not advocating that mitigation is more important than prevention but that mitigation is becoming more and more important now that morbidity and mortality are taking their toll. Until now, not all stakeholders have adequately addressed the problem of mitigation, and ultimately the appropriate response is probably a combination of prevention and mitigation activities aimed at halting further infection and at alleviating the growing effects. It should be stressed that without prevention the spread of the disease would not be halted and any efforts to mitigate its effects would never be sufficient.

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