1. IMPACTS OF HIV/AIDS
The impacts of HIV/AIDS on poor rural populations are many and intertwined. The impacts can be felt most dramatically in entrenched poverty, food insecurity and malnutrition, in the reduction of the labour force, and in the loss of essential knowledge that is transmitted from generation to generation. And the impacts are felt disproportionately among women.
What's more, these same consequences of HIV/AIDS - poverty, food insecurity, malnutrition, reduced labour force and loss of knowledge - contribute to making the rural poor more vulnerable to HIV/AIDS infection. This devastating cycle must be broken, and the agricultural sector has a critical role to play.
It is estimated that 42 million people in the world are infected with the HIV virus. Assuming that each HIV/AIDS case directly influences the lives of four other individuals, at least 168 million people are likely to be affected by the epidemic. And approximately 95 percent of them live in develping countries.
Food security
HIV/AIDS takes its toll on food security in a number of ways. For example: HIV increases fatigue and decreases work productivity, which means less food on the table. In households coping with sick family members, food consumption generally decreases. As adults fall ill, families face increasing medical and health care costs, thus reducing the possibility for them to purchase the food that they can no longer produce. While the number of productive family members decline, the number of dependants grows, as households lose adults and take in orphans of dead relatives, further threatening household food security. Rural communities face a greater burden of care as many sick urban dwellers and migrant labourers return to their village homes. As more household members die, families face declining productivity, loss of knowledge of indigenous farming methods and the continual depletion of assets. Research in Tanzania showed that per capita food consumption in the poorest households decreased by 15 percent when an adult died. A study carried out in Uganda showed that food insecurity and malnutrition were foremost among the immediate problems faced by female-headed, AIDS-affected households.
In addition to household food security, national food production is also affected by the loss of agricultural workers, especially in countries where agriculture forms a large part of the gross domestic product.
Nutrition
HIV/AIDS has direct impacts on nutrition, particularly for people living with HIV/AIDS and for nutritionally vulnerable members in HIV/AIDS-affected households.
People living with HIV face a vicious cycle in which repeated episodes of illness caused by HIV lead to malnutrition, and malnutrition in turn further accelerates the onset of AIDS. HIV damages a person's immune system, and the repeated illness that ensues reduces appetite; moreover, nutrients are lost from vomiting and diarrhoea, and the use of certain medications. Infections also interfere with the body's ability to absorb and use nutrients, which are needed to fight off HIV. This has serious consequences for the poor, who are more likely to be malnourished even before they become infected.
Malnutrition in itself also leads to the suppression of the immune system, giving rise to more frequent illnesses and accelerating the development of AIDS. It may also be associated with increased risk of HIV transmission from mother to child.
The recurring bouts of sickness of those living with HIV places an enormous workload on those who care for them and those who foster orphans. Female-headed and orphan-headed households are most at risk. Moreover, the costs of health care and the labour constraints gradually drain the household of its means to make a living. This further exacerbates poverty, food insecurity, malnutrition and disease. Food-insecure households are more likely to turn to livelihoods that put them at greater risk of infection, such as migration and prostitution.
Labour
As HIV is predominantly a sexually transmitted disease, the largest number of people infected are those of reproductive age. Thus, the HIV epidemic not only reduces the total number of people, but the age and sex composition changes, with a population dominated by the elderly and the youth.
The reproductive age group is also the most productive. When a person is sick, the household not only has to manage without his or her labour contribution, but also with the loss of labour from those who have to care for the sick family member.
AIDS is characterized by recurrent periods of sickness, and consequently a recurrent loss of labour. This eventually erodes agricultural production and food security. Much of rural agricultural production is highly labour-dependent. In some agro-ecological zones, labour demands are concentrated in specific and critical periods of the year. In those areas sickness or funeral attendance may mean that the planting season is missed, and with it a full crop.
FAO estimates that in the 25 hardest-hit countries in Africa, AIDS has killed around 7 million agricultural workers since 1985; it could kill 16 million more before 2020. The most affected African countries could lose up to 26 percent of their agricultural labour force within two decades. As agriculture still represents a large proportion of the gross domestic product, this loss in labour could have severe impacts on national economies.
In many countries, AIDS is erasing decades of progress made in improving mortality conditions and extending life expectancies. The average life expectancy in sub-Saharan Africa is now 47 years, when it would have been 62 years without AIDS. In Botswana, for example, life expectancy at birth has dropped to a level not seen in this country since 1950.
Gender
Gender inequality is one of the driving forces behind the spread of HIV. In many places, HIV infection rates are three to five times higher among young women than young men.
This disparity can be partly explained by biological factors, which make women more vulnerable to HIV, especially in youth and adolescence. However, it also reflects a number of prevailing cultural factors: men are more dominant, they tend to choose younger women, and tradition and social pressures limit women's ability to express their wishes regarding their sexuality, their choice of sexual partners and their ability to demand protected intercourse. Taken together, these factors increase women's risk of contracting HIV.
Gender inequalities also make women more vulnerable to the effects of the HIV/AIDS epidemic. Rural women's domestic workloads tend to increase, as they are often the care providers when household members are sick. In addition, access to productive resources, including land, credit, training and technology, frequently favour men.
As the household asset base dwindles and more members become sick, women's access to scarce resources is further diminished. Moreover, following the death of a spouse, a widow may lose access to household and productive resources such as land, resulting in further impoverishment. | KnowledgeIn countries where HIV is largely transmitted through heterosexual intercourse, the majority of AIDS-related deaths occur in the sexually active age groups, which are usually the most economically productive groups as well. The loss of farm labour has a visible impact on agricultural production, but there are less tangible losses associated with the death of a family member - indigenous knowledge, for instance.Rural farming systems depend upon a wealth of local agricultural and biodiversity knowledge that is essential for maintaining production. The loss of reproductive generations takes with it the channel for passing livelihood skills and agricultural knowledge from generation to generation. The result? A young population ill-equipped to manage the impacts of the epidemic and to maintain successful agricultural production. Other types of community knowledge, such as maintaining local genetic diversity, is often passed orally from generation to generation and are fundamental for nurturing and preserving cultural identity. The death of a generation means a break in the chain, and with it a disruption of the oral tradition. | | 2. RESPONSES 1. The impact of HIV/AIDS on food security and rural livelihoods is devastating. A comprehensive, long-term perspective is essential if the agriculture sector is to be successful in addressing the HIV pandemic. 2. Preventing HIV/AIDS and mitigating its consequences must be seen as mutually supportive activities. The agriculture sector is faced with a dual challenge: supporting rural livelihoods and reducing the vulnerability of farm households to the impacts of HIV/AIDS; and satisfying national economic objectives, in which agriculture often has a key role to play. 3. FAO is developing a multi-dimensional agriculture-sector response to HIV/AIDS. Each response represents a strategy that consists of a set of possible programmatic activities to alleviate problems created by HIV/AIDS. 4. The responses are based on a number of general principles: 5. Supporting diversity, gender equality and human rights; Reducing the stigma that accompanies HIV/AIDS; and Building partnerships and developing creative synergies with other sectors. 6. All of the strategies require the agriculture sector to be more creative in delivering services, working with other stakeholders to provide a coordinated response in which rural institutions are strengthened and community-based initiatives promoted. The people must be at the center. 3.1 Introducing labour-saving technologies
The labour shortage caused by the illness or death of household members is one of the most pervasive and well documented consequences of HIV/AIDS.
Therefore, the use of labour-saving technologies represents an important mitigation strategy. Technologies are needed that reduce the time spent on agricultural and household tasks and that can be used efficiently by youth and the elderly.
Recommendations include: low-input agriculture, lighter ploughs and tools that can be used by older children, women and the elderly; improved seed varieties that require less labour for weeding, intercropping; minimum tillage; access to potable water; and fuel-efficient stoves that can free women for more economically productive activities.
Labour can be saved indirectly through improved storage facilities, which can help reduce post-harvest losses and increase food security.
Home gardens with a variety of nutritious food crops could contribute towards household food production. Although home gardens can be labour-intensive, the distribution of labour over the production cycle is regular and does not depend strictly on planting times.
Small ruminants can also provide high-protein foods. Moreover, they can be kept close to the house and require minimal care. 3.2 Preserving knowledge transmission
Most AIDS-related deaths occur in the reproductive age group. This generational loss can result in a corresponding loss of agricultural knowledge, practices and skills that are passed from one generation to the next.
Recommendations on how to preserve knowledge and transmit it across gender and generations are: informal and formal community institutions, such as extension services and schools, that are reoriented to meet the information needs of households that have lost an adult. Local knowledge, including biodiversity and gender-specific skills, must be preserved.
Orphan and female-headed households, as well as widowers, need information to be able to maintain agricultural production. Moreover, households without an adult need to be able to draw up cropping plans, maintain animal husbandry practices, store grain, market agricultural production, and be knowledgeable about gender-specific production practices. Effective initiatives need to be designed, implementated, and evaluated in order to meet the informational needs of these households. 3.3 Strengthening rural Institution
Mitigation strategies to cope with the epidemic need to be directed not only to individuals and households, but also to community organizations and institutions, which also suffer from the loss of staff, implementation capacity and institutional knowledge due to AIDS deaths. Rural service providers of all types -- for education, health, agricultural extension, credit and finance; women's associations; nutrition groups; irrigation committees; and terrace maintenance associations -- need to be supported.
Staffs need to be equipped with knowledge of the impact that HIV/AIDS has on rural livelihoods and how to incorporate AIDS-sensitive strategies into their work. Some communities have been extremely responsive to the epidemic, and institutions have been strengthened to be able to deal with a variety of problems created by increased morbidity and mortality. Social support groups, savings clubs and credit associations, self-help groups, community-based organizations, income-generating projects and exchange of labour are all essential in supporting rural livelihoods.
An agriculture-sector strategy must not overlook these institutions and their initiatives. External support from donors, NGOs, religious organizations or other groups should be directed towards strengthening these kinds of community-based initiatives rather than replacing them. As most assistance provided to AIDS-affected households comes from family, neighbours and local informal community institutions, it is important that the lessons from these initiatives be documented, shared and built upon.

3.4 Enhancing nutrition
Two major responses can address nutrition issues in the HIV/AIDS context: improving the nutrition status of people living with HIV/AIDS; and protecting the food security and nutrition in HIV/AIDS-affected households.
Good nutrition helps those who are infected to extend the period during which they are socially and economically active and able to support other family members. Maintaining or improving nutrition means: having a balanced and varied diet; maintaining weight and eating regularly; staying active and taking sufficient rest; and stimulating the appetite and thus the immune system.
For HIV/AIDS-affected households, strengthening their livelihoods has a direct impact on the nutrition status of orphans, vulnerable children and people living with HIV/AIDS. Two important elements must be addressed, including strengthening the capacity of local institutions to address the impact of HIV/AIDS on household food security and nutrition, and providing assistance to HIV/AIDS-affected communities and households. This assistance can take several forms: livelihood support; strengthening community-level care systems; and providing nutritional care for parents, caretakers and children with HIV/AIDS.
The well-being of the children must also be addressed by increasing their access to basic education, life skills and vocational training opportunities through a mix of formal and informal education. This is not only important to their short-term survival, but also to their long-term prospects of food, nutrition and livelihood security.

3.5 Promoting gender equality
Although gender equality is an issue that is not specific to the agricultural sector, it is so integral to the HIV/AIDS epidemic and its social and economic consequences that it should be a part of any agriculture strategy designed to alleviate the impacts of the epidemic.
Not only are women physically more vulnerable to HIV infection than men, they are also more vulnerable to negative social and economic outcomes as a result of HIV/AIDS because of the inequalities in their access to land, credit, employment, education and information.
In some countries, legislation has been passed providing women with equal inheritance rights to land when their husband dies. While this is an important legal precedent, the enforcement of this law over local customary practices is equally critical. In this regard, the capacity of local officials needs to be supported so they are able to negotiate this delicate process.
Many of the persistent gender issues are "structural" concerns of societies and require a re-negotiation of gender relationships. Re-negotiating often means challenging existing power structures, not only at the local level but through policy and legislation at national and regional levels.
The agriculture sector needs to actively promote gender equality in the areas of its competence, with an emphasis on access to and control over productive resources, including land, credit, knowledge, agricultural inputs and technology. 3.6 Preparing an emergency response
Emergency food aid or food for work programmes could represent short-term answers to the problem of acute food insecurity associated with the HIV/AIDS epidemic. However, determining which individuals, households and communities should receive such assistance is an extremely delicate process as it can lead to further stigmatization or marginalization.
One targeting strategy could be to include orphan-headed and foster households or those that have lost one or more family members. However, even this strategy requires flexible criteria.
Another emergency reponse could be to provide food rations to school children - one ration while they are at school and another to take home with them. In this way, they are encouraged to attend school and their nutritional needs are met. This response has been developed by the World Food Programme.
Whatever the emergency reponse, the longer-term view must not be overlooked. Longer-term mitigation strategies must seek to influence one or more of the livelihood assets -- such as labour-saving technologies or seed distribution - so that households can re-establish their agricultural base and have a safety net as they are coping with, or recovering from, the crisis.