The Challenge of HIV/AIDS for Food Security and Nutrition

Tony Barnett

School of Development Studies, UEA, Norwich, UK

Contact: a.barnett@uea.ac.uk

Introduction

As early as 1988[i] it was apparent that the HIV/AIDS epidemic was likely to have profound effects on agriculture in the worst affected areas.  These effects were modelled in 1989[ii], and documented from Uganda in 1990[iii] and 1992[iv].  More detailed data on a wider area became available in 1993[v], 1998[vi] and 1999[vii].

The connection between food availability and HIV/AIDS arises from the age cohort specific effects of a heterosexually transmitted infection whereby morbidity and mortality is concentrated in those age groups which would normally supply most of the labour needed in labour intensive agricultural systems.   This is apparent from Figure 1.

The impact of AIDS on a small farm is succinctly shown in Figure 2 which summarises observations made in Uganda in 1989.

Figure 2: The impact of HIV/AIDS on a Ugandan rural household 1980-89[viii]

At that time the main observed impacts of HIV/AIDS were:

1.      Decrease in area cultivated to accommodate labour constraints

2.      Reduced range of cash crops – neglect of coffee

3.      Reduced range of food crops – in particular substitution of labour and storage demanding crops (in this case savoury plantain) by less demanding crops such as cassava

4.      Reduction of range of relish crops – which are often a source of micronutrients

5.      Following from 3 and 4, lower quality household diet

6.      Decrease in numbers of small stock

7.      Increased insect, animal and possibly viral pests as cultivated area fell and ecological control broke down – a phenomenon previously noted by Kjekshus[ix] in relation to trypanosomiasis.

Kwaramba[x] showed the effects of these processes on the smallholder sector in Zimbabwe.  Figure 3 provides an indication of the observed productivity decline by crops in 1997.

More recent studies

Malawi[xi]

This study theorises the impacts of HIV/AIDS as shown in Table 1.

Table 1 : Impact Of Chronic Sickness And Death Due To Chronic Sickness[xii]

The main factors which affect food security according to this study are:

§         loss of labour,

§         delayed agricultural activities and

§         depletion of any reserves that a household may have.

In addition , this table notes that the timing, age and gender of the death are significant.

Labour loss

About 70 per cent of households in this study experienced loss of labour because of sickness.  A large number of these losses resulted from “chronic sickness” which is a proxy measure including (but not exclusively) HIV/AIDS sickness.  The effects of “chronic sickness” are shown in Figure 4.

Figure 4: Percentage Of Households that Experienced Labour Loss[xiii]

Cropping mixes

The authors note that:

“With shortage of labour in the household and lack of resources to obtain agricultural inputs, many households have to resort to changing their usual crop mix, in order to cope with the stress of chronic sickness.  The more labour intensive crops, as well as those requiring expensive inputs, may be dropped (tobacco).  When faced with making the difficult choice, a household may decide to grow crops only in their garden or only the field, thereby dropping all the crops grown in one area.  In an indirect way chronic sickness and death in the household also impacts the crop-mix adopted by the household when they deplete all their resources to meet the medical needs of the sick person, and then are left with no cash to buy fertilizers or seeds.  This forces the household to drop one or two crops for that agricultural season.”[xiv]

This impacts most acutely on the poorest, as shown in Figure 5[xv].

  Figure 5: Percentage Of Households That Changed Their Crop Mix

This figure shows that rich households are more able to cope with the stress of sickness without having to change their crop-mix.  However, about a quarter of the poor and very poor households affected by chronic sicknesses had to change their crop-mix.

Fallow

Loss of production is also reflected in longer and more extensive fallowing.  The effects of this are shown in Figure 6.

Figure 6 : Percentage Of Households That Left Land Fallow[xvi]

Once again faced by chronic or other sickness the poorer households are more likely to leave land fallow.  Over a quarter of poor and very poor category households affected by chronic sickness had to leave some of their land fallow.  The rich households had the resources to hire replacement labour and were less likely to resort to fallowing.

Delaying agricultural operations

Delayed agricultural operations usually means reduced yield.  In very dry regions, delay may mean no yield at all.

In the case of the Malawi study, one of the main reasons for delay in agricultural operations was due to household members having to work on other people’s field in order to earn cash.  For households affected by chronic sickness the problems are compounded because they may be looking after a sick person or have to meet medical expenses for which they don’t have money.  Under the circumstances these people are forced to seek work on other people’s farms, leaving work on their own fields until later - by which time it is too late for sowing, weeding or harvesting.  This adds to their already low crop yields.  When a household is looking after a sick person, they may not have the time to attend to their field or garden.  “We were told that in some cases a household may be able to borrow money or an oxcart (to transport the sick to the clinic or the hospital) only on the condition that the loan be repaid in kind, i.e. by providing labour on the creditors' fields”[xvii]. 

Figure 7: Percentage Of Households That Had To Delay Agricultural Activities[xviii]

The study notes that: “Nearly half the households affected by chronic sickness, and a quarter of the households affected by other sicknesses had to delay their agricultural activities.  The same figure for those not affected by any health related problem was insignificant.”[xix] 

Decrease In Agricultural Productivity

This study tried to disaggregate the effects of chronic illness from background factors such as a poor preceding season.  It concluded that it was probable that decreased crop yields was higher among households that also faced chronic sicknesses.  The proportion of households with decreased crop yields was highest among the poor and very poor households affected by chronic sickness (82 – 93% of the households).  These data are shown in Figure 8.

Figure 8: Percentage Of Households That Experienced A Decrease In Agricultural Productivity

This study supports the findings derived from the earliest field studies in Uganda.

Namibia[xx]

This is a study of commercial and smallholder farming.  Its results may be summarised as follows:

Labour reduction

Table 2 shows that although there were differences between parts of the country, overall 62 per cent of farmers who were interviewed thought that HIV/AIDS had reduced labour availability for agricultural activities.

Table 2:   Reduction of labour on farm activities as a result of HIV/AIDS

                        Infections* - smallholder farms

In the commercial sector this was less apparent because of the existence of a large labour pool[xxi].

The effects of reduced labour availability on the smallholder farms is described in Table 3.

Table 3: Effects of labour shortages resulting from HIV/AIDS infections[xxii]

Regions:  1 =  Omusati, 2 = Oshikoto, , 4 = Caprivi, 6 = Omaheke

We can see that reduction in cultivated area is a dominant response: changes in crop mix are less apparent – perhaps because this dryland area has a narrower range to choose from in the first place in contrast to both Uganda and Malawi where higher rainfall permits a wider crop portfolio.  We should note that increased use of child labour is reported and if this were to be a more widespread response across Africa, it could have significant implications for child welfare, particularly among the plentiful orphans of the epidemic.  Further more generalised studies of this issue are in progress and we await their results in the coming months.

Land area cultivated

In this study a small number of the 315 respondents were known to have had an AIDS death in the household.  Of these households (about 20), 75 per cent reported reduced areas of staple crops such as maize and sorghum[xxiii].

Overall responses in Namibia

These are summarised in Table 4.

Table 4: Importance of different coping strategies to reduce labour shortages

                      due to HIV/AIDS[xxiv]

Values above are the means of 34 responses based on the following scale:

‘Ranking of effects of labour shortages due to HIV/AIDS’: 1 = least important, …, 5 = most important.

Kenya[xxv]

This research used a database of 1400 households from 22 districts of Kenya. The material was collected between 1997 and 2000.

Cultivated Land

The results of the study  suggest that

§         the death of a prime-age household head weakly decreases the size of cultivated land by 20 percent.

§         The death of a spouse has a comparably negative effect on area cultivated

§         When cultivated land was disaggregated into three crop categories – cereals, root crops, and high-value crops – significant gender differences appeared.

§         Women in Kenya, as in most parts of Eastern and Southern Africa, are primarily responsible for the household’s food crop cultivation, while typical “cash crops” such as coffee, tea, sugarcane, and export-oriented horticultural products are primarily mens’ activities. Thus, the gender of deceased members may affect land allocation.

§         The death of a spouse decreased the size of cultivated land devoted to cereals by 42 percent, while the death of either a male household head or other non-head male member decreased the size of cultivated land devoted to high-value crops by more than 30 percent. 

§         When a non-head male member dies, households convert land that was formerly devoted to high-value crops to cereals; an estimated 31 percent decline in area under high-valued crops is compensated by a 27 percent increase in area to cereals. 

§         Households were unable to maintain the total cultivated land size after a death of household head or spouse but were able to maintain the total cultivated land size by switching from high-value crops to cereals after a death of a non-head male member. 

Production

The total gross value of output decreased by 58 percent after the death of a male household head. There were no significant changes in total farm output after a death of other household members. When total net value of output was examined, after taking account of the costs of chemical fertilizer, seed, and land preparation, the results were similar to those for gross output: the death of a household head reduced the net output by 68 percent. The main difference is that a prime-age spouse’s death is found to reduce total net crop output by 46 percent.

Cultivated area

To examine how much of the decline in farm output was due to a reduction in cultivated land and how much was due to a reduction in land productivity, these researchers estimated the total output per acre.  The results indicated that adult mortality did not appear to have any significant effects on the gross value of output per acre.  There was a 65 percent reduction in the total net crop output after a household head’s death. This was primarily attributable to reduced cultivated area rather than less intense cultivation of the reduced area remaining under cultivation.

Assets

Assets can be used to mitigate the shocks of adult mortality and other shocks.  Previous studies found a large reduction in asset holdings when households experienced adult mortality.  The research team looked at changes in land owned, the number of bulls, the quantity of farm equipment (e.g., ploughs or sprays), and of non-farm assets (e.g., bicycle or radio).  Although, we could calculate values of assets and bulls by using regional prices. 

The death of a household head reduces the quantity of farm equipment by 0.76 items and the number of non-farm assets, such as bicycles,  radios, and TVs, by 0.52 items.  The death of a spouse seems to have a similar negative impact, 0.60 items.  The death of a female adult is associated with a reduction in the number of cattle.  The death of a spouse reduces the number of cattle by 1.69, while the death of another prime-age woman and female elderly reduce it by 1.11 and 1.30 respectively.

The overall conclusions of this study in relation to the impact of HIV/AIDS on agriculture and food security in Kenya may be summarised as follows: 

§         First, roughly half of the deceased prime-age men were in the highest per capita income quartile in the 1997 survey.  This is consistent with findings from other studies showing a positive correlation between HIV infection and socioeconomic status, such as education and income.  This may change in the future, however, as people with high level education and income start protecting themselves from HIV infection.  This finding is interesting as it points to the importance of considering any results in relation to the assumed stage of the epidemic in a particular country.

§         Second, the prevalence of adult death is concentrated in particular areas.  Of the 91 prime-age adults who died between the 1997 and 2000 surveys, 36 (about 40 percent) were from Nyanza Province, where HIV infection rates are known to be high. 

§         Third, after the death of a household head or spouse, households were unable to maintain their household sizes and the numbers of adults.  This finding is in contrast to earlier findings from Tanzania.

§         Fourth, the death of a household head is associated with a 60% reduction in the value of the household’s crop production (net of major cash input costs). 

§         Fifth the gender of the deceased adult affects the type of crop suffering a shortfall. Grain crops are adversely affected in the case of adult female mortality and “cash crops” such as coffee, tea, and sugar are most adversely affected in households experiencing the death of the male household head.  The deaths of other prime age adults and elderly adults have less severe effects on crop production.  

§         Sixth, the death of a household head is associated with a significant reduction in the quantity of farm equipment, non-farm asset items (e.g., radio or bicycle), and off-farm income.

Food Security and Disorder

Food security depends only partially on the actions of individuals and households.  Like the HIV/AIDS epidemic itself, there are strong relationships between the social and economic context and what is possible in the way of food security.  If we examine the extent of food insecurity in Africa we can see that in addition to general causes such as long term climate change, the policy environment and international terms of trade there is also a close relationship between regions and countries where food insecurity is greatest and the frequency of war and other forms of civil disorder.  It is arguable that the epidemic is also likely to be most pronounced in some if not all of those regions and countries.  However, this can only remain an assumption because data are naturally poor from such areas.  Table 5 shows some of these countries and the nature of the disorder.

Table 5: Food emergencies, causal factors and HIV/AIDS in Africa[xxvi]

There is another aspect to this problem.  Even in areas where civil disorder is not a problem, many rural livelihoods are innately unsustainable.  In part this is because they depend on production for niche markets and are thus depend upon tastes and preferences in rich countries. Or they may depend on a major input from migrant labour revenues.  These are often unsustainable livelihoods.

Knowledge systems

Rural production depends on knowledge and its transfer from generation to generation. Under normal circumstances the young are cared for by their parents, and later provide support for those parents. Some social scientists describe this as the “inter-generational bargain”[xxvii]. This is one of the core and most important bargains made and maintained between people. It is a basis on which social order and continuity are constructed. It is also where knowledge of all kinds is transferred, including agricultural knowledge of various kinds, practical and theoretical.

Orphans are part of all communities. There will always be children who have had the misfortune to lose parents. In many poorer countries families routinely took in children from the wider family. In rich countries institutions were available to care for these children. The scale of AIDS orphaning is such that these coping mechanisms are collapsing in the poor world.  The epidemic has vastly increased the numbers of orphans in Africa. Caring for them within the “extended family” is desperately hard.  Levels of care are variable and some end up on the streets of the cities, others are drawn into soldiering.  In either case these lives are hardly a preparation for the future as a member of a household, of a community, least of all as a citizen.  As these orphans grow into youth and adulthood, there are serious implications for those societies in which they will live their lives.  There are also important implications for the maintenance and sustainability of rural knowledge and in particular agricultural knowledge. Children who grow up with elderly grandparents as primary carers or who lack primary carers are less likely to learn how to use and sustain the land than those who have parents.  This is an important and little understood aspect of the effect of the HIV/AIDS epidemic on rural life and food security.

The present situation in southern Africa

More recently, particularly in Southern Africa, we are seeing growing food insecurity at the national level in Malawi, Zambia and Mozambique.  How far this is the result of long and short term climatic factors and how far communities’ abilities to cope with the effects of these has been sapped by a decade of HIV/AIDS is not clear. It seems unlikely that at least part of the current upswing in food insecurity in these regions is not due to HIV/AIDS.  Figure 9shows some of the affected areas and summarises their situations.

In circumstances such as those outlined, poverty and disorder drives behaviours (migration for work or to population movement in the face of violence) which are known to increase rates of sexual partner change.  Thus to speak of food insecurity only as a characteristic of households or communities without taking account of these broader structural factors fails to understand the real relationships between HIV/AIDS, livelihoods and food insecurity.  Equally, to report food insecurity without considering the possibility that it reflects the long term impact of HIV/AIDS on communities’ ability to cope is to continue to ignore just how serious is the relationship between this epidemic and food insecurity.

TONY BARNETT

Tony Barnett is Professor of Development Studies at the University of East Anglia, UK.  Since 1986, he has researched and lectured widely on the social and economic impact of HIV/AIDS.  This work as taken him to many parts of Africa, south and south-east Asia and the Former Soviet Union.  He has been Overseas Visiting Professor at the Institute of Developing Economies, Tokyo and has lectured at the Harvard School of Public Health.  In the course of his academic work, Tony Barnett has been an advisor to many UN agencies, NGOs and to the business sector.  His previous books on HIV/AIDS and agriculture include AIDS in Africa: its present and future impact (co-authored with Piers Blaikie) and The Effects of HIV/AIDS on Farming Systems in Eastern Africa (published by FAO).   His most recent book (co-authored with Alan Whiteside) is: AIDS in the 21^st Century: disease and globalization, London and New York, Palgrave-Macmillan, which can be ordered from http://www.palgrave.com/catalogue/catalogue.asp?Title_Id=140390006X or purchased at a special conference discount from Herreros Medical Bookshop in Barcelona.

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