Saturday, September 6, 2008


Islam and HIV/AIDS:

Muslim countries, previously considered protected from HIV/AIDS due to religious and cultural norms, are also facing a rapidly rising cases. Despite the evidence of an advancing epidemic, sometimes the usual response from the policy makers in Muslim regions for protection against HIV infection is a major focus on propagating abstention from illicit drug and sexual practices. Sexuality, considered a private matter, is usually a taboo topic for discussion as in many cultures.

Reducing the risks to the individual and the community associated with some often stigmatized, antisocial or illegal behaviors becomes important but sometimes elusive. The reliability of the available HIV/AIDS incidences, prevalence and mortality data for Muslims is low because many Muslim countries maybe either their strict following of the religious teachings that are less influenced by other external forces(western oriented) or they do not report their statistics/are good at under-reporting. Either way- HIV/AIDS is far more than a medical and biological problem around the world. In recent years, increasing attention is being paid to the manner in which social and cultural variables influence risk behaviors related to HIV infection transmission. Though the association of contentious ethical and moral issues with HIV risk behaviors exists in all societies, it is much more pronounced in the Muslim world. Thus understanding the role of social and cultural variables affecting HIV transmission in Muslim countries is critical for the development and implementation of successful HIV prevention programs as would in other regions.

As in this case where a Muslim missionary stationed in Gaborone, Sheikh Hategeaikimana Hassan, said that the government's ABC - Abstain, Be faithful, Condomise - model is not entirely compatible with the teachings of Islam. The 'C' is the problem."As Muslims, we encourage and emphasize abstinence until marriage," He said. Abstinence, the primary prevention message for Muslims, is viewed as an act of faith and compliance, but evidence from other parts of the world shows that not all Muslims have been able to comply all the time. A study carried out in Morocco showed that about 50 percent of Muslim women in that country who have AIDS were infected by their husbands. The implication is all too clear: the men had illicit affairs. From a common sense perspective, it would seem realistic to encourage those who find it difficult to A or B, to at least C. However, Hassan sid that as Muslims, they "don't condomise" and that compromise on that score would be tantamount to "encouraging unlawful desire". Generally, the rate of infection in Muslim communities is typically less than in other groups and that have been attributed to the Islamic way of life. Senegal, whose population is 92 percent Muslim, has one of the lowest rates of HIV infection in Africa.

The surgical operation is considered one of the five acts of cleanliness in Islam and the World Health Organization estimates that, on a global scale, 30 percent of males have been circumcised, with almost 70 percent of them being Muslims. The prime health benefit of male circumcision is that it thwarts transmission of HIV as there would be no foreskin to harbor and pass the virus to the rest of the body. While not recommending it as protection against HIV/AIDS, WHO and UNAIDS put out a statement last year that said that male circumcision significantly reduces the risk of HIV transmission. WHO has recommended that countries should implement free or low-cost male circumcision programmes if a high percentage of their population is uncircumcised, if HIV is widespread and if HIV spread is predominantly heterosexual. It says that most such nations are in southern Africa and, to a lesser extent, in eastern Africa.

Turning back the hands of time would be impossible but it is tempting to speculate on how Botswana's HIV/AIDS situation would be like if one time-travel back to the 1980s. Two American academics, Drs. Daniel Halperin of the University of California in San Francisco and Robert Bailey of the University of Illinois undertook a "what-if" study on Botswana's HIV/AIDS situation and reached a very interesting conclusion. Their findings suggested that if in 1985 all Botswana men and boys had been circumcised, HIV/AIDS might never have reached the pandemic proportions it did in subsequent years. Muslims have not established common ground on when circumcision should be done but some scholars recommend the seventh day of infancy. He said that if one converts to Islam in adult life, he should undergo the operation.


The low rate of HIV infection among Muslims is also attributable to the fact that Islam forbids intoxicants for all its adherents. Compliance is helpful in avoiding the consequences of loss of inhibition that drugs like alcohol would otherwise provoke. Across the border, in South Africa, grave concern has been expressed that Muslim groups have been conspicuously absent at many provincial and national forums on HIV/AIDS. In the Botswana case, however, Hassan said that the Muslim community has been working very closely with the government and relevant NGOs.
Personally, he has participated in one of the studies carried out by the Ministry of Health. He stresses the importance of working with these parties in an effort to find workable solutions to the HIV/AIDS scourge. "We respond to their call whenever our assistance is needed. We attend their meetings and workshops and exchange views on how we should deal with this problem," Hassan said. However, that collaboration has not extended to financial matters. He says that they have not benefited from any government money or funds disbursed by AIDS NGOs.
What the Muslim community has been doing over the years is raising its own funds. However, the assistance is limited because, as Hassan revealed, no one in the Muslim community has come forward to declare his or her HIV status. Furthermore, no statistics are available to ascertain the level of prevalence and trends of the disease in that community. "This does not mean that there are no Muslims who are not infected by this disease," Hassan states, adding that they use statistics obtained from the government and various NGOs. Last year, Johannesburg, South Africa hosted a five-day Islam and HIV/AIDS conference that was attended by over 200 delegates from different countries. According to Hassan, there were no delegates from Botswana.
He also said that the local Muslim community has literature on HIV/AIDS that it distributes not just to Muslims but to everybody else who wants to get up on the Islamic. approach to fighting HIV/AIDS. "Islam is a complete way of life, it deals with any social problem when the need arises," he said.
As in any other societies- Reasons for the spread of HIV in Muslim countries are open to speculations. Islam places a high value on chaste behavior and prohibits sexual intercourse outside of marriage. It specifically prohibits adultery, homosexuality, and the use of intoxicants. Then how can the spread of HIV/AIDS in Muslim countries be explained- A logical explanation is that in spite of Islamic teachings, some Muslims do engage in activities that lead to acquiring HIV; these risky practices include illicit drug use and/or premarital or extra marital sex. Men who engage in risky behaviors have the potential of transmitting the disease to their unsuspecting wives. Women, on the other hand, also are directly susceptible; in many Muslim countries, brothels and other forms of commercial sex trade are prevalent. The sex workers have poor social support and sometimes they are not screened properly or at all for sexually transmitted diseases including HIV, thus contributing to the spread of infection. Injection drug users IDUs also are rapidly becoming a population of increasing concern in the transmission of HIV and AIDS including Muslim countries. Sex- and drug-related behaviors of IDUs can facilitate HIV transmission even when syringes are not directly shared.

HIV/AIDS and Christianity:

Mostly the Christian religious groups-especially the western leaning religious groups (religious rights movements/evangelicals as they are called sometimes) tend to look at HIV/AIDS as the African disease-a continent a few centuries ago they flocked in to redeem it/her from darkness and from it/her-self, I guess and thus feels obliged to continue doing so (forget that little instrumental part they played in colonization in the name of redemption. This Dark Continent! How only the bad things are found but never the good things?

So here they come in the name of missionaries, Ngo’s, World Banks, IMFs, and in other big sounding names that the locals bleed to pronounce. They come with material aids in the name of investments-(read opportunists), misinterpretations, stigmatization, and disregard of local cultural practices pronouncing them as non-modern and manipulation of geopolitical agenda, data inflation-(High cases of diseases/other catastrophies ring a bell?) so that they can keep getting more funds from their countries of origin and usually they start/pretend by initial formation of support groups-
The routine activities of the support group typically begin with the singing of choruses and hymns, followed by a Word of God and the prayer. After that new members were welcomed through the exchange of hugs and motivated to live positively by any confident member who had already spent a reasonable amount of time with the group. At times, an opportunity was created for other members to testify about the greatness of God over their HIV infection.

According to this abstract- Although a large majority of South Africans (about 79% according to 2001 census) are affiliated to Christian churches
(Statistics South Africa, 2004), an epidemic fuelled by sexual behavior remains a major challenge in the fight against AIDS (Garner, 2000). In South Africa, one in
ten people aged 15 to 24 years is said to be HIV positive (Campbell, Foulis, Maimane & Sibiya, 2005). As many people presumably contract HIV outside
Wedlock, it is perceived as a double-sin (Duffy, 2005). This perception is not only based on the view that premarital HIV infection suggests premarital sex, and at
Worst promiscuity (Duffy, 2005), but more so, given the prevailing moral judgement about the ‘ungodliness’ of HIV infection (Machyo, 2002), it can be viewed as a
‘Punishment’ or curse from God (Takyi, 2003). However, there are mixed views about the relationships between ‘ungodliness’ and HIV infection, as well as sin or evil and diseases in general (Sanders, 2006; Wiley, 2003) Gilman (2000) draws connections between sexually transmitted diseases (STDs) and religious impurity or
Dirtiness. He argues that stigmatization of people suffering from STDs dates as far back as the end of the first millennium when leprosy emerged. In Europe,
Lepers were required to wear identifying clothes and to warn of their presence (Green & Ottoson, 1994). Like leprosy, and as a STD, the diagnosis of syphilis at the
end of the 19th century evoked similar moral judgment and stigma. Despite the complexities of these inextricable connections (disease, HIV infection
And sin/evil, and or dirtiness), there is no conclusive evidence that the presence of any disease, and AIDS in particular, suggests a ‘punishment’ from God or any
sort of dirtiness (Gilman, 2000).This view recalls Jesus Christ’s response in the Book of John 9: 2-3: when confronted with a question about the man born blind, and whether it was through his sins or his parents’ sins that he was blind, His response was,” Neither he nor his parents sinned. He was born blind so that the works of God might be displayed in Him” (Machyo, 2002, p. 6). Machyo further warns against the passing of premature judgment on HIV positive people, citing the unconditionality of God’s love as a guiding
principle. Fatovic-Ferencic and Durrigl (2001) have documented the non-refutation of the relationship between sin or evil and disease by medieval medical authors, further presenting evidence of Christ casting out a devil from a boy suffering from epilepsy. The relationship between HIV infection and sex further complicates attempts to connect it with sin or ‘punishment’ from God. A search for studies that connect sin/evil and HIV infection largely unsuccessful, and we only managed to gather materials that present anecdotal connections between sin/evil and disease. Limited discussion of sex among most, if not all, religious denominations, as well as a lack of commitment in the fight against this pandemic by some religious groups, in our view further Complicates existing stigma and moral judgments. Despite these multifaceted arguments, religion and spirituality remain invaluable coping resources for dealing with pain (Rippentrop, Altmaier, Chen, Found& Keffala, 2005), particularly for people living with HIV (Simoni, Martone & Kerwin, 2002; Takyi, 2003), as well as throughout life in general (Machyo, 2002; Stuckey, 2001). In a study conducted among people living with HIV/AIDS (PLWHA) in Australia, Ezzy (2000) established an increased likelihood of religiosity resulting from HIV diagnosis.



If the common goal is to end the global epidemic then it is time to look at the problem beyond a focus on the virus, as it exists within the human body, and to find ways to alter the social and economic environment that enable it to flourish. It is time for global education not only about HIV/AIDS but also about the social context of underdevelopment and poverty that engulfs many of those communities which also have the highest rate of infection. It is time for human society to work at all levels to develop ways to find lasting solutions to the right problems. Finding treatments that protect babies from infection or that add years to the lives of people living with HIV/AIDS is a brilliant first step and has saved children from infection and restored life and hope to many infected people. Such improvements must continue. However, this progress is grossly inaccessible where most needed. If, one day, a vaccine for HIV and cure for AIDS are developed, they must be available to the developing world.

Even then, will enough have been accomplished if the spread of HIV is halted, but the human suffering that provided fertile ground for the epidemic in the first place is allowed to continue until the next virus that might get the world's attention?
The Impact on the Rural Economy:
It is widely acknowledged within general development literature that the urban and rural economies are usually intrinsically interlinked and that incomes within the rural environment depend upon wages earned within the urban economic environment. Thus it is clear that the impact of HIV/AIDS on the formal, largely urban-based economies of Southern and Eastern Africa will increasingly have an impact in reducing the options and the cash flows between the two sectors.
Within Southern and Eastern African countries, HIV/AIDS has been acutely experienced in rural areas. A recent Fact Sheet prepared by the FAO (2000) clearly describes the threat to rural Africa:
•More than two-thirds of the populations of the 25 most-affected African countries live in rural areas.
•Information and health services are less available in rural areas than in cities. Rural people are therefore less likely to know how to protect themselves from HIV and, if they fall ill, less likely to get care.
•Costs of HIV/AIDS are largely borne by rural communities as HIV-infected urban dwellers of rural origin often return to their communities when they fall ill.
•HIV/AIDS disproportionately affects the economic sectors such as agriculture, transportation and mining that have large numbers of mobile or migratory workers.

As discussed earlier, the extensive labor migration between and within countries, associated with annual or more frequent visits home, has facilitated the spread of HIV/AIDS to the most remote rural. The prevalence of HIV/AIDS in rural areas is not adequately documented due to poor health infrastructure, restricted access to health facilities and inadequate surveillance. This emphasizes the fact that rural communities have fewer resources to prevent infection and to nurse ill people. Access to treatment and other services, as well as education, are often limited in such contexts.

The effects of HIV/AIDS within a rural economy may include:
•Redistribution of scarce resources with an increasing demand for expenditure on health and social services;
•A collapse of the educational system due to high morbidity and mortality rates amongst educator and learners;
•Younger and less experienced workers replacing older AIDS related casualties, causing reduction in productivity;
•Employers becoming more likely to face increased labor costs because of low productivity, absenteeism, sick leave and other benefits (attending funerals), early retirement and additional training costs.

Agricultural production is often central to the rural economy. This form of production is usefully differentiated into the commercial farming sector, where the organization and running of a farm/shamba often approximates a business, and the subsistence sector, which is characterized by a close relationship between the general activities of a household (including child rearing, supporting relationships between adult members, home maintenance and food processing) and the production of crops and of animals.

The Impact on Agricultural Production:

Agriculture is one of the most important sectors in many developing countries, providing a living or survival mechanism for up to 80 percent of a country’s population. However, while agriculture is extremely important to many African countries, not least of all for household survival, there are marked differences among countries in terms of current economic conditions and agricultural and economic potential.

Agriculture faces major challenges including unfavorable international terms of trade, mounting population pressure on land, and environmental degradation. The additional impact of HIV/AIDS is also severe in many countries. The major impact on agriculture includes serious depletion of human resources, diversions of capital from agriculture, loss of farm/shamba and non-farm income and other psycho-social impacts that affect productivity.

The adverse effects of HIV/AIDS on the agricultural sector can, however, be largely invisible as what distinguishes the impact from that on other sectors is that it can be subtle enough so as to be undetectable. In the words, even if rural families are selling cows to pay hospital bills, one will hardly see tens of thousands of cows being auctioned at the market...Unlike famine situations, buying and selling of assets in the case of AIDS is very subtle, done within villages or even among relatives, and the volume is small Furthermore, the impact of HIV/AIDS on agriculture, both commercial and subsistence, are often difficult to distinguish from factors such as drought, civil war, and other shocks and crises.

For these reasons, the developmental effect of HIV/AIDS on agriculture continues to be absent from the policy and programmes agendas of many African countries. Many studies on HIV/AIDS that have focused on specific sectors of the economy such as agriculture have been limited to showing the wide variety of impacts and their intensity on issues such as cropping patterns, yields, nutrition, or on specific populations. They have not adequately touched on questions such as the effects of changes in prices of commodities, such as tea or cocoa, land tenure and the rights of women and children.

Impact on the Commercial Sector:

Commercial agriculture is particularly susceptible to the epidemic and is facing a severe social and economic crisis in some locations due to its impact. Morbidity and mortality due to HIV/AIDS significantly raise the industry’s direct costs (medical and funeral expenses) as well as indirectly through the loss of valuable skills and experience.
The epidemic thus adversely affects companies’ efficiency and productivity. Thus HIV/AIDS is leading to falling labor quality and supply, more frequent and longer periods of absenteeism, losses in skills and experience, resulting in shifts towards a younger, less experienced workforce and subsequent production losses. These impacts intensify existing skills shortages and increase costs of training and benefits.

At a FAO Conference on HIV/AIDS and agriculture, an example was given of the costs to this particular sector. It was argued that in Sub-Saharan Africa’s 25 worst affected countries, seven million agricultural workers have died from the epidemic since 1985 and sixteen million more may die by 2020, according to that report. Table below depicts the grim picture of the agricultural labor force decreases in the ten most heavily affected countries in the continent. Intensive agriculture will be severely impacted through the loss of this specialized labor. Areas of production such as harvesting and processing that require a high level of skill will be most severely affected.

Impact of HIV/AIDS on agricultural labor in some African countries (projected losses in percentages)

Country 2000 2020

Namibia 3.0 26.0
Botswana 6.6 23.2
Zimbabwe 9.6 22.7
Mozambique 2.3 20.0
South Africa 3.9 19.9
Kenya 3.9 16.8
Malawi 5.8 13.8
Uganda 12.8 13.7
Tanzania 5.8 12.7
C.A. Republic 6.3 12.6
Ivory Coast 5.6 11.4
Cameroon 2.9 10.7

It should also be emphasized that the impact on commercial agriculture is only one side of the story. In much of southern Africa, agriculture is not the dominant economic sector, even while access to land and its resources is important for the diverse multiple livelihood strategies of many rural denizens.

Impact on the Small-Scale and Subsistence farming Sectors:

Many studies conducted on the impact of HIV/AIDS in Africa have focused on the farm-household level - where agricultural production at the subsistence or small-scale level is often embedded within multiple-livelihood strategies and systems. Over the past two decades there have been profound transformations in these livelihood systems in Africa, set in motion by Structural Adjustment Programmes, the removal of agricultural subsidies and the dismantling of parastatal marketing boards. As a result of these and other issues, many African households have shifted to non-agricultural income sources and diversified their livelihood strategies accordingly.

However, despite the evident of diversification out of agriculture, rural production remains an important component of many rural livelihoods throughout Sub-Saharan Africa. ‘African rural dwellers ...deeply value the pursuit of self-provisioning is gaining in importance against a backdrop of food inflation and proliferating cash needs. Participation in “small-plot/shamba agriculture” is highly gendered, with women taking major responsibility for it as one aspect of a multiple livelihood strategy. Access to land-based natural resources remains a vital component of rural livelihoods particularly as a safety net. In this context, land tenure becomes increasingly important for the diverse livelihood strategies pursued by different households.

Diversification out of agriculture may be compounded by the affect of HIV/AIDS in a number of ways. These include its impact on labor, the disruption of the dynamics of traditional social security mechanisms and the forced disposal of productive assets to pay for such things as medical care and funerals. In turn, local farming skills are drained and biodiversity in crop variety diminished. Indigenous knowledge systems and technology adapted by farmers to suit the particular conditions of specific areas often die with the farmers, a dangerous trend as far as cultural practices are concerned. A large number of Sub-Saharan African countries have already experienced a shift in the allocation of labor especially by subsistence households. A study in Zimbabwe conducted by the Zimbabwe Farmers Union (some times back-but still relevant )showed that the death of a breadwinner due to AIDS will lead to a reduction in maize production in the small-scale farming sector and communal areas of 61 percent.

The loss of agricultural labor is likely to cause farmers to move to production of less labor intensive crops in a bid to ensure their survival. This often means a shift from cash to food crops or high value to low value crops. The impact of HIV/AIDS on crop production relates to a reduction in land use, a decline in crop yields and a decline in the range of crops grown, mainly with reference to subsistence agriculture. Reduction in land use occurs as a result of fewer family members being available to work in cultivated areas and due to poverty resulting in malnutrition leading to the inability of family members to perform agricultural work. This, in turn, leads to less cash income for inputs such as seeds and fertilizer. In Ethiopia, for example, labor losses reduced time spent on agriculture from 33.6 hours per week for non AIDS-affected households to between 11.6 to 16.4 hours for those affected by AIDS.

At another workshop on HIV/AIDS and land, the then FAO director in South Africa stated that the food shortages facing several Southern African countries, including Lesotho and Zimbabwe, were ‘a stark demonstration of the collective failure to recognize and act upon the deep-rooted linkages between food security and HIV/AIDS’. This reiterates the argument that the continuous interruption of labor may also impact on the type of crops grown, and hence substitution between crops may take place. This is especially true for labor intensive crops, which would likely result in the substitution for less labor intensive production and a possible decrease in the area being cultivated. Food security therefore becomes an important issue in the context of HIV/AIDS.

Food security implies that every individual in a society has a sustainable food supply of adequate quality and quantity to ensure nutritional needs are satisfied and a healthy active life be maintained. At a household level, food security refers to the ability of households to meet target levels of dietary needs of their members from their own production or through purchases.

Therefore, the impact of HIV/AIDS on agriculture directly affects food security, as it reduces:

•Food availability (through falling production, loss of family labour, land and other resources, loss of livestock assets and implements).
•Food access (through declining income for food purchases).
.The stability and quality of food supplies (through shifts to less labour intensive production).

HIV/AIDS can therefore be a cause of food insecurity and a consequence thereof. For example, during times of food insecurity, such as during drought, individuals or families can be forced to engage in survival strategies that increase their vulnerability to contracting HIV.

Natural resource management has also been directly impacted on by HIV/AIDS, which has important implications for non-agriculturally based multiple livelihood systems. Conservation and resource management are also dependent on human factors such as labor, skills, expertise and finances that have been affected by the epidemic. Therefore the reduction in the number and capacity of ‘willing, qualified, capable and productive people’ who have managed natural resources has negatively impacted on sustainable utilization of these resources. In addition, the epidemic can impact natural resource conservation and management by accelerating the rate of extraction of natural resources to meet increased and new HIV/AIDS demands.
These issues relating to labor, production, natural resource management and food security are elaborated in more detail in the following section describing household production.

The Impact on Household Livelihood Strategies:

As demonstrated above, various “research” initiatives have shown that HIV/AIDS first affects the welfare of households through illness and death of family members, which in turn leads to the diversion of resources from savings and investments into. It is expected that the premature death of large numbers of the adult population, typically at ages when they have already started families and become economically productive, can have a radical effect on virtually every aspect of social and economic life. This is clearly indicated by an increase in the number of dependents relying on smaller numbers of productive household members and increasing numbers of children left behind to be raised by grandparents or as child-headed households or extended family members.

Once a household member develops AIDS, increased medical and other costs, such as transport to and from health services, occur simultaneously with reduced capacity to work, creating a double economic burden. The households with an AIDS sufferer frequently seek to keep up with medical costs by selling livestock and other assets including land. Members who would otherwise be able to earn or perform household and family maintenance may then be spending their time caring for the person with AIDS. An example a son with a sick mother in Zambia- reported that he spent more time looking for money to make ends meet by working in the field and doing casual jobs, and in addition having to contribute an average of three hours a day towards caring for his mother and staying up part of the night attending to her needs. Cases like that are not unique; rather they are more frequent and familiar in most families in developing countries.

This emphasizes an impact of HIV/AIDS illness and death, which often results in the re-allocation of livelihood tasks amongst household members. Reports that intensive use of child labor increases as a major strategy and it’s typically used by the afflicted household during care provision. Children may be taken out of school to fill labor and income gaps created when productive adults become ill or are caring for terminally ill household’s members or are deceased. Another example from Tanzania-and many other countries whose populations are struggling with the effects of the disease- shades light on to how the illness affects time allocation puts pressure on children to work, divert household cash and the disposal of household productive assets. HIV/AIDS is therefore an impoverishing process that leads to other problems such as malnutrition, inaccessibility to health care, increased child mortality and hence intergenerational poverty.

It is important to recognize that the impact of HIV/AIDS on rural households is not equal: the poorer- especially those with small land holdings are much less able to cope with the effects of HIV/AIDS than wealthier households who can hire casual labor and are better able to absorb shocks. The question as to who benefits from the sales of assets by farming-households attempting to cope with the long drawn-out effects of HIV/AIDS could be unclear. Number of occurrences evident could lead to significant changes in the socio-economic structures of villages, redistribution of wealth and of land. HIV/AIDS infection ultimately stretches the resources of an extended family beyond its limits as both material and non-material resources are rapidly consumed in caring for the infected.

The manner, in which HIV/AIDS can cause affected households to become socially excluded, thus diminishes their ability to cope with further crises. Similarly, extended family networks sometimes collapse, not least due to pressure of having to support orphaned children. Moreover, it has been argued that for instance in KwaZulu-Natal, South Africa, HIV/AIDS has forced a change in household composition, severely weakening and often breaking the young adult nexus between generations. This, in turn, exacerbates an already existing social crisis of care, which worsens as the epidemic progresses. It is a social context that is unlikely to withstand the weight of need that HIV/AIDS related deaths generate and many, especially children and the aged, face economic and social destitution.

It is increasingly clear that as a result of HIV/AIDS causing significant increases in morbidity and mortality in prime-age adults, increasing negative social, economic and developmental impacts will occur. As can be clearly indicated, the economic impact at the household level will be decreased, increased health-care costs, decreased productivity capacity and changing expenditure patterns. Major survival strategies developed in response to the epidemic may include the altering household composition the withdrawal of savings and the sale of assets, the receipt of assistance from other households. Following death the impact breaks out the households and cutting into the community in the form of increasing number of dependents such as orphans.

Coping Strategies - or simply surviving?

In the face of the extreme impact of HIV/AIDS, individuals and households undergo processes of experimentation and adaptation when adult illness and death impacts whilst an attempt is made to cope with immediate and long-term demographic changes. Several factors determines a household’s ability to cope including access to resources, household size and composition, access to resources of the extended family, and the ability of the community to provide support. The interaction of these factors will determine the severity of the impact of HIV/AIDS on the household.

Household Coping Strategies:

Strategies aimed at improving food security Strategies aimed at raising & supplementing income to maintain household expenditure patterns Strategies aimed at alleviating the loss of labor
•Substitute cheaper commodities (e.g. porridge instead of bread)
•Reduce consumption of the item
•Send children away to live with relatives
•Replace food item with indigenous/wild vegetables
•Income diversification
• Migrate in search of new jobs
• Loans
• Sale of assets
• Use of savings or investment • Intra-household labor re-allocation and withdrawing of children from school
• Put in extra hours
• Hire labor and draught power
• Decrease cultivated area
• Relatives come to help
• Diversify source of income

The household experience in the context of HIV/AIDS and may divert policy-makers from the enormity of the crisis. AIDS-induced morbidity and mortality has an immense impact on rural households but questions whether the observed effects should be defined as “coping strategies”. And any meaningful analysis of coping behavior must include the real and full costs of coping.

There are several reasons why the concept is of limited use and explores alternative ways of conceptualizing the impact of HIV/AIDS in more detail. Firstly one could define the concept as being essentially concerned with the analysis of success rather than failure of the household as it implies that the household is managing or persevering. This ignores evidence that households often dissolve completely with survivors joining other households. This runs contrary to a concept of strategy intended to avert the breakdown of the household unit.

Secondly, households do not act in accordance with a previously formulated plan or strategy but react to the immediacy of need, disposing of their assets when no alternatives present themselves. Decisions are not based on the importance or usefulness of the asset to the household as saving lives is deemed more important than preserving assets. More evidence is emerging that even land, the “most important agrarian asset”, may not be spared in the quest to ‘cope’ with illness. Indeed, a recent study on the impact of HIV/AIDS on female microfinance clients in Kenya and Uganda, found that there was a clear sequence of “asset liquidation” among AIDS caregivers in order to cope with the economic impact - first liquidating savings, then business income, then household assets, then productive assets and, finally, disposing of land. This last resort of disposing of land has profound consequences for people losing their economic base. People are likely to be those with fewest options and those who are most vulnerable.

Thirdly, coping strategies tend to be defined as short-term responses to entitlement failure giving the impression that it involves few additional costs thereby obscuring the true cost of coping. In Tanzania, short and long-term costs included curtailing the number and quality of meals that a household could afford which resulted in poor nutrition with obvious implications for health. Another household option was the withdrawal of children, mostly girls, from school in order to utilize their labor and save money, which, amongst other things, had ramifications for future literacy levels and the child’s participation in the modern economy. The positive gloss accorded to coping invariably ignored long-term costs that fundamentally jeopardize recovery of a household let alone sustainability.

In summary, one would argue that references to coping strategies may make sense in circumstances of drought or famine but not for the impact of HIV/AIDS, which not only changes communities and demographic patterns but also agro-ecological landscapes with long-term implications for recovery. The fact that AIDS kills the strong people and leaves behind the weak undermines the capacity of households and communities, especially in the long-term. It is therefore important to further differentiate the household according into their various possible members with an emphasis on the power relations between people forced to respond to the compounding impact of HIV/AIDS on their livelihood strategies.

Women and HIV/AIDS:

There are a number of interlocking reasons why women are more vulnerable than men to HIV/AIDS, which include female physiology, women’s lack of power to negotiate sexual relationships with male partners, especially in marriage, and the gendered nature of poverty, with poor women particularly vulnerable (Walker, 2002: 7). Inequities in gender run parallel to inequities in income and assets. Thus women are vulnerable not only to HIV/AIDS infection but also to the economic impact of HIV/AIDS. This is often a result of the gendered power relations evident in rural households, which can leave women prone to the infection of HIV. With increasing economic insecurity women become vulnerable to sexual harassment and exploitation at and beyond the workplace, and to trading in sexual activities to secure income for household needs.
As a result, women have experienced the greatest losses and burdens associated with economic and political crises and shocks with particularly severe impact from HIV/AIDS.

The epidemic exacerbates social, economic and cultural inequalities (economic need, lack of employment opportunities, poor access to education, health and information), which define women’s status in society;
•Breakdown of household regimes and attendant forms of security: Decades of changes in economic activity and gender relations have placed many women in increasingly difficult situations. HIV/AIDS has accelerated the process and made “normal” sexual relations very risky. Women whose husbands have migrated for work are afraid of the return of the men knowing that they may be HIV-infected. Although poorly documented, the range and depth of women’s responsibilities have increased during the era of HIV/AIDS. More active care giving for sick and dying relatives have been added to the existing workload. Children have been withdrawn from school, usually girl-children first, to save both on costs and to add to labor in the household.

Thus HIV/AIDS is facilitating a further and fairly rapid differentiation along gender lines.
•Loss of livelihood: Whether women receive remittances from men working away from home, are given “allowances”, or earn income themselves, HIV/AIDS has made the availability of cash more problematic.
•Loss of assets: Although poorly documented, fairly substantial investments in medical care occur among many households affected by HIV/AIDS. These costs may be met by disinvestments in assets. Household food security is often affected in negative ways. Furthermore, in many parts of Africa, women lose all or most household assets after the death of a husband.
•Survival sex: Low incomes, disinvestments, constrained cash flow - all place economic pressures on women. Anecdotal evidence and some studies indicate that these pressures push a number of women into situations where sex is coerced in exchange for small cash or in-kind payments.

Women frequently carry a double burden of generating income outside the home and for care giving as well as maintaining family land. In this regard, women are responsible for caring for sick members of the household as well as being heavily involved in generating income and supplying food for their households through agricultural production. Further, the burden of caring for people living with HIV/AIDS and for orphans’ falls largely on women. Thus, it has been argued that the illness and death of a woman has a “particularly dramatic impact on the family” in that it threatens household food security, especially when households depend primarily on women’s labor for food production, animal tendering, crop planting and harvesting.

In rural areas, women tend to be even more disadvantaged due to reduced access to productive resources and support services. The issue of AIDS and inheritance is therefore particularly important when discussing the impact of HIV/AIDS on women. Many customary tenure systems provide little independent security of tenure to women on the death of their husband, with land often falling back to the husband’s lineage. While this may, traditionally, not have posed problems, it may create serious hardship and dislocation in the many cases of AIDS-related deaths. While this may create an opportunity for communities to tweak/ and or address the land-ownership related cases, by no means this should be an opportunity for others (parties/groups) - Read (westerners and the like, who have little knowledge or care not to understand other people’s customs) to condemn/denounce-ridicule-belittle or categorize it as inferior. In other words it should be an inside job –done by the community members as they understand their customs, thus better to address it accordingly.

The Elderly and HIV/AIDS:

As already illustrated, the HIV/AIDS epidemic has immense ramifications for the structure of households with prolonged emotional and financial responsibilities of child-raising for grandparents. Large numbers of orphans have been left in the care of their grandparents across the globe. The role of the elderly in rural development in the context of the HIV/AIDS epidemic has been neglected. The elderly play a crucial role, not just in care giving, but in ensuring the food security of millions of affected rural farm-households as they become an alternative for the family.
The reports on population projection with HIV/AIDS scenario highlights changes in sex and age structure from the perspective of elderly at the national level, particularly for countries like Botswana and South Africa, two of those that have been worst affected countries. Thus the population pyramids for these countries suggest that:

•In 20 years time a significant number of 60-69 year olds will be dead (HIV mortality peaks around 30-34 years for women and 40-44 years for men),
•The surviving younger elderly of 60 years or more will have a role as care and subsistence of older ones.
•Number of children will decline significantly over 20 years,
•Due to change in sex ratio for adults, female age group, middle age and young elderly will have a burden of care and housework and this will force changes in division of labor.
•In Botswana more rapid ageing is seen in rural areas than in urban areas. This is also reflected in South Africa as a result of younger working age people migrating from rural communities and older people often returning. In countries such as Kenya, infection rates tend to be higher in densely populated areas, which are the most productive agricultural areas. With this spread of HIV/AIDS, it can be concluded that if this is not addressed aggressively, there will be fewer young adults who will be able to carry out essential tasks.

Therefore the elderly will increasingly be required to do such tasks. Thus it’s easy to conclude that the elderly are a largely invisible resource in the context of HIV/AIDS, requiring assistance and empowerment in order to fulfill its indispensable potential in areas of crisis. Thus the rural elderly have a potential to play a pivotal role of holding together farm households, ensuring food security and survival of orphans.

A Conceptual Framework: HIV/AIDS and Land:

A man is taken ill. While nursing him, the wife can’t weed the maize and cotton fields, mulch and pare the banana trees, dry the coffee or harvest the rice. This means less food crops and less income from cash crops. Trips to town for medical treatment, hospital fees and medicines consume savings. Traditional healers are paid in livestock. The man dies. Farm tools, sometimes cattle, are sold to pay burial expenses. Mourning practices in most Africa countries forbid farming for several days. In the next season, unable to hire casual labor, the family plants a smaller area. Without pesticides, weeds and bugs multiply. Children leave school to weed and harvest. Again yields are lower. With little home-grown food and without cash to buy fish or meat, family nutrition and health suffer. If the mother becomes ill with AIDS, the cycle of asset and labor loss is repeated. Families withdraw into subsistence farming. Overall production of cash crops drops-that is a typical scenario.

The narrative captures the stark reality of the cruel impact that HIV/AIDS has on the household producing on the margins (and above) the subsistence level. Many of these experiences indicate the powerful linkages between HIV/AIDS and land. There are therefore it is clear that prolonged illness and early death alter social relations. It can therefore be assumed that such relations would include institutions governing access to and inheritance of land.

Prolonged morbidity and mortality would also contribute to the disposal of land to cater for the care, treatment and funeral costs. this is a double-edged sword as on the one side access and utilization are affected among households and individuals, and on the other hand it would affect land planning and administration at various levels. These changes, particularly as they relate to individuals and households, would have dimensions across both age and gender. Therefore, in summary, HIV-related mortality would alter the land rights or the command positions held by people of different age and gender over land. An analysis of the impact of HIV/AIDS on land is essentially an analysis of changes in social institutions in which rights to land are anchored.

Therefore the analysis needs to take cognizance of a range of social attributes that affect the dynamics of land relations:

•Cultural, legal, political and other social dimensions affecting entitlement;
•How HIV/AIDS affects land entitlement and how land entitlement affects HIV/AIDS;
•Whether lack of entitlement to land increases vulnerability to HIV/AIDS;
•How HIV/AIDS impacts on institutions involved in land administration;
•The inputs needed to secure effective use of land by HIV/AIDS affected households;
•The fact that entitlement is not static and changes across gender and age;
•The complex continuum from landed to landless;
•The fact that although access to land may not be the most effective strategy for HIV/AIDS affected households, in rural areas it is likely to remain central to their survival.

From this- it is evident that the concept of land issues is extremely broad. To further help conceptualize the impact of HIV/AIDS, these issues have been differentiated into three main areas, namely land use, land rights and land administration. The impact on these areas is usefully conceptualized through the lens of the household particularly as HIV/AIDS is depriving families and communities of their young and most productive people:

•HIV/AIDS-affected households generally have less access to labor, less capital to invest in agriculture, and are less productive due to limited financial and human resources. Thus the issue of land use becomes extremely important as a result of the epidemic’s impact on mortality, morbidity and resultant loss of skills, knowledge and the diversion of scarce resources. A range of multiple livelihood strategies, often involving land, has been affected resulting in changes as rural households fight for survival in the context of the epidemic.

•The focus on land rights considers the extent of impact on the terms and conditions in which individuals and households hold, use and transact land. This has particular resonance with women and children rights in the context of rural power relations, which are falling under increasing pressure from HIV/AIDS. Anecdotal evidence from around the globe indicates that dispossession, particularly for AIDS-widows, is increasingly becoming a problem in locations with patrilineal inheritance of land. There are, however, a number of other issues to be examined in relation to HIV/AIDS and land tenure especially in localities that are experiencing increasing land pressure, land scarcity, commercialization of agriculture, increased investment, and intensifying competition and conflicts over land.

•The impact on land administration is a related issue and is a result of epidemic affecting people involved in the institutions that are directly or indirectly involved in the administration of land. These include local level or community institutions such as traditional authorities, civil society, various levels of government, and the private sector.


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