IN DEPTH: How does AIDS cause famine?

What does it mean for a society when 10, 20, or 30 per cent of the population is HIV-infected?

A homeless, orphaned child in the border town of Chirundu, Zambia sleeps on a concrete step. Photo: Stephen Matthews, World Vision

The international community has been slow to realise that HIV/AIDS is so much more than a health problem. It is also a social, cultural and economic issue with major impacts on individuals, communities, societies and even the level of macroeconomics.

Today, Southern Africa faces a huge food shortage, partly as a result of HIV/AIDS. The pandemic threatens not only the livelihood of families and households, it threatens the long-term food-security of whole communities and nations.

"HIV/AIDS has weakened family structures," a recent UN report on the crisis claims, "and left thousands of orphans and elderly people without the strength to plough fields or undertake supplementary income generation activities or even seek appropriate health care.”

The impact on families
There are many ways that AIDS reduces the ability of families to get enough food.

When one adult in a household falls ill as a result of HIV/AIDS and can no longer work, food production and income drop dramatically. Other family members will spend time and money looking after the sick person, multiplying the effect. Time and resources available to spend on caring for children, hygiene, food processing and preparation, are reduced. Consequently, health and nutrition levels drop. Families lose their savings and seek support from relatives, borrow money or sell their productive assets.

If both parents are infected by HIV/AIDS, as so often happens, the downward spiral accelerates. The problems are even worse for families who have taken in sick relatives or who foster AIDS orphans. Many HIV-infected workers return from the city to their traditional home in rural communities once they fall ill, to be cared for by relatives.

Once parents die, families are often reduced to impoverished elderly people and children. The process of passing on knowledge and expertise in land preparation, crop cultivation, handicrafts, cultural beliefs and traditions to the next generation is seriously undermined. Survivors may have limited access to resources, and often lack the knowledge, experience or physical strength to farm their land well or to earn their living in other ways.

Consequently, children who are orphaned as a result of HIV/AIDS face enormous difficulties in establishing a livelihood. Researchers in Kenya have found that only 7 per cent of farming households headed by orphans have adequate knowledge of agricultural production. Many AIDS orphans with no other options end up on the streets, and some turn to crime and prostitution for survival.

The cost of health care is also a major factor. One study in Uganda showed that 65 per cent of AIDS-affected households were obliged to sell property to pay for health care. Funeral expenses are also a major burden. A study in Namibia found that it was common for families to sell their livestock to support the sick or to pay for funerals. This threatens the livestock industry in the short term, and also the long-term food security of the family and community.

Much of the burden of the crisis falls on women. Traditional roles ensure that women carry much of the responsibility for caring for the sick and dying. And women's lower income, status, education levels and limited legal rights mean less access to resources, health services, and other social services.

Women are also biologically more at risk of HIV infection than men, and traditional gender roles and economic factors often make them powerless to keep themselves safe. One of the most difficult issues for women is their limited ability to exercise control over their own sexuality, in terms of their choice of sexual partners and their ability to insist on “safer-sex” practices, such as condom use.

Macro-level
World Vision’s Nigel Marsh sums up the situation in Southern Africa: “A quarter to a third of the productive workers on the land are becoming sick. That removes any hope a nation has of absorbing other calamitous events, such as the combination of flood and drought that we’ve seen across the region.

"Where women are left to care for large numbers of children alone as their husbands die, the amount of attention the family can give to their land diminishes rapidly. Tens of thousands of families of grandparents caring for orphans, and children living alone, have neither the skills nor strength to produce enough food for themselves, let alone contribute to the wider agricultural economy.”

In high-prevalence countries, AIDS has left a huge proportion of the labour force unable to work, and economies are grinding to a halt. By the next decade, South Africa, which represents 40 per cent of the region’s economic output, faces a real Gross Domestic Product 17 per cent lower than it would have been without AIDS.

The brain drain
The pandemic is also eating into the skill base of affected societies. When trained professionals such as nurses, teachers, engineers, mechanics, and government workers die, they leave huge gaps in institutions such as schools, universities, health services, and other essential services. It is estimated that AIDS causes 58 per cent of staff deaths in Kenya's Ministry of Agriculture, and 16 per cent of staff in Malawi’s Ministry of Agriculture and Irrigation have the disease.

One study notes that, “Nurses and teachers are dying faster than they can be replaced. Last year, around 1 million African schoolchildren lost their teachers to AIDS. In Malawi, 6 to 8 per cent of the teaching workforce dies each year. AIDS has orphaned nearly 14 million children. In Sierra Leone, the war left 12,000 children without families; AIDS has already orphaned five times that number.”

World Vision’s response
In the past, working to ensure food security has involved initiatives in agriculture, training, food distribution and reform of the international trading system. Now, working for food security also means responding to the AIDS crisis. Programmes addressing economic instability and food insecurity now have to be coupled with HIV/AIDS prevention and care.

World Vision is active in long-term community development in each of the affected Southern African nations - Angola, DRC, Lesotho, Malawi, South Africa, Swaziland, Zambia, Zimbabwe, and all of World Vision's programmes in the area contain HIV/AIDS activities.

World Vision is also running relief programmes to deal with the immediate food shortage, and experts in food distribution, food security and AIDS response have combined to form a unified strategy. The impact of HIV and AIDS is being directly addressed in all of World Vision’s food distribution work.

As American AIDS activist Vitto Russo said in 1998, “We are all being tested right now ... everyone on the planet. AIDS is a test of who we are. AIDS is going to reveal through the responses of all people, what we are made of as a people.”

Based on an article by Colleen Daniels and Don McArthur, World Vision Australia.

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