of her nine grandchildren, whose parents have died of AIDS.
Major findings about this devastating trend, using data for sub-Saharan Africa, home to the most-affected countries, can be summarized as follows.
AIDS is mostly a rural issue
- More than two thirds of the population 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 economic sectors such as agriculture, transportation and mining that have large numbers of mobile or migratory workers.
- AIDS has killed around 7 million agricultural workers since 1985 in the 25 hardest-hit countries in Africa. It could kill 16 million more before 2020.
- More than a third of the gross national product of the most-affected countries comes from agriculture.
- In contrast to other diseases, AIDS mostly devastates the productive age group -- people between 15 and 50 years.
- Up to 25 percent of the agricultural labour force could be lost in countries of sub-Saharan Africa by 2020 (map, click to enlarge).
- AIDS reduces productivity as people become ill and die and others spend time caring for the sick, mourning and attending funerals. The result is severe labour shortages for both farm and domestic work.
- Labour-intensive farming systems with a low level of mechanization and agricultural input are particularly vulnerable to AIDS.
- People are dying before they can pass on knowledge and expertise to the next generation. A study in Kenya showed that only 7 percent of agricultural households headed by orphans had adequate knowledge of agricultural production.
- In Kenya's Ministry of Agriculture, 58 percent of all staff deaths are caused by AIDS, and in Malawi's Ministry of Agriculture and Irrigation at least 16 percent of the staff are living with the disease. One study found that up to 50 percent of agricultural extension staff time was lost through HIV/AIDS in sub-Saharan Africa.
- In the first ten months of 1998, Zambia lost 1 300 teachers to AIDS -- the equivalent of around two thirds of all new teachers trained annually.
- The sale of productive resources to care for the sick and pay for funerals diverts funds away from long-term development.
AIDS threatens food security
- The loss of productive members of society is severely affecting household capacity to produce and buy food.
- Fostering AIDS orphans or hosting and caring for sick relatives reduces the amount of food available for each household member.
- Evidence from Namibia shows widespread sale and slaughter of livestock to support the sick and provide food for mourners at funerals. This jeopardizes the livestock industry and longer-term food security and survival options.
- Women whose husbands are migrant workers are especially vulnerable to AIDS, as their spouses may have other sexual partners. The women themselves may engage in commercial sex in periods of economic stress.
- Some of the traditional mechanisms to ensure widows' access to land contribute to the spread of AIDS -- for example, levirate, the custom that obliges a man to marry his brother's widow. Unfortunately, initiatives to stop these practices may leave widows without access to land and food.
- Biological and social factors make women more vulnerable to AIDS, especially in adolescence and youth. In many places HIV infection has been found to be three to five times higher in young women than in young men.
- In several countries, studies have found that rural women whose husbands had died of AIDS were forced to engage in commercial sex to survive because they had no legal rights to their husband's property.
FAO: HIV/AIDS: a rural issue.