DOCUMENT 3 (C) HIV/AIDS AND RURAL DEVELOPMENT: AN ACTION PLAN

Introduction to HIV/AIDS and Rural Development

The disease AIDS, caused by the Human Immunodeficiency Virus (HIV), has been recognised since 1981. AIDS is, in some ACP countries, already affecting sizeable populations and has important implications for development. At the most basic level it will increase morbidity (illness) and mortality (death), particularly among young adult populations; decrease life expectancy, and increase infant and child mortality rates. The full impact is not clear, as nowhere has the epidemic run its course.

HIV/AIDS is of concern in the rural development sector. Evidence shows that in many countries there is currently a lower rate of HIV infection in rural areas. For example in Zambia in 1993, prevalence rates among women ranged from 33.3% in urban areas to 13.2% in rural. However, in other countries, for example Swaziland and South Africa, there is little difference in the infection rates between the rural and urban areas. The key determinant of the differential levels of infection is the amount of movement and interchange between urban and rural areas. Ironically, successful rural development will facilitate this process. It is possible that, even in rural areas with current low levels of HIV infection, these may climb, and in time approach those of the urban areas. Even if there is a differential between rural and urban areas, the rural sector will not be immune to the impact of the epidemic. It may experience the following:

• A decline in remittances as members of the community who are employed in the urban areas fall ill and die.
• An increased demand for resources if people return home for care as they fall ill.
• Changes in the family structure and orphans returning to the (extended) family home needing care (and expenditure).
• Government budgets will face greater demands, especially social expenditure, and rural areas are usually already disadvantaged - AIDS may increase urban bias.
• Skilled labour (for example nurses and teachers) may be in short supply and less willing to accept unpopular rural postings.

The European Union and Rural Development

"Within the framework of development co-operation between the EU and developing countries, agriculture and rural development have occupied a prominent place for more than 35 years. This has been particularly true of the Lomé Conventions."¹ The agricultural/rural development sector continues to get the largest allocation within country programmes, although its overall share has declined with the growing importance of social sector support and structural adjustment.

Agricultural co-operation is aimed at food self-sufficiency and security and improving the standards, lifestyles and conditions in the rural areas.² Of particular importance is the emphasis on encouraging participation of women and the development of social and cultural activities (such as health, education and culture) essential for improving rural lifestyles.

Despite rapid urbanisation, the bulk of the populations in the ACP countries still live in the rural areas and depend on agriculture for their livelihoods. This ranges from 94% rural in Rwanda to 34% in Trinidad and Tobago. Globally 72% of the populations of low-income and 53% of lower-middle-income countries live in rural areas. Agriculture employs 69, and 31% of the labour forces in low-income and lower-middle-income countries respectively.³

Types of Support

The support provided by the EC to rural development can typically be divided into:

1. Direct support to small scale farmers through supply of inputs such as seed and fertiliser, credit and extension services.
2. Provision of infrastructural support such as roads and water.
3. Development of human resources in rural areas through education, training and health support.
4. Developing an environment conducive to rural development through support to markets and addressing policy issues.

Rural Areas at Special Risk

The following features of the rural sector should be borne in mind when planning for the impact of HIV/AIDS:

1. Subsistence farming is characterised by a very close relationship between the general activities of the household (for example child care and child rearing, recreation, support relations between adult members, home maintenance, food processing) and the production of crops and care of animals to feed that household.
2. Few rural areas are entirely self-sufficient, most are in contact with the wider economy and society (for example, marketing of produce or handicrafts, purchasing inputs and consumer goods, paying taxes, and entering the labour market for various periods.
3. Rural people combine a range of activities into a livelihood strategy which enables individuals and households to "provision" themselves.
4. Rural areas rely on labour for production and given the nature of the work, good health is crucial.

Many of these points of interaction between the subsistence household and the wider economy and society may provide conduits for the spread of infection into or out of communities and the impact of HIV/AIDS-related illness or death will not only affect the quantity and quality of labour inputs to "farm" production, but will also affect the balance of labour available between the household and the farm.

Labour.Subsistence production depends very heavily on labour. Thus the impact of the epidemic on households and communities focuses on points where domestic or farm labour supply may come under pressure. Figure 1 shows some of the ways that HIV/AIDS may affect a subsistence household.

For example, the need to nurse a sick household member may force a woman to choose between bringing a bucket of clean water, washing soiled bed linen or preparing a cash crop once more. Access to clean water would have a marked effect on the amount of time women have for other activities, so a piped water supply or improvement of a closer supply, might help maintain standards of child care, crop and/or animal care, and household maintenance.

Climate. The climate may determine the degree to which labour is a critical constraint in subsistence production. Where rainfall is seasonal, demand for labour is likely to be concentrated into short periods of a few months, or even (in very dry places) a few weeks. Death and illness reduce labour availability, both directly through affecting productive members of the household, and indirectly through diverting labour to caring for the sick.

Both of these effects mean that during the rainy period - a period of high labour demand for land preparation, sowing and weeding - labour demand for farm work may remain unmet, as urgent domestic tasks are forced to take precedence.

In places where rainfall is more evenly spread through the year, demand for labour will peak so much, and it is probable that the impact of illness and death on the domestic-farm labour interface will initially be less intense, as the more even spread of labour demand over the year permits coping mechanisms (occasional assistance from relatives and neighbours, longer working hours, hiring labour) to come into operation. It is suggested that the farming system might therefore be classified in terms of its vulnerability to loss of labour. This is set out in Figure 2.

From Knowledge to Action

How should those working in the area of rural development respond to the HIV epidemic? There are a number of things that can be done depending on the type of support being offered.

Figure 3. Responding to the HIV/AIDS Epidemic : Steps For Rural Development
A. Analysis
Step	Response	Tool
1. Establish if HIV is an issue for the country.	If yes, proceed.	Document 2 of Toolkit
2. Establish if HIV is an issue for the region.	If yes, proceed	Adapt Document 2 plus local knowledge.
3. Apply general sector checklist with Figure 1 of this document to establish susceptibility and vulnerability	Having identified susceptibility and vulnerability, design interventions.	Document 3 and Figure 1 of this document.
B. Interventions 1. Improve human capital - where possible include a health component in projects. 2. Assist vulnerable groups - improve women's income earning opportunities , provide labour/time saving interventions. 3. Include HIV/AIDS education and interventions in rural development projects, for example have agricultural exterior workers trained in HIV/AIDS interventions and distribute condoms. 4. Re-orientate programmes to take account of impact of HIV/AIDS.

Clearly there can be no one blueprint for interventions in rural areas, as there is a great deal of variation from area to area depending on the country, climate, production system and culture. The above sets out some steps that can be taken. In addition rural development projects have to go through the project cycle management process, in which case document 4 can be used. Consultants may be employed and they can be given Document 5, Including HIV/AIDS in Consultants' Terms of Reference.

Finally

By considering HIV/AIDS in this systematic, but imaginative way, those working in the area of rural development may ensure that the spread of the epidemic is not facilitated by development efforts. It will also help to mitigate the effects of the disease. If it is not done then rural populations, who generally make up the bulk of the population and who are often the poorest, may bear the brunt of the consequences of the disease, although they have the fewest resources.

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Notes:

[1] Uwe Werblow, The case for a more sector-orientated approach to agricultural development: From sector objectives and strategies to investment programmes, The Courier, no 156, March-April 1996, p59.

[2] Full details are in the text of the Lomé Convention, in particular Part 1 General Provisions of ACP-EC Cooperation, Chapter 2 Objectives and guidelines of the Convention in the main areas of cooperation, Article 15, and Part 2 The Areas of ACP-EC Cooperation, Title II Agricultural cooperation, food security and rural development.

[3] World Bank, World Development Report 1996, Oxford University Press, New York and Oxford, 1996.

[4] Information in the next section is drawn from Tony Barnett, Subsistence Agriculture, AIDS Brief, The Academy of Educational Development, Washington DC, 1996.

The World Bank Development Economics Development Research Group