HIV/AIDS Epidemic is Shifting From Cities To Rural Areas -- New Focus On Agricultural Policy Needed
June 22, 2000
The fight against the HIV/AIDS pandemic in developing countries has been mostly perceived as an "urban problem", but the absolute numbers of people living with HIV are actually increasing rapidly in many rural areas, the UN Food and Agriculture Organization (FAO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) said today.
In some countries, the gap in HIV infection rates between urban and rural areas is narrowing. But so many people in developing countries live in rural areas that, in terms of absolute numbers, the numbers of rural inhabitants who are infected are very high.
In a new publication entitled Sustainable Agricultural/Rural Development and Vulnerability to the AIDS Epidemic FAO/UNAIDS called upon governments to pay more attention to the real burden of HIV/AIDS on local communities and to ensure that rural development also aims at combating the epidemic. "HIV/AIDS is not only a health but also a development problem," FAO/UNAIDS said.
The report concludes that the rural epidemic has been underestimated: in India, where 73% of the population is rural, recent studies have shown that HIV is spreading faster in some rural areas than in urban ones. In many countries in Africa, urban and rural HIV prevalence rates are similar.
The report says it is urgent to address rural HIV prevention and care needs. Though HIV prevalence is rising in rural areas, the infrastructure needed for prevention programmes -- counselling and testing, condom availability and AIDS information -- is less developed.
Moreover, health facilities are often inadequate in rural communities, which bear the main burden of care for people with HIV. Many HIV infected people return from the cities to their villages when they fall ill. Rural families provide most of the care for AIDS patients; the households mostly bear the costs for food, medicine and funeral expenses. Agricultural development policies rarely take this fact into consideration.
Besides the human suffering, AIDS threatens sustainable agriculture and rural development. Sickness and death of an adult family member can result in the inability of a household to cultivate the land. Tending for the sick can take a considerable amount of time, which is then no longer available for agriculture. As a result, more remote fields tend to be left fallow, and switching from labour-intensive to less labour-intensive crops is more likely. Families can wind up having to sell off their livestock.
AIDS widows may have no legal rights to land and property after their husbands' death due to customary inheritance laws. Many women therefore often have to leave their homes and are facing severe poverty.
"Rural HIV often remains silent and invisible," according to the report, because of poor health infrastructure, restricted access to health facilities and inadequate surveillance. For this reason, HIV in rural populations often remains "an unknown entity for policy-makers and development planners."
Where people are exposed to poverty, food insecurity, gender inequality, migration, war and civil conflict, their vulnerability to HIV increases, FAO/UNAIDS said. In rural areas of most developing countries, therefore, the spread of HIV is accelerated by migration, trade, the movement of refugees and strengthened rural-urban linkages. Considerations relating to HIV/AIDS should be incorporated in agricultural and rural development, the UN organizations urged. Ministries of Agriculture and Rural Development should be sensitised about HIV/AIDS education and advocacy, and where required, should review their policies and activities. Households affected by the pandemic should have better access to and control over resources such as extension, credit and land.
The study mentions two types of rural areas particularly vulnerable to HIV: those along truck routes and those that are sources of migrant labour to urban areas. Many traditional subsistence areas are also vulnerable if people are migrating from there in the agricultural lean season. Nomadic pastoralists are at increased risk of contracting HIV due to their mobility, marginalization, and limited access to social services. Women remaining on farms with seasonal migrant husbands are also vulnerable to HIV infection if their husbands bring the disease back with them.
According to UNAIDS, an estimated 33.6 million people were living with HIV/AIDS at the end of 1999, of which over 90 percent were in developing countries. Africa, which accounts for only one tenth of the world's population, bears the brunt of the epidemic with more than 80 percent of all deaths to date. In Asia, HIV seropositivity rates are still comparatively low but the spread of the pandemic is rapid. Almost 6 million people are believed to be infected with HIV.
This article was provided by UNAIDS. Visit UNAIDS' website to find out more about their activities, publications and services.