1. Introduction

In the past 20 years HIV/AIDS has become an increasing global phenomenon. In countries hard hit by the pandemic, morbidity and mortality have risen and are expected to continue to rise. The implications of rising morbidity and mortality are not only that HIV/AIDS is changing the demographic structure of the household but also that it is taking a heavy toll on the socio-economic well-being of households and communities. It has become apparent from research studies done mostly in the 1990s that HIV/AIDS is having an adverse impact on smallholder agriculture and therefore on the livelihoods of rural households. This alone demands attention at policy level. These socio-economic effects are largely borne by individuals, households, and communities with little, if any, support from the technology change community and policy makers. According to the 1998 report of the Joint UN Programme on HIV/AIDS (UNAIDS), more than 33 million people are living with HIV/AIDS throughout the world. Some 60% of those infected live in sub-Saharan Africa, where poverty, gender inequality and vulnerability to natural disasters create an environment that exacerbates the impacts of HIV/AIDS.

The major route of HIV infection in sub-Saharan Africa is heterosexual intercourse, estimated to account for 93% of all adult cases, followed by vertical transmission and blood transfusions. Research in developing countries on the socio-economic impacts of HIV/AIDS on households has shown the main impacts to be social, psychological and economic (see Table 1, p. 15, for a detailed listing of impacts). Rural subsistence households are often more acutely affected than urban families. They suffer loss of productive labour, loss of income, loss of food reserves, savings and assets which are diverted to meet health care and funeral costs. Additionally, educational opportunities are reduced as children are withdrawn from school to care for the sick or to do odd jobs for extra income. Reduced levels of nutrition have been found in poor households (Loewenson et al. 1997).

At the community level, as the HIV/AIDS epidemic deepens, the socio-economic impacts widen to affect the whole community, resulting in an adverse long-term effect on community structure and function. The loss of human resources affects all institutions (NGOs, CBOs) and community structures, and these losses need to be planned for. Community problems that arise include the need to support an increasing number of orphans, reduced participation of the community in neighbourhood and community structures, increased homelessness and increased crime. In other words, social cohesion is threatened, a situation that in turn increases the risk of HIV transmission.

Households and communities have already taken some initiatives to cope with the impacts of HIV/AIDS as they have done with other calamities such as drought. If they did not, they would simply cease to exist. The worst affected households are the poor households where the impact of AIDS is to compound the problems, deepen the poverty and extend the length of the time to recover. The traditional community safety net has been weakened by the growing economic decline in sub-Saharan Africa and the increase in households in need (Tibaijuka, 1997).

Very little research has been done in identifying and analysing the cost-effectiveness of the household and community coping mechanisms. The aim of this study is to document rural household and community responses to HIV/AIDS and their impact and sustainability. It will also suggest areas for potential improvement and consideration by policy makers and form the basis from which an advocacy tool may be developed. This literature review will focus on some of the following questions:

· What are the existing household and community responses to the impacts of HIV in rural areas?

· How frequent is the response adopted by different households in different localities?

· What are the costs associated with each particular type of response?

· What are the impacts (social and economic) associated with each type of response?

· How sustainable is each type of response?

· What are the emerging policy implications for future policy formulation?

Answers to these questions are crucial to policy makers and development organizations concerned with developing short-term and long-term strategies to overcome the impacts of HIV/AIDS. Without information on the responses by households and communities most affected by morbidity and mortality, few specific conclusions can be reached about the impact of alternative policies and projects.

This report is divided into six sections. Section 2 outlines the study objectives, methods and definitions of the major terms used in the study; section 3 describes current household responses to alleviate the impact of HIV/AIDS in rural areas and discusses the identified household coping strategies; section 4 identifies policy implications on strengthening the household’s coping capacity; section 5 details existing community responses to alleviate the impact of HIV/AIDS in rural areas and discusses the identified community coping strategies; section 6 presents options for strengthening such strategies; and section 7 presents conclusions.

Table 1: Potential impacts of AIDS on household

Source: Hunter and Williamson (1997).