AIDS: Exacerbating Poverty Cycles and Challenging the Limits of Program Design

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AIDS  Exacerbating Poverty Cycles and
Challenging the Limits of Program Design

• Joan Parker
• Development Alternatives, Inc.
• November 16, 2004

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HIV/AIDS is

• Increasingly a driver of poverty, and
  conversely, of development outcomes
• Causing fundamental changes in our target
  populations, our staff, our resources, our
  results
• Forcing us to change program priorities, plans,
  implementation strategies

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Regional HIV and AIDS statistics and features,
end of 2003
2.2 million 2.0 2.5 million
3.0 million 2.6 3.7 million
7.5 6.9 8.3
25.0 million 23.1 27.9 million
24 000 9 900 62 000
0.2 0.1 0.6
75 000 21 000 310 000
480 000 200 000 1.4 million
460 000 290 000 700 000
0.6 0.4 0.9
850 000 430 000 2.0 million
6.5 million 4.1 9.6 million
44 000 22 000 75 000
0.1 0.1 0.2
200 000 62 000 590 000
900 000 450 000 1.5 million
84 000 65 000 110 000
0.6 0.5 0.8
200 000 140 000 340 000
1.6 million 1.2 2.1 million
35 000 23 000 59 000
2.3 1.4 4.1
52 000 26 000 140 000
430 000 270 000 760 000
49 000 32 000 71 000
0.6 0.4 0.9
360 000 160 000 900 000
1.3 million 860 000 1.9 million
6 000 lt8 000
20 000 13 000 37 000
580 000 460 000 730 000
0.3 0.2 0.4
16 000 8 300 25 000
0.6 0.3 1.0
44 000 16 000 120 000
1.0 million 520 000 1.6 million
700 lt1 300
0.2 0.1 - 0.3
5 000 2 100 13 000
32 000 21 000 46 000
2.9 million 2.6 3.3 million
1.1 1.0 - 1.2
4.8 million 4.2 6.3 million
37.8 million 34.6 42.3 million
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Uganda AIDS Casesby Sex and Age, 1996
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In absence of treatment

• An individual with AIDS has an average of 17
  medical emergencies over 2-3 year period,
  culminating in death
• Shift of household consumption and asset sales to
  respond to crisis around key household member
• Hits households in multiple waves repeat cycles
  of crisis
• Widening income and wealth disparities between
  households
• Hits some communities disproportionately -
  reducing overall social safety net

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Urban Impact Côte dIvoire 1997
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Rural Impact Zimbabwe 1997 Households with AIDS
Death

• Crops
• Maize
• Cotton
• Vegetables
• Groundnuts
• Cattle

Reduction in output 61 47 49 37 29
Source Kwaramba, P., The Socio-Economic Impact
of HIV/AIDS on Communal Agricultural Production
Systems in Zimbabwe, Zimbabwe Farmers Union and
Friederich Ebert Stiftung, Harare, December 1997.
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Rural Impact Kenya 2002

• Death of a household head associated with 68
  reduction in the value of the households crop
  production
• Grain crops decline where female dies
• Cash crops (coffee, tea, and sugar) decline
  where male dies.

Takashi Yamano. T. S. Jayne, Melody McNeil
Measuring the Impacts of Adult Death on Rural
Households in Kenya, April 2002, World Bank,
Washington DC, unpublished paper.
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Types of Household Impact

• ECONOMIC
• Income decline (and shift in time use)
• Expenditure increase
• Physical asset sales
• Savings loss and debt shifts
• Household skills lost
• Economic relationships lost
• Land losses

• NON-ECONOMIC
• Nutrition declines
• Non-AIDS health care declines
• Childrens education declines
• Risk of family dissolution
• Out Migration
• Potential of risky behavior
• Psycho-social damage

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How much long-term poverty impact?

• Ultimate ability to cycle back out of AIDS crisis
  is a function of initial asset base
• Only the better off can sustain impact of
  HIV/AIDS without irreversible coping mechanisms
• Key difference from other forms of crisis
  permanent losses in
• Adult labor, skills, relationships (and
  cross-generational parenting and skill transfer)
• Land via sales or grabbing

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Household Pattern of Degradation
From J. Donahue, et.al., The Silent Crisis,2001
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Evaluating development options in the four waves
of the epidemic

• Wave 1 increasing HIV infection rates
• Wave 2 increasing transition from HIV to AIDS,
  with rising morbidity and mortality
• Wave 3 large numbers of orphans
• Wave 4 coping with grown up populations of
  orphans
• How do programming responses vary
• to meet these waves?

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Example Natural Resources program (USAID/Malawi)

• Aim enhance poor households capacity and income
  through community-based natural resource
  management (CBNRM)
• Initial Approach local CBOs brought together
  (intact) households
• Reality in AIDS environment
• AIDS-affected households fell out of program
  sick adults, orphan headed households
• The most-poor turned to natural resource base for
  survival without long-term management goals
• New Approach program around most vulnerable with
  safety net plus CBNRM skills/programs

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Example Agricultural Market Linkages program
(USAID/Uganda)

• Aim link poorest farmers to commercial markets
  (with training, finance, inputs, etc.)
• Initial approach Work with local farmers
  associations
• Reality in AIDS environment
• Widows were not members of farmers associations
• Widows gathered at local literacy program
• Boy orphans found working in informal charcoal
  production
• AIDS-affected needed additional near-by services
• New approach design program from outset to find,
  understand, and attract most vulnerable, and
  other members of the community will also come.

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Example Microcredit (Global programs)

• Aim enhance households savings, economic
  diversification, and asset base
• Initial approach Required savings held as
  collateral for loans with tight repayment
  schedules.
• Reality in an AIDS environment
• Productive activities languish as households
  redirect loans to non-productive uses (medical
  care).
• Regular loan repayments lapse during periods of
  crisis.
• If need to access savings, exit program.
• Possible options replace required savings with
  accessible savings work with households in
  crisis to keep business (OI/Zimbabwe)

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Example Land Tenure for Widows (USAID/Zimbabwe)

• Aim protect the most critical assets of the
  household for land rights for surviving
  spouse and children.
• Pre-AIDS challenge in getting community and
  leaders support for wills.
• Post-AIDS leaders coping with significant number
  of dispossessed widows
• Currently programs beginning to move into the
  mainstream. Still see wills written after one
  spouse (usually man) is gone.

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Critical Elements of Poverty Reduction in an AIDS
Environment

• Work with a-typical populations
• Young (minor-headed households)
• Elderly or sick
• Dispossessed, under-educated
• Recognize limited capacities
• Energy, skills, experience, contacts, mobility
• Land, physical assets, capital
• Focus on maintaining or rebuilding key assets
• Land
• Skills/knowledge
• Access to markets/social networks/safe savings
• Combine safety-net with development programming

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