Janet Seeley and Colin Pringle



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FINAL. 29th December 2001

Sustainable Livelihoods Approaches and the HIV/AIDS epidemic. A preliminary resource paper

Janet Seeley and Colin Pringle




Abstract

With 40 million people worldwide living with HIV/AIDS, no development initiative can afford to ignore the epidemic now and in the longer term. While the literature on HIV/AIDS continues to grow rapidly, much of the non-medical literature repeats lessons already highlighted over the last decade. The examples cited in this paper and referenced in the appendices show that what has worked in arresting the HIV/AIDS epidemic and mitigating its impact has often been local responses rather than global initiatives or grand strategies. What needs to be done is to support such local responses and to share the learning across sectors, regions and organisations. Sustainable livelihoods approaches, which bridge sectoral divides, are well placed to provide a vehicle for this. A livelihoods approach to the HIV/AIDS epidemic offers the chance to mitigate its impact on the poor by looking at their circumstances `in the round’, looking at the connections between different livelihood assets and taking into account the fact that an intervention in one area will impact on other areas of people’s lives. Impact mitigation needs to be seen as an urgent task, independent of, but related to, the health-led HIV/AIDS initiatives but of equal importance for funding. Drugs and vaccines will not rebuild the communities of those devastated by the epidemic. The biggest challenge facing us is to build on the strengths of what is already known, what is already tried and tested, and to support and encourage people as they reconstruct livelihoods to enable them and their families to live with and counter the impact of HIV/AIDS.

Throughout history, few crises have presented such a threat to human health and social and economic progress as does the HIV/AIDS epidemic” FAO report for the 27th Session of the Committee on World Food Security, 2001


At the end of 2001, 40 million people worldwide are living with HIV/AIDS, 90 per cent in developing countries and 75 per cent in Sub-Saharan Africa.1 In 2001 there were 3 million AIDS-related deaths. Sub-Saharan Africa is frequently viewed as the ‘hot spot’ of the epidemic, but the impact is global and cross sectoral. Significant epidemics occur in SE Asia, the Indian Subcontinent, Latin America, North America and the Caribbean and Eastern and Central Europe. The importance of addressing the impact on development of HIV/AIDS has been highlighted in the Millennium Development Goals where Target 6 is to `have halted by 2015 and begun to reverse the spread of HIV/AIDS’.
The purpose of this paper is to help with initial thinking on Sustainable Livelihoods Approaches and the HIV/AIDS epidemic, setting out in the annexes some of the resources available on the impact of the epidemic on peoples’ livelihoods. This is part of a process by which the Sustainable Livelihoods Support Office of DFID aims to engage with a range of people to look at HIV/AIDS as a `livelihoods issue’ impacting on many different aspects of peoples’ lives.
`HIV/AIDS is not only a health issue that demands prevention and care for the sick; it is also a livelihoods issue, since, if AIDS-depleted households are not the target of particular support, the precarious livelihoods of survivors are likely to collapse under the impact of the epidemic’.2
The examples cited in this paper and referenced in the appendices show that what has worked in arresting the HIV/AIDS epidemic and mitigating its impact have been local responses, not global initiatives or grand strategies. What needs to be done is to support such local responses and to share the learning across sectors, regions and organisations. Sustainable livelihoods approaches, which bridge sectoral divides, are well placed to provide a vehicle for this.
Background
The HIV/AIDS epidemic is not, of course, new nor is the acknowledgement that HIV/AIDS is having an impact on development a novel idea. Fifteen year olds growing up in Kampala, Uganda, do not know of a world without HIV/AIDS messages and slogans, their lives and livelihoods have been and will continue to be profoundly affected by the epidemic. There is a vast, and growing, literature on the medical and social aspects of HIV/AIDS. But in the course of reviewing the literature for this paper, it was apparent that much of the non-medical literature (particularly that in the social sciences) reiterates observations made in the early 1990s, and does little to take forward our understanding of the impact of HIV/AIDS and how that impact might be mitigated. And much excellent work remains unpublished or only available in academic journals not readily accessible in the public domain, or readily translatable into action.
While White and Robinson3 may be correct to say that HIV/AIDS has `become a matter of concern beyond the fields of biomedicine and preventive and curative health’ and has become increasingly understood as a development issue, much of the thinking remains sectorally-focused and the work that is `livelihoods’-related’ tends to focus on particular occupational groups or sectors such as `agriculture-based’ livelihoods in Africa. We found no long-term in-depth research that looked at the impact on `joined-up livelihoods’; that explored the ways people adapt their livelihoods, often taking risks or seemingly -to the outsider - irrational decisions in an effort to cope. Attention to the personal cost of HIV/AIDS, which is an important influence on how people respond and what decisions are taken, often appears in anecdotes or as quotes in case studies, but seldom seems to be fed into the literature providing guidelines and toolkits for development practitioners. Despite the large volume of publications, web-sources and anecdotal evidence on the impact of HIV/AIDS and the necessary response, the `literature on the social, economic and demographic impact of the epidemic is comparatively small and limited to a few authors (unlike the medical literature).’4
One of the reasons why the social science has not kept pace with the medical research is undoubtedly funding, but there is also the sense that the solution to the epidemic must be medical: through drugs or vaccine and therefore efforts need to be focused to support that work. Therefore, much of the non-medical funding has been for behavioural research, in support of medical solutions. Too little funding has gone for research on prevention and, importantly, on impact mitigation. For much of the world, interventions are coming too late to prevent the epidemic from spreading, even if the Millennium Development Goal Target 6 is attained and the epidemic arrested, we still need research and development that builds on people’s strengths to cope with the wide-ranging impact, of which medical interventions will only be a small part.
The situation in South Africa feels so urgent. Personally I have two cousins living with AIDS right now. The Oxfams’ have talked about treating HIV as an emergency situation, but how long can you have a crisis for? We were calling it a crisis in 1982. We need to think longer term: nothing we do now will show major change for another five years.

Dawn Cavanagh, `The Right to Equity’: the South African joint Oxfam HIV/AIDS program www.caa.org.au/horizons/february_2001/aids.html
There is, therefore, plenty of room for innovation in finding ways forward and there are many, often small-scale and localised, examples of good practice to share and from which to learn.
UMN, an international development organisation based in Nepal and supported by various donors (including DFID) produce 'Pipal Pustaks', a series of books for Non Formal Education that have won international literacy awards. They are based on true stories and are usually written by newly literate people and are published for their peers.

Recognising the need for HIV/AIDS materials for NGOs in Nepal, a Pipal Pustak on Care and Support, and one on raising awareness/advocacy for HIV/AIDS were produced. They are now used within rural and urban development projects in UMN (and beyond) as well as in education and health programmes.

(source: Andrew Furber, DFID supported HIV adviser, UMN pers. comm. )
Amambisi and communities like it are fighting back against the disease with the few weapons at their disposal. "You are a journalist, don't say we are helpless against this scourge, we are doing a lot," Chief Lingazwe told IRIN. The endless funerals have also brought the reality of HIV/AIDS home to Amambisi. Sister Nogzima's classes and a new outreach programme means the safe sex message is finally getting through and communal structures are managing to absorb the growing number of AIDS orphans. "Our close networks mean people are talking and learning and behaviour is, I think changing," said Lingazwe. "We'll see many more funerals, but we're not just lying down and letting this thing eat us, we need government support and international help, and we need it now," he added. (source IRIN-SA, IRIN-AIDS Weekly 2001, email: AIDS@irin.org.za)

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