The Rationale for Mainstreaming HIV/AIDS in Agriculture & Rural Development

Vulnerability and Risk among Rural Populations

Information about the scale of the problem of HIV/AIDS in rural areas in South Asia is scarce, but survey findings in selected areas show that rural areas are not immune. For example in Tamil Nadu, India, a prevalence of 6.7% has been found¹.  The vulnerability and risk of rural populations to HIV/AIDS is influenced by:

Migration: Migration of poor, rural, sexually active young people to urban centers and abroad plays a major role in transmission  of HIV to rural areas.² Large numbers of men and women migrate from rural to urban areas in search of employment opportunities, particularly in the agricultural lean season. Rural areas are also the source of large numbers of migrant workers traveling abroad to neighboring countries and the Middle East. They spend a lot of time away from home, are removed from social structures, separated from spouses or partners, and may engage in high risk sexual behaviors, become infected and upon return to their homes, may also infect their spouses.

Access to health services: Rural areas tend to have fewer health providers and other health services than urban areas. Some areas are very remotely located and difficult to reach and without services.

Literacy and awareness: There is low awareness and knowledge about HIV/AIDS and STIs in most rural areas, and high levels of illiteracy compound this knowledge deficit. In addition, talking about sex is often taboo.

Gender: The low social status of women in some countries, especially in rural areas, increases their vulnerability to HIV. They are typically not empowered to negotiate safe sex, including with their spouses. In one study, 3.8% of housewives in rural areas were infected with HIV, mostly by their spouses or regular partners.³ It is also common for husbands to make decisions on health care for many rural women, limiting their access to health care and proper treatment. Education levels are lower among rural women than men.  Some 60 percent of women in rural areas of Tamil Nadu were unaware that consistent condom use can prevent HIV transmission compared to 30 percent of rural men.⁴

Marginalized populations: Tribal populations and low caste households living in rural areas who are marginalized in the society, tend to be among the poorest and most vulnerable.  In Jharkhand, AIDS awareness among tribal communities, who constitute 27 percent of the state's population, is only 4.2 percent. In urban areas of the state 49 percent are aware of HIV/AIDS and in rural areas only 8.4 percent know about it.⁵

Selling and buying sex: Commercial sex work is frequent in both urban and rural area, especially traditional sex work. 25% of sex workers in Karnataka, India were Devadasi sex workers, who are largely based in rural areas.^6,7

The Impact of HIV on Rural Development

Potentially catastrophic impact on livelihood: A great part of the rural economy depends on labor-intensive activities such as agriculture, fishing and other manual work. HIV infection leads to more sick days and a reduction in productivity, which may result in loss of livelihood. In most parts of South Asia the prevalence is still low and levels of absenteeism and attrition remain low. In areas with high HIV prevalence, at the household level, the impact on the affected family is huge with productivity and income losses as family members become ill and/or die and others devote time to caring for the sick, or planning for and attending funerals.

Erosion of social capital: HIV is a highly stigmatized disease, and in many communities infected individuals are ostracized or excluded from the community and lose the social networks and support that help them cope with adverse events. When parents die and leave orphans, there is a need for a sense of social cohesion to encourage adoption and care of children orphaned by HIV/AIDS as well as for home-based care of the sick. India currently has the largest number of AIDS orphans in the world.⁸

Increased Cost of Health care services: HIV/AIDS remains an expensive illness to manage and the associated costs of treatment will deplete the already limited resources allocated for health care delivery in rural areas. This is important given the other competing health priorities in most countries. Poor rural households are more likely to dispose of assets to meet medical expenses.