Learning to live positively:
A key development tool for promoting "treatment preparedness" amongst HIV/AIDS-affected rural communities in Africa
Sam Page1, Brice Gbaguidi2 & Fortunate Nyakanda3
CABI UK, International Institute of Tropical Agriculture, African Farmers' Organic Research and Training (AfFOResT)
SARPN acknowledges Dr. Sam Page as the source of this document:
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Community learning processes are crucial to increasing resilience to HIV/AIDS in Africa’s remote rural areas: This paper describes our experiences of using the “How to Live Positively” discovery-learning process to empower rural communities in Benin, Malawi, Nigeria and Zimbabwe to reduce their vulnerability to HIV/AIDS, improve household nutrition and clean up their environment to reduce opportunistic infections. This process also promotes “treatment preparedness” amongst resource-poor farmers and should, therefore, be implemented alongside national and international programmes to roll out anti-retroviral drugs across Africa.
The extent of the AIDS problem in Africa
According to UNAIDS (2005) the HIV/AIDS epidemic killed more than 2.4 million people in sub-Saharan Africa last year, while an estimated 3.2 million more people acquired HIV during this time. This means that there are currently 25.8 million Africans, 57% of them women, who are living with HIV/AIDS. Most of these people live in remote rural areas and depend on subsistence agriculture for their survival. Extreme poverty is driving the HIV/AIDS pandemic: the poverty that forces men to leave their wives for many months at a time in order to find work and the destitution that forces women and girls to indulge in “survival sex” (De Waal and Whiteside, 2003). The deaths of so many men and women is thus plunging whole communities into destitution as their labour capacity weakens, incomes dwindle and assets are depleted (FAO, 2003)
Whereas much attention has been focussed on prevention of infection in young people and home-based care for patients with full-blown AIDS, little has been done in Africa to address the needs of millions of apparently healthy people who are still in the early stages of the disease. This is despite the fact that life expectancy for people living with HIV in Africa is comparatively short as a result of chronic malnutrition and ignorance of the underlying causes of opportunistic infections. African women are particularly vulnerable due to their continued subjugation at both family and societal levels. The premature deaths of these women are having terrible consequences on young children who are being orphaned prematurely. Such orphans are severely traumatised and, without guidance from a caring adult, are likely to grow up displaying anti-social behaviour, which will increase their vulnerability to HIV/AIDS (Page, 2001). Women are also the guardians of household food security and with their passing, indigenous knowledge on the production of food crops in Africa’s diverse and hostile environments, that has taken thousands of years to accumulate, is also lost.
Almost everyone in sub-Saharan Africa is now either affected by or infected with HIV/AIDS:
In the absence of a national welfare system, the impacts of HIV/AIDS become progressively severe in terms of increasing poverty and labour constraints, as time goes by. These impacts can be described as “moderate”, where affected households are barely able to cope with caring for orphans or a sick relative, to “severe” where a single adult is taking responsibility for the orphans or sick relative and “very severe”, where the carers are becoming sick and the surviving children begin fending for themselves (see Table 1). In Africa’s rural areas, households that are severely impacted by HIV/AIDS suffer from food insecurity and extreme poverty, together with the stress associated with these conditions. Such households are no longer able to be self-reliant due to fatigue, reduced access to land, declining soil fertility, erosion of indigenous knowledge, lack of appropriate seed and an inability to generate income. Systems of good agricultural practise must be developed to address all these problems at no cost and without increasing the demand for labour.
People are affected by HIV/AIDS either directly or indirectly. This could be because of the need to share household resources with orphans or someone who is dying of AIDS, or by being part of a community that is severely impacted by the pandemic.
Infected people are HIV positive and in the early stages of the disease can pass it on unwittingly unless they have access to voluntary counselling and testing. These people are susceptible to opportunistic infections and will quickly develop full-blown AIDS, in the absence of basic health care, a balanced diet and emotional support. This situation puts a great strain on the household and their contribution to the well-being of the community (Gari, 2001)
CABI UK, Silwood Park, Ascot, SL5 7TA, UK.
International Institute of Tropical Agriculture, 08 B.P. 0932 Tri Postal, Cotonou, Benin.
African Farmers’ Organic Research and Training (AfFOResT) P. O. Box WGT 1320, Westgate, Harare, Zimbabwe.