Development Programming

We design or adapt development programmes to reduce vulnerability to HIV infection and meet the needs of PLHIV and affected communities.

HIV is having a major impact on household food security, nutrition, and livelihoods, most visibly in high-prevalence countries. Household food security declines as HIV-related illness and death affects agricultural production, transmission of knowledge about farming practices, availability of labour and seasonal employment opportunities for labourers. Food availability decreases through falling production; food access declines due to loss of income; and food utilisation is compromised because of changes in the type and quantity of food consumed. As food consumption declines, malnutrition increases. Malnutrition inhibits immunity to disease and increases the likelihood of opportunistic infections among PLHIV.

The need for food can lead to the sale of productive assets, undermining long-term food security; encourage families to withdraw children, especially girls, from school; and result in coping strategies that increase the risk of HIV transmission, notably migration for work and selling sex. The common impact is a decline in income, savings and livelihood opportunities that can increase household and community vulnerability. The impact on individual households depends on a variety of factors, such as economic status, size of the household, which members are ill, and the strength of social networks and support. 

We need to ensure that development programmes:

  • reach households where there are limited employment options, where food supplies are insecure and/or income-generating capacity is affected by HIV-related illness or death, and where there is reduced productivity due to increased burden of care, and/or changes in family composition, including grandparent-, women- and child-headed households
  • support the capacity of individuals, households and communities to be resilient in the event of ill health, including strategies such as building up protective assets and preserving and investing in family and community relationships
  • develop and promote technologies and approaches that address changes in labour and other resources
  • facilitate the transfer of traditional and institutional knowledge about life skills and livelihoods across generations
  • assess the wider effects of HIV, beyond the household, to address the impacts on social systems, human capital, infrastructure, environment and other community assets, and
  • track changes in vulnerability over time as households and communities respond and adapt to the impact of HIV, and respond accordingly.

Different kinds of development programme can be adapted to respond to the ways that HIV has affected the lives of individuals, families and communities. The following are some examples.

Agricultural programmes have a vital role to play in reducing vulnerability to HIV and its impacts among rural communities. Several studies have found that agricultural outputs fall by up to 50 per cent in AIDS-affected households, not only decimating earnings, but also leading to a reduction in land under cultivation, the forced sale of productive assets and loss of knowledge as families revert to subsistence crops.

NGOs providing agricultural programmes need to:

  • develop and promote labour-saving agricultural technologies
  • promote appropriate diversification of crop production, including introduction of new, appropriate technologies that match the labour and nutrition needs of the affected households, and
  • ensure that PLHIV and affected communities have access to appropriate credit, tools and knowledge, such as transfer of customary and institutional knowledge about agricultural practices and skills across generations.

Adjustments to agricultural programmes may include:

  • use of threshing machines, mills, wheelbarrows and carts to reduce demands on labour-constrained households
  • tools and techniques that are better suited to young, elderly or weak people
  • livestock that is better suited to vulnerable households in producing quick returns and aiding accumulation of assets, such as rabbits and chickens, which are easier to look after and reproduce more rapidly
  • composting, mulching and applying manure and ashes from the burning of crop residue to increase production, without the use of expensive chemicals
  • locating production outside the home, including in kitchen gardens, and
  • intercropping to reduce weeding work.

Micro-finance projects or savings and credit schemes can help households to increase their income and build up assets, so as to reduce their vulnerability to HIV and to address its consequences. NGOs providing micro-finance and micro-credit schemes need to consider how these schemes can be adapted to meet the needs of PLHIV and affected communities, without compromising the sustainability of such initiatives. Approaches to doing so may include:

  • flexibility in rules governing schemes and allowing for breaks within the savings and credit cycle while retaining membership
  • introducing rules to protect the savings of married women, which may otherwise be acquired by their husbands' relatives if they are widowed
  • enabling household members to take on responsibility for, or take over, loans if the original member becomes ill or dies, and
  • setting up a simple community bank so that people excluded from credit schemes because they are too economically vulnerable can save money and, in time, gain access to the credit facilities of the micro-financing scheme.

The dual challenges of HIV and unsafe water and sanitation predominantly affect poor and marginalised populations, particularly women and girls and PLHIV. Collecting water can make woman and girls vulnerable to sexual violence. Lack of water can force women and girls to exchange sex for access to resources.  Water and sanitation issues also affect PLHIV, as unsafe water and food often cause diarrhoea, which hastens the progression of HIV-related disease. Access to safe and adequate water is also essential for people taking medicines.

Adjustments to water and sanitation programmes to address access to and safety of water for PLHIV and affected communities may include:

  • establishing a management role in water and sanitation projects for women's groups, particularly widows and other marginalised women, and making them the caretakers of water points, with appropriate incentives for their time
  • establishing a safety net to ensure access for the poorest households, who cannot afford to pay for access
  • establishing community mobilisation strategies around access to safe water, including addressing misconceptions about contamination of water with HIV and raising awareness among all community members about the rights of PLHIV and affected communities, particularly women and girls, and their access to facilities
  • establishing mechanisms for reporting and handling complaints regarding access
  • placing latrines and water points appropriately to reduce risk of sexual violence
  • involving PLHIV and women's groups in the promotion of point-of-use safe water treatments
  • ensuring safe water strategies and education in all clinic- and community-based HIV programmes, including home-based care of PLHIV, and ensuring safe water and hygiene education in all antenatal care, and that HIV-positive mothers who choose formula feeding have access to safe water.