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Contextualising the Emergence and Impacts of the AIDS Epidemic on Rural Livelihoods and Household Food Security in Masaka, Uganda

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Contextualising the Emergence and Impacts of the AIDS Epidemic on Rural Livelihoods and Household Food Security in Masaka, Uganda Contextualising the emergence and impacts of the AIDS epidemic on rural livelihoods and household food security in Masaka, Uganda Jackson Tumwine Thesis committee Promotors Prof. Dr C. Leeuwis Professor of Knowledge, Technology and Innovation Wageningen University & Research Prof. Dr A. Niehof Emeritus Professor of Sociology of Consumers and Households Wageningen University & Research Other members Prof. Dr M.A. Koelen, Wageningen University & Research Prof. Dr J.W.M. van Dijk, Wageningen University & Research Prof. Dr G.E. Frerks, Wageningen University & Research Prof Dr P.C. Struik, Wageningen University & Research This research was conducted under the auspices of the Wageningen Graduate School of Social Sciences (WASS). Contextualising the emergence and impacts of the AIDS epidemic on rural livelihoods and household food security in Masaka, Uganda Jackson Tumwine Thesis submitted in fulfilment of the requirements for the degree of doctor at Wageningen University by the authority of the Rector Magnificus, Prof. Dr A.P.J. Mol, in the presence of the Thesis Committee appointed by the Academic Board to be defended in public on Tuesday 13 March 2018 at 4 p.m. in the Aula. Jackson Tumwine Contextualising the emergence and impacts of the AIDS epidemic on rural livelihoods and household food security in Masaka, Uganda, 191 pages. PhD thesis, Wageningen University, Wageningen, the Netherlands (2018) With references, with summary in English ISBN: 978-94-6343-255-9 DOI: https://doi.org/10.18174/440702 Dedication To my dear family, living and deceased, with deep gratitude for their support. Most especially to my mother Jovia Bwagiro, wife Florence Epodoi, daughters Jayden Epodoi Tumwine, Jensine Kyobugabe and son Joachim Tumwine for their love, encouragement, patience and sacrifices during the study period. Table of Contents Chapter 1: General Introduction to the Study 1.1 Evolution of the study................................................................................................ 1 1.2 General and theoretical ackground............................................................................. 2 1.2.1 Africa and the geography of disease.......................................................................... 5 1.2.2 Linking Ford to Stillwaggon’s work on HIV/AIDS.................................................. 9 1.2.3 AIDS impacts as documented in the literature........................................................... 13 1.3 Problem statement and research questions................................................................. 16 1.4 Conceptual framework............................................................................................... 18 1.5 Study design and data collection................................................................................ 20 1.5.1 Study design, study area, and time frame of the study.............................................. 20 1.5.2 Description of the methods used................................................................................ 21 1.5.3 Data analysis.............................................................................................................. 26 1.6 Outline of the dissertation........................................................................................... 27 Chapter 2: Contextualizing the Ecology of AIDS in Uganda and Masaka 2.1 Factors that shaped the epidemic in Uganda.............................................................. 29 2.1.1 Uganda’s governance crisis: 1962-1986.................................................................... 29 2.1.2 Economic decline, poverty, and people’s vulnerability to diseases: 1972-1986........ 32 2.1.3 The decline of health services: 1972 to 1986.............................................................. 35 2.1.4 AIDS and the demographic picture in Uganda........................................................... 39 2.2 The local context of Masaka....................................................................................... 40 2.2.1 Geographical location and history.............................................................................. 40 2.2.2 The decline of farm-based livelihood opportunities and the alternative of fishing.... 42 2.2.3 Labour migration and population mobility................................................................. 43 2.3 Discussion and conclusion.......................................................................................... 47 Chapter 3: The General and AIDS-related Profiles of the Survey Households 3.1 General profile of the households in the survey......................................................... 54 3.2 AIDS-related profile of the survey households.......................................................... 57 3.3 Discussion and conclusion......................................................................................... 66 Chapter 4: Agricultural Production, Land Ownership and Utilisation 4.1 AIDS and the context of agriculture in Uganda and Masaka..................................... 72 4.2 Landownership........................................................................................................... 74 4.3 Land utilisation and farming practices....................................................................... 77 4.4 Changes in crops and livestock.................................................................................. 80 4.5 Determinants of land use other than household HIV and AIDS status...................... 84 4.6 Discussion and conclusion......................................................................................... 86 Chapter 5: AIDS and Household Food Security 5.1 The concept of food security and its indicators.......................................................... 90 5.2 Food availability and consumption............................................................................ 95 5.3 Households’ weekly food intake................................................................................ 97 5.3.1 Discussion of the different food groups consumed.................................................... 100 5.4 Households’ perception of dietary intake and food security status............................ 103 5.5 Household food shortages and coping strategies........................................................ 107 5.6 Determinants of household food security................................................................... 108 5.7 Discussion and conclusion......................................................................................... 110 Chapter 6: Households’ Resilience to AIDS Impacts 6.1 The concept of resilience............................................................................................. 115 6.1.1 Social capital and resilience........................................................................................ 115 6.1.2 Livelihood, vulnerability and resilience...................................................................... 116 6.2 Presentation of the cases.............................................................................................. 118 6.3 Analysis and discussion............................................................................................... 130 6.4 Conclusion................................................................................................................... 135 Chapter 7: Conclusion and Discussion 7.1 Objective of the study and approach.......................................................................... 137 7.2 Overview of the findings............................................................................................ 138 7.3 Theoretical and policy implications........................................................................... 150 7.4 Looking ahead and concluding remarks..................................................................... 153 References 156 Appendices 167 Thesis summary 177 Acknowledgement 181 About the author 182 WASS Training and Supervision Plan 183 List of tables Table 1.1 Cereal production in countries with a generalised AIDS epidemic 1989-2004……… 5 Table 1.2 Time frame for the study…………………………………………………………….... 21 Table 2.1 National coverage of ART services by type and level of facility, September 2014........ 39 Table 2.2 ART data for Masaka district in 2005-2011………………………………………….... 47 Table 3.1 General profile of survey households according to AIDS status, 2007-2009(*)……..... 55 Table 3.2 Household economic status by Household HIV and AIDs status in 2007-2009………. 58 Table 3.3 Education of household members by household HIV/AIDS status 2007-2009……….. 59 Table 3.4 Household morbidity and HIV/AIDS status in the last 5-10 years prior to 2007……... 59 Table 3.5 Morbidity in the households 2008 and 2009 by household HIV/AIDS status……….... 60 Table 3.6 Household mortality by HIV/AIDS status in the last 5-10 years prior to 2007……...... 60 Table 3.7 Mortality in the households in 2008 and 2009 by household HIV/AIDS status……..... 61 Table 3.8 Causes of deaths by household status in the last 5-10 years prior to 2007……………. 62 Table 3.9 Members leaving the household in the last 5-10 years prior to 2007…………………. 62 Table 3.10 Members leaving the household by HIV/AIDS status in 2008 and 2009………….….. 63 Table 3.11 Members who moved into the household in the last 5-10 years prior to 2007………... 63 Table 3.12 Members who have moved into the household in 2008 and 2009………………..….... 64 Table 3.13 Fostering in of children by household status in the last
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