Volume 11, Number 3 Factors Fueling the HIV/AIDS Pandemic in Africa’s Rural Communities: Implications for Agricultural Extension and Communication1

Robert Agunga, Ph. D, Associate Professor Agricultural Communication Program Department of Human and Community Resource Development The Ohio State University 203 Agricultural Admin. Building, 2120 Fyffe Road Columbus, Ohio 43210 E-mail: [email protected]

Rachna Sundararajan, M.S. Environmental Communications Specialist Innovative Resources Management 2421 Pennsylvania Ave., NW Washington D.C. 20037 E-mail: [email protected]

Abstract The human immunodeficiency virus (HIV) causing the acquired immunodeficiency syndrome (AIDS) is invading rural farming communities in Africa and posing a great threat to agricultural production and food security in a continent already ravaged by war and famine. AIDS is no longer just a health problem but a concern for agricultural extension workers as well. Therefore, understanding potential factors that may be fueling the spread of the disease, such as, polygamy, illiteracy, and circumcision could help in the development of an extension education curriculum on HIV/AIDS. This article calls on agricultural extension workers, particularly in Africa, to get involved in HIV/AIDS education because the future of and food security depends heavily on eradicating the pandemic.

Keywords: HIV/AIDS, Extension Education, Food Security, Small Farmers, Women in Development, Agricultural and Rural Development, and Health Communication

1 Acknowledgments: This study was supported by a grant from the Ohio Agricultural Research and Development Center (OARDC), College of Food, Agricultural, and Environmental Sciences, The Ohio State University, USA. Fall 2004 79 Volume 11, Number 3 Introduction Women and children are most affected, HIV/AIDS is something not many accounting for almost 8 million of the 14 people talk about but agricultural extension million AIDS deaths (or roughly 60%). workers must because the disease is About 80% of the dying is between the ages affecting the farming population. HIV/AIDS of 20 and 50, that is, people in their prime is ravaging African rural communities like and constituting the main agricultural labor wild fire and affecting food production and force (Piot, 2003). At the 15th International security (World Food Summit Report, AIDS Conference in Bangkok, Thailand this 2003). Agricultural extension workers in year, participants observed the global Africa can no longer ignore the HIV/AIDS implications of this disease, which has no pandemic. The authors argue that cure, to be overwhelming. The World Health understanding factors that may be fueling Organization reported that the world has the disease offers fodder for an extension failed miserably in getting lifesaving drugs curriculum on HIV/AIDS. The study is to millions afflicted with HIV, estimated at based on a survey of male and female 38 million. Of this total, 28 million are in farmers in the Upper East Region of Ghana. sub-Saharan Africa and 7.2 million in Asia (Mader, 2004). Theoretical Framework Haslwimmer (1996) discussed the Africa is a continent in perpetual impact of HIV/AIDS on small-scale crisis. It started with colonial rule in the agricultural productivity. She noted that crop 1800s, which gave way to short-lived production seriously declined in many areas democracies in the late 1960s. Many African due to reduction in land use and/or poor crop leaders who were democratically elected at yields because money saved for farm inputs independence quickly turned their was diverted to medications or funerals. She governments into single-party dictatorships, added that sickness and death in households characterized by mismanagement of national meant not many family members remained resources, civil unrest, and nepotism. Harsh to work in the fields. Piot (2003) traces the climatic conditions, such as drought and link between agriculture and HIV/AIDS in flood, have also taken a heavy toll on the southern Africa: continent’s agricultural productivity. Now, It’s no coincidence that the six southern the HIV/AIDS epidemic seems poised to African nations that now face the sweep the continent clean of any healthy prospect of mass famine—Lesotho, human population. AIDS is perhaps Africa’s Malawi, Mozambique, Swaziland, major nightmare (Agunga, 1997). Zambia, and Zimbabwe—also have Nurtured by misconceptions that substantial and still-growing HIV HIV/AIDS was a western problem or a epidemics, with between one-sixth and disease common to promiscuous city one-third of their populations infected. dwellers, African leaders failed to take In southern Africa, famine and AIDS are proactive measures to curb it. Numbers of directly related. the dead and dying in Africa are staggering. A 1998 Joint United Nations Program on The magnitude of the catastrophe in AIDS (UNAIDS) noted that more than 30 agricultural communities in southern Africa million people were infected in the world is also captured by Olivea Muchena, Deputy and nearly 70% of them are in Sub- Saharan Minister of Lands and Agriculture for Africa. In southern and eastern Africa, the Zimbabwe, reported by Mutangadura et al. number of people infected is nearing an (1999): epidemic—about 25% of Kenyans, and over The major impact of HIV/AIDS on 30% in Swaziland, Botswana, , smallholder agriculture includes serious and Malawi (Mutangadura et al., 1999). depletion of human resources, diversion

80 Journal of International Agricultural and Extension Education Volume 11, Number 3 of capital from agriculture, loss of farm Purpose and Objectives and non-farm income and other The primary purpose of this study psychosocial impacts that affect was to identify factors in the rural agricultural productivity. Women and environment that may be causing the spread men, young and old, people expected to of the HIV/AIDS. The specific objectives of plough the land, tend the crops, harvest the study were to determine: and store the produce, are dying. 1. Demographic characteristics, such as age, family size, and income as these Further justification for treating relate to poverty, malnutrition, HIV/AIDS as an agricultural extension predisposition to diseases, and labor for concern comes from United Nations agriculture. Secretary-General Kofi Annan, in his 2. Levels of illiteracy as it relates to address to the World Food Summit traditional and mythical beliefs. Delegates in 2002 (see World Food Summit 3. Levels of consumption of bushmeat, as Report, 2003). He noted that 800 million of wildlife may be carriers of the HIV the world’s one billion undernourished are virus. in rural areas and depend on agriculture. He 4. Extent to which polygamy is practiced as warned that agricultural productivity and it implies sexual relationship with standards of living in the countryside cannot multiple partners and hence a potential be improved if problems outside the fueling factor for HIV/AIDS. agricultural sector, such as illiteracy, 5. Seasonal and population growth and ill health, especially prostitution as possible sources of the spread of AIDS, were not addressed. transmission of the disease. Roling & Engel (1991) described 6. If circumcision, particularly female extension as an “Agricultural Information genital mutilation (FGM), is practiced in and Knowledge System” (AKIS), implying the region as studies show that FGM that providing people with information, on enhances the spread of the disease. issues that affect their lives, must be the primacy of extension. The Ghana Ministry Methodology of Food and Agriculture (MOFA) supports This was an exploratory study using this holistic view of agricultural extension, an interview schedule. Although every effort arguing that “emerging issues, such as the was made to obtain a representative sample HIV/AIDS pandemic, empowerment of through stratification, systematic random farmers, environmental degradation, and sampling was not possible because there poverty reduction need to be tackled within were no farmer directories to draw from. the Extension delivery system”(MOFA, Table 1 shows how the sampling was 2003, p. 1). The MOFA further notes that no done. In all, 280 farmers (140 male and 140 “demand-driven” extension system in Africa female) were interviewed. It took 14 can avoid addressing the HIV/AIDS extension workers, including females, using problem. motorcycles, to collect the data. Since data From the foregoing, the authors was collected by direct contact, the threat of contend that HIV/AIDS education must be a non-response was fully controlled, yielding critical component of agricultural extension a response rate of 100%. Interviewers were programming in Africa. This study has briefed on how to administer the identified factors in Africa’s rural areas that questionnaire. The questionnaire was written may be fueling the AIDS pandemic— in English. However, interviewees were information that could serve as the basis for trained to adlib, that is, translate the an HIV/AIDS extension curriculum. questions instantaneously into the local language and then record farmers’ responses

Fall 2004 81 Volume 11, Number 3 back in English (O’Barr, et al., 1973). Given statistics were used to summarize the data. that the interviewers were highly competent Cronbach’s alpha was not calculated in both English and the local language, any because no Likert-type questions were used. reliability error introduced was minor. The simple measure of central tendency was Reliability and validity concerns sufficient to give enough information to were addressed through a team of experts adequately describe the characteristics of and pilot-testing the instrument. Data farmers. analysis was completed using the Statistical Package for the Social Sciences. Descriptive

Table 1

Procedure of Selecting Farmers for the Study f Sub- #/Sub- District Pop. Sub-districts districts district Males Females Days Bawku East 307,162 Bawku 4 15 8 7 2 Bugri 15 8 7 2 Garu 15 8 7 2 Pusiga 15 8 7 2 Bawku West 81,927 Kusanaba 3 10 5 5 2 Zebilla 10 5 5 2 Sapeliga 10 5 5 2 Bolgatanga 225,864 Talensi 3 20 10 10 3 Nabdam 20 10 10 3 Frafra/Gurunei 20 10 10 3 Bongo 76,773 Gurune 2 30 15 15 4 Builsa 74,576 Buli 2 40 20 20 5 Navrongo 150,949 Kassem 4 30 15 15 4 Nankem 30 15 15 4 TOTAL 914,251 18 280 140 140 40

Findings feel that the two sets of data provide the The study set out to examine reader a sense of changes in the region over sociocultural, educational and economic the 26-year period. Table 2 shows factors that may be fueling the HIV/AIDS comparative data on the age of farmers. pandemic in northern Ghana. From the two studies, it is clear that the population of the region is much younger. Socio-economic Status Only 21.1% of those surveyed in 2002 were The study examined the over 50 years compared to 42.3% in 1976. socioeconomic status of subsistence farm The number of farmers aged 20–30 years in families in the Upper East Region of Ghana. 1976 was 7.6% compared to 18.6% in 2002. We asked questions on age, marital status In 26 years, the population has more than and property ownership (as a measure of reversed itself. The sexually active income), to name just a few. Some of the population, aged 20–50 years, has also questions were repeated from a 1976 study increased. It was 56.1% in 1976 compared of 419 farmers in the Navrongo district of to 77.5% in 2002 thereby significantly the region. Although the 2002 sample increasing the risk of contracting population differed from that of 1976, we HIV/AIDS.

82 Journal of International Agricultural and Extension Education Volume 11, Number 3 Table 2 64.6%, an improvement of 24.2%. The number of respondents with primary, middle Age Distribution of Farming Population in or other education also has increased. 1976 and 2002 However, the level of increase in literacy in 1976 2002 the region is small compared to the rest of Age Groups f % f % the country. Under 20 7 1.6 4 1.4 According to the World Bank (2003) 20-30 32 7.6 52 18.6 the region’s 25% literacy rate is the lowest 31-35 38 9.1 32 11.4 in the country. The national average is 70%. 36-40 60 14.3 40 14.3 Illiteracy, defined as the inability to read or 41-50 105 25.1 93 33.2 write in the local language or English, is a Over 50 177 42.3 59 21.1 major handicap to development. Amartya Total 419 100.0 280 100.0 Sen (2002), the 1998 Nobel Prize winner in economics, noted that basic education can Farming remains the primary transform societies and cites Japan, China, occupation of the people. In 1976, the Taiwan, and South Korea as cases in point. number of respondents who mentioned Joseph Chanie (2002), director of the farming as their primary occupation was 387 UNAIDS, notes that literacy opens people’s out of 419 (92.7%). In 2002, it was 238 out eyes to the reality that AIDS kills and they of 280, or roughly 90% of respondents. It must change their behaviors or die. Without suggests that after 26 years, farmers remain literacy, people think that they are either at relatively fixed on their small pieces of land. no risk at all or at small risk of contracting There are no industrial jobs to draw labor AIDS. Without literacy, people also tend to out of agriculture. Industry accounts for only hold mystical beliefs about how the disease one percent of the labor force in the region spreads. For example, some respondents’ (World Bank, 2003). believed it was an Act of God or caused by Socioeconomic status, or a person’s Angry Spirits. level of poverty, is considered a major factor in his or her ability to ward off disease. Table 3 Hunger, poverty, and HIV/AIDS are strongly linked. Jeter (2002) in a Educational Level of Respondents Based on Washington Post article noted that AIDS 1976 and 2002 Studies and hunger are bedfellows, in that, the 1976 2002 incidence of AIDS is highest among the Levels f % f % farming population, the poorest of African No Education 370 88.8 181 64.6 society. In southern Africa, where famine Primary 4 1.0 20 7.2 afflicts 20 million people, the AIDS Middle 19 4.5 33 11.9 epidemic is deepening the misery. Hunger Other (night 26 6.2 46 16.6 accelerates the onset of debilitating diseases school, vocational and even death among household training etc.) breadwinners. Economic conditions play a major role in the spread of HIV and AIDS Consumption of Bushmeat among the poor (Piot, 2003). We asked respondents to indicate their primary sources of meat for Illiteracy and Traditionalism consumption. Table 4 shows the vast Table 3 shows the level of education majority (more than 80%) get their meat of respondents in 1976 and 2002. Over a 26- from farm animals, such as , goats, and year period the percentage of farmers with poultry. About 62% depend on meat from no education has dropped from 88.8% to the market. However, a substantially large

Fall 2004 83 Volume 11, Number 3 number, 16% of respondents consume a 26-year period, remains roughly the same, bushmeat, whether hunted or purchased polygamous and stable. from the market. Table 5 Table 4 Marital Status of Respondents Meat Sources for Respondents’ Families 1976 2002 Meat Sources f % Navrongo Upper East Homegrown (Farm/Domestic) 229 81.8 District Region Market 173 61.8 (N = 419) (N = 140) Bushmeat hunted by self/family 30 10.7 # of Wives f % f % Bushmeat from market 17 6.1 Single/Divorced 65 15.5 13 9.2 Fishing by self/family 19 6.8 1 wife 233 55.6 86 61.4 Fish from market 206 73.6 2 wives 96 22.9 29 20.7 Vegetarian 3 1.1 3 wives 21 5.0 8 5.7 Other 10 3.6 4 wives 4 1.0 2 1.4 5 or more 2 1.4 A study in Cameroon by Peeters et al. (2002) says that monkeys and However, when polygamy is chimpanzees carry the mild form of combined with high birth rate, HIV/AIDS and when improperly cooked unemployment, illiteracy, a teaming and consumed could be a source of population of youth, and limited medical transmission into humans. They note that facilities, a breeding ground for the spread bites from pet primates and possible contact of HIV/AIDS and other communicable with the animals’ feces and urine may also diseases emerges. Divorce and re-marriage transmit the virus. However, they are not also spread HIV/AIDS (Toubia, 1995). In certain if it infects humans. Nevertheless, essence, a polygamous environment could their study suggests that people who hunt fuel the spread of HIV and needs to be and/or eat bushmeat should exercise caution seriously addressed. Associated with until scientific findings become more polygamy is breast-feeding, a significant conclusive given the enormous capacity of way of transmitting HIV from mother to HIV strains to mutate and thrive in other child (Helmes, 2002). species. Seasonal Migration and Prostitution Polygamy The Upper East Region not only has Of the 280 interviewed in 2002, 228 the lowest literacy rate, it is also the poorest (81.5 %) were married, 16 (5.7%) single and economically. As a result, many, mostly 34 (11.2%) divorced or widowed. Given that young men, leave their wives behind and 80% or more were married this may suggest migrate to southern Ghana during the off a community with a stable sexual farm season to work on cocoa plantations. relationship which could ward off the Away from home and family, they may epidemic. Of the male respondents (N = engage in sexual activities with multiple 140), 127 (90.7%) were married. Of those partners and/or prostitutes and become married, 86 (67.7%) indicated having one susceptible to sexually transmitted diseases wife; 41 (32.3%), 2 wives; 10 (3.6%), 3-4 and viruses, which may be transferred to wives; and, 2 (0.7%), 5 or more wives their wives upon their return home. (Table 5). The data are similar to what were Respondents were asked if men often found in 1976. The two sets of data show leave their wives to work in the cities during that the marriage pattern in the region, over the off-season. One hundred and sixty

84 Journal of International Agricultural and Extension Education Volume 11, Number 3 (57.1%) said “yes,” 42 (15.0%) said “some practiced in the region. As shown in Table 6, times” and 69 (24.6%) said “no.” Farmers about 83% of respondents acknowledged the were also asked whether they felt prevalence of male circumcision compared prostitution prevailed in their communities. to only 7.2% who said female circumcision Eighty respondents (28.6%) said “yes,” was practiced in their communities. The 41(14.6%) said “sometimes,” while 136 main reasons for circumcision varied from (48.6%) said there was no prostitution in tribal rite of passage through religious their communities. With about 60% of beliefs, to the need to ensure virginity before respondents acknowledging the presence of marriage. Of those who mentioned that migration and another 40% reporting the female circumcision was practiced, 7.2% presence of prostitution in their offered tribal rites as the main reason, communities, the potential for the spread of followed by religion (3.6%), chastity HIV/AIDS exists. Kulis et al. (2004) noted (1.8%), and ensuring virginity (1.1%). The that the mobile work force in Africa is a reasons for male circumcision were the same major source by which AIDS is spread to except that the number of respondents to this women, particularly, housewives. question was much larger. About 26.4% mentioned religion, followed by rite of Male Circumcision and Female Genital passage (22.9%), chastity (11.1%) and Mutilation (FGM) ensuring virginity (4.3%). Our study examined whether circumcision, both male and female, was

Table 6

Male and Female Circumcision Rates in Upper East Region of Ghana Type of Circumcision f Reason(s) for Practice Female 20 (7.2%) Tribal rites of passage, 20 (7.2%). Religion, 10 (3.6%) Chastity, 5 (1.8%) Ensure virginity, 3 (1.1%) Male 233 (83.2%) Tribal rites of passage, 64 (22.9%). Religion, 74 (26.4%) Chastity, 31 (11.1%) Ensure virginity, 12 (4.3%)

Although the practice of FGM in Conclusion and Recommendations Ghana is relatively small it is highly This study set out to identify factors pervasive in other parts of Africa. For that may be fueling the spread of HIV/AIDS example, in Burkina Faso, Egypt, Djibouti, in the Upper East Region of Ghana. These Ethiopia and the Gambia, 70% or more of factors are: polygamy, illiteracy, poverty, the population practice it. It is estimated that migration, prostitution, consumption of over 135 million girls and women in the bushmeat, and female circumcision. world, and about 100 million in Africa Although no generalization of the findings is alone, are genitally mutilated (Toubia, intended, it is clear that these fueling factors 1995). Whatever the reason, it is clear that predominate in many countries in Africa. circumcision, especially FGM, can fuel the Therefore, the study has implications for spread of HIV/AIDS (Bongaarts et al., Ghana and other African nations. We 1989). believe that extension education could be

Fall 2004 85 Volume 11, Number 3 modeled on these factors. Therefore, we Haslwimmer, M. (1996). AIDS and make the following recommendations. agriculture in Sub-Saharan Africa in 1. We found the region has a very large “What has AIDS to do with concentration of youth. Therefore, agriculture?” (FAO, 1994). FAO HIV/AIDS education must actively Farm Management and Production focus on this impressionable age group Economics Service (AGSP). Posted particularly the prepubescent and June 1996 at pubescent demographic—stressing on http://www.fao.org/waicent/faoinfo/s responsibility to self and family, gender ustdev issues, reproductive health and Helmes, J. (2002, May 10). We cannot turn knowledge and abstinence. away. The Washington Post, p. B07. 2. Given the high rate of illiteracy in the Jeter, J. (2002, May 10). Famine sweeps region, HIV/AIDS education must focus Southern Africa: Millions suffering not only on preventive measures, such as in crisis created by nature, condoms or abstinence, but also on the exacerbated by man. The health effects and vulnerability of Washington Post, p. A01. populations practicing polygamy and Kulis, M., Chawla, M., Kozierkiewicz, A., seasonal migration. & Subata, E. (2004). Truck drivers 3. Agricultural extension workers could use and casual sex: An inquiry into the on-farm topics as a springboard to potential spread of HIV/AIDS in the introduce HIV/AIDS education to Baltic Region. World Bank Working farmers. Paper No.37. June 2004. Washington 4. Many extension workers in developing DC. countries are not adequately trained in Mader, I. (2004, July 14). U. S. is called on HIV/AIDS education. Intensive training to do more to get drugs to AIDS programs that are culturally inclusive victims. The Columbus Dispatch, p. and appropriate are essential before A8. embarking on an HIV/AIDS extension Ministry of Food and Agriculture (2003, education effort. This training has June). Agricultural extension policy. already begun in the Upper East region. Directorate of Agricultural Extension Services. References Mutangadura, G., Jackson, H., & Agunga, R. A. (1997). Developing the third Mukurazita, D. (Eds.). (1999). AIDS world: A communication approach. and African smallholder agriculture. New York: Nova Science Publishers. Harare, Zimbabwe: SAFAIDS. Bongaarts, J., Reining, P., Way, P., & O’Barr, W. M., Spain, D. H., & Tessler, M. Conant, F. (1989). The relationship A. (1973). Survey research in Africa: between male circumcision and HIV Its applications and limits. Evanston, infection in African populations. IL: Northwestern University Press. AIDS 1989, 3(6), 373-377. Peeters, M. Courgnaud, V., Abela, B., Chanie, J. (2002, June 23). Much of world Auzel, P., Pourrut, X., Bibollet- still knows little about AIDS, study Ruche, F., Loul,S., Liegeois, F., says by Barbara Crossette. The Butel, C., Koulagna,D., Mpoudi- Columbus Dispatch, p. A15. Ngole, E., Shaw, G. M., Hahn, B. H., & Delaporte, E. (2002). Risk to human health from a plethora of simian immunodeficiency viruses in primate bushmeat. Emerging infectious diseases, 8(5), 451-457.

86 Journal of International Agricultural and Extension Education Volume 11, Number 3 Piot, P. (2003, November 27). Global Toubia, N. (1995). Female genital challenges|delayed action in fight mutilation: A call for global action against AIDS means increased (2nd ed.). New York: Rainbow longterm costs. The Washington Productions. Post, p. A17. World Bank (2003). Ghana living standards Röling, N., & Engel, P. G. H. (1991). The survey, 1998/99. Washington, D.C.: development of the concept of The World Bank, Africa Region. agricultural knowledge information World Food Summit Report (2003). The systems (AKIS): Implications for world food summit: Five years later. extension. In W. M. Rivera, & D. J. Report of the World Food Submit: Gustafson, (Eds.), Agricultural Five Years Later, 10-13 June. Part I. extension worldwide: Institutional Food and Agriculture Organization. evolution and forces for change (pp. Rome. 125-137). New York: Elsevier. Sen, A. (2002, May 27). To build a country, build a schoolhouse. The New York Times, Late Edition-Final. Section A, p. 13, Col. 2.

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