IMPACT OF HIV/AIDS ON THE WELL-BEING OF THE RURAL POPULATION IN EAST GOJJAM, AMHARA, ETHIOPIA HULET-IJU ENESSIE; GOZAMEN; SHEBEL-BERENTA Woredas (Districts) Yeshiwas Bekele PhD DISSERTATION IN DEVELOPMENT STUDIES St Clements University ---------------------------------------------------------------------------------------------------------------------------- Development Studies- Yeshiwas Bekele 2007 ¾e’MTƒ.Ø“ƒ - ¾g=ªe ukK 1999 TABLE OF CONTENTS ACKNOWLEDGEMENTS ..........................................................xii ABSTRACT............................................................................. xiii ACRONYMS ............................................................................xx CHAPTER ONE - INTRODUCTION 1.1 BACKGROUND 1 1.2 STATEMENT OF THE PROBLEM 2 1.3 OBJECTIVES OF THE STUDY 4 1.4 THE SITUATION, DATA SOURCE AND METHODOLOGY 5 1.4.1 The Situation 5 1.4.2 Background of Survey 11 1.4.3 Survey Methodology 11 1.4.3.1 Sampling Frame 11 1.4.3.2 Sample Design 11 1.4.3.3 Sample Size 12 1.4.3.4 Sample Selections 13 1.5 DATA SOURCE AND METHODOLOGY 13 1.5 FIELD ORGANIZATION 14 1.5 PRECISION OF SURVEY RESULTS 15 1.5 SIGNIFICANCE OF THE STUDY 17 ---------------------------------------------------------------------------------------------------------------------------- Development Studies- Yeshiwas Bekele 2007 ¾e’MTƒ.Ø“ƒ - ¾g=ªe ukK 1999 i CHAPTER TWO - LITERATURE REVIEW 2.1 BACKGROUND 18 2.1.1 Global 19 2.1.2 AIDS in Africa 21 2.1.3 AIDS in Sub - Saharan Africa 22 2.1.4 AIDS in Ethiopia 26 2.1.5 Impact of the AIDS policy on the target area 38 2.2 GENERAL IMPACTS OF HIV/AIDS 2.2.1 Economic Impact 40 2.2.2 Social Impacts 42 2.2.3 Agriculture Impacts 43 2.2.4 Impact on the Health Sector 46 2.2.5 Impact on the Education Sector 46 2.2.6 Other Impacts 47 ---------------------------------------------------------------------------------------------------------------------------- Development Studies- Yeshiwas Bekele 2007 ¾e’MTƒ.Ø“ƒ - ¾g=ªe ukK 1999 ii CHAPTER THREE - DEMOGRAPHIC AND SOCIOECONOMIC CHARACTERISTICS OF RESPONDENTS 3.1 DEMOGRAPHIC CHARACTERISTICS OF RESPONDENTS 48 3.1.1 Distribution of Respondents by Age, Sex, Religion and Education 48 3.1.2 Distribution of Respondents by Occupation, Ethnic Group and Marital Status 50 3.1.3 Distribution of Respondents by Number of Marriages, Age at first sex and First Sex Partner 51 3.2 SOCIO ECONOMIC CHARACTERISTICS OF RESPONDENTS 53 3.2.1 Type of Employment, Possession of livestock and Land for Agriculture 53 3.2.2 Adequacy of Land for Agriculture and Status of Cultivating of Domestic and Cash Crops 54 3.2.3 Sufficiency of Production, Food Shortage and Reason for Shortage Food 57 3.2.4 Production at one time and Average Monthly Income 59 3.2.5 Health Status and Type of Illness 60 ---------------------------------------------------------------------------------------------------------------------------- Development Studies- Yeshiwas Bekele 2007 ¾e’MTƒ.Ø“ƒ - ¾g=ªe ukK 1999 iii CHAPTER FOUR - ANALYSIS OF THE DETERMINANTS AND IMPACT OF HIV/AIDS (SURVEY RESULT) 4.1 HIV/AIDS AND AWARENESS OF ITS IMPACTS 62 4.1.1 Awareness, Sources of Information and Knowledge of HIV/AIDS 62 4.1.2 Knowledge and Belief about the Causes of HIV/AIDS 64 4.1.3 Knowledge and Ways of HIV/AIDS Transmission 65 4.1.4 Knowledge and Methods of HIV/AIDS Prevention 66 4.1.5 Perception of Illnesses that are caused because of HIV/AIDS 67 4.1.6 Knowledge and Sources of Information about Anti-retroviral 68 4.1.7 Knowledge of a Place for HIV/AIDS Test 69 4.1.8 Respondents’ Sexual Behaviours 70 4.1.9 Respondents HIV/AIDS Status and Testing for HIV/AIDS 71 4.1.10 Knowledge and Relation ship with PLWHA 73 4.1.11 Attitude toward People Living With HIV/AIDS /PLWHA/ 74 4.1.12 Perception of the Problems that are caused by HIV/AIDS 76 4.1.13 Opinion on how HIV/AIDS affects Different Socio-Economic Groups 77 4.1.14 Perceptions ways how HIV/AIDS Affects Occupation, Agriculture and the Community Development. 79 4.1.15 Knowledge of HIV/AIDS and Orphan hood 80 ---------------------------------------------------------------------------------------------------------------------------- Development Studies- Yeshiwas Bekele 2007 ¾e’MTƒ.Ø“ƒ - ¾g=ªe ukK 1999 iv 4.2 FEEDBACK OBTAINED FROM AIDS PATIENTS 81 4.2.1 Livelihood of the patients 81 4.2.2 Status of AIDS patients and their family 82 4.2.3 Care taker and medical service 83 4.2.4 Negative consequences of AIDS on the patients’ family 85 4.2.5 Participation of NGOs in care and support for AIDS patients and AIDS orphans 86 4.2.6 Attitude of some target groups towards AIDS patients and AIDS orphans 87 4.2.7 Negative impacts of being an AIDS patient 87 4.3 RESULTS OBTAINED FROM FAMILY MEMBERS OF THE DECEASED 88 4.3.1 Respondents’ relationship to the deceased person 88 4.3.2 Livelihood of the deceased 99 4.3.3 Previous status of the AIDS deceased and school participation of the deceased children 90 4.3.4 Living condition of the deceased before he/she became AIDS patient 91 4.3.5 Health status of the spouse of the deceased 93 4.3.6 Attitude of the community towards PLWHA AIDS patients and AIDS orphans 95 4.3.7 Negative consequences on the deceased family as a result of the death of the AIDS patient 96 4.4 EMPIRICAL ANALYSIS SUING A CROSS REGIONAL DATA 97 4.4.1 Econometric Results 98 ---------------------------------------------------------------------------------------------------------------------------- Development Studies- Yeshiwas Bekele 2007 ¾e’MTƒ.Ø“ƒ - ¾g=ªe ukK 1999 v QUALITATIVE ANALYSIS 4.5 FOCUS GROUP DISCUSSION AND FREQUENTLY ASKED QUESTION OUTCOMES 101 4.6 RESULTS OF IN-DEPTH INTERVIEW WITH WOREDA HEALTH OFFICERS AND HEALTH CARE FACILITIES OFFICERS 103 4.7 RESULTS OF IN-DEPTH INTERVIEW WITH WOREDA EDUCATION OFFICERS AND SCHOOL DIRECTORS 104 4.8 IMPACT OF HIV/AIDS 106 4.8.1 Economic Impact of HIV/AIDS 106 4.8.1.1 Impact on the agricultural sector 108 4.8.1.2 Impact on the health Sector 110 4.8.1.3 Impact on the education sector 111 4.8.1.4 Social impacts of HIV/AIDS 111 4.8.2 Cultural norms and practice within rural communities 112 CHAPTER FIVE -SUMMARY, RECOMMENDATIONS AND CONCLUSIONS 5.1 SUMMARY 113 5.2 RECOMMENDATIONS - POSSIBLE ACTION PLAN TO MITIGATE HIV/AIDS 122 5.3 CONCLUDING RECOMMENDATION SPECIFIC FOR THE STUDY AREA 128 ---------------------------------------------------------------------------------------------------------------------------- Development Studies- Yeshiwas Bekele 2007 ¾e’MTƒ.Ø“ƒ - ¾g=ªe ukK 1999 vi Annex 1.0 BACKGROUND OF THE STUDY, WHY CONDUCT SUCH A STUDY, METHODOLOGY AND APPROACHES............................134 2.0 GUIDE TO THE QUESTIONNAIRE.............................................143 3.0 QUESTIONAIRE ON THE IMPACT OF HIV/AIDS ON THE WELL-BEING OF THE RURAL POPULATION IN GOJJAM –.........146 3.1 SECTION I-DEMOGRAPHIC DATA ...................................... 146 3.2 SECTION II SOCIO ECONOMIC DATA ...................................... 150 3.3 SECTION III- HIV RELATED QUESTIONS ................................... 154 3.4 QUESTIONNAIRE FOR FOCUSED GROUP DISCUSSION.............. 162 3.5 FREQUENTLY ASKED QUESTIONS............................................. 163 3.6 QUESTIONNAIRE FOR AIDS PATIENTS WHO ARE HEADS OF HOUSEHOLDS............................................................................. 165 3.7 QUESTIONNAIRE FOR THE FAMILY MEMBERS OR RELATIVES OF DECEASED AIDS PATIENTS .............................. 167 3.8 QUESTIONNAIRE FOR THE HEAD OF THE WOREDA HEALTH OFFICE AND HEAD OF THE HEALTH CARE FACILITY .............. 169 3.9 QUESTIONNAIRE FOR THE HEAD OF THE WOREDA EDUCATION OFFICE AND SCHOOL DIRECTORS........................ 171 5.0 BIBLOGRAPHY ........................................................................173 6.0 MAPS OF THE SURVEY WOREDAS (DISTRICTS) ......................177 ---------------------------------------------------------------------------------------------------------------------------- Development Studies- Yeshiwas Bekele 2007 ¾e’MTƒ.Ø“ƒ - ¾g=ªe ukK 1999 vii LIST OF TABLES Table 1.1 Sample Size by Woreda .................................................... 12 Table 1.2 Precision Level or Margin of Error of Some Selected Variables .................................................. 16 Table 2.1 Global summary of the HIV and AIDS epidemic (December 2004).............................................................. 20 Table 2.2 Adults and children estimated to be living with HIV as of end 2005 (Global) ...................................... 21 Table 2.3 Total Fertility Rate (TFR) and Infant Morality Rate (IMR).......................................................... 26 Table 2.4 Comparative selected; health indicators (mid 2004) ....................................................................... 30 Table 2.5 Percentage of respondents' knowledge about HIV/AIDS (Year 2005)............................................. 37 Table 2.6 Effects of HIV/AIDS on the community ........................... 41 Table 3.1 Distribution of Respondents by Age, Sex, Religion and Education and by Woreda............................. 49 Table 3.2 Distribution of Respondents by Occupation, Ethnic Group and Education and by Woreda..................... 50 Table 3.3 Distribution of Respondents by Number of marriages and First sex partner ....................................... 51 Table 3.4 Percentage Distribution of Respondents by Employment Status, Possession of Livestock and Land for Agriculture and Woreda ............................... 54 Table 3.5 Percentage Distribution of Respondents by Land holding size, Sufficiency of Land for