Examination of Witnesses (Questions 413
- 419)
TUESDAY 11 JULY 2000
MR JACQUES
DU GUERNY
Chairman
413. May I welcome you very much, Mr du Guerny,
to this Committee, to discuss this extremely difficult and painful
issue of HIV/AIDS. I understand that you would like to open with
a short statement, but I would be grateful if it could be short
because we have a lot of questions we would like to ask on the
papers you have submitted to us. We are very grateful to you for
taking the time and trouble to send them to us, but we have a
lot of questions to ask and we will need the time to do so. So
if you would open with just a short statement we would be grateful.
(Mr du Guerny) Thank you, Mr Chairman.
I am extremely happy to have this opportunity to try to help this
Committee in this very important area. What I would like to stress
beyond the documentation which you have received, is to clarify
that the Food and Agriculture Organisation of the United Nations,
as a technical specialised development agency, does take the development
approach within its mandate, focusing on agriculture, rural development
and the welfare of rural populations. So it is from this perspective
that we look at the epidemic. We first started by looking at what
the impact of the epidemic could have on rural populations, their
food production, and food security. Then when we verified that
the epidemics had very serious impacts, we were concerned with
what kind of response the agricultural sector and its institutions
could provide, in order to contribute to combating the epidemic.
So we look at it from a kind of systems perspective. We look at
the farming system, which is in a certain environment and produces
certain crops. Within this system, like a coffee or banana system,
there are sub-systems, which are farm household systems. These
are the units of production. Now what is important to note is
that there is no more subsistence agriculture. This is something
of the past. Therefore, all these farm household units are somehow
related to the outside world: through markets, but also through
rural/urban migration. They need to be attached to the outside
world, either to sell their products but also in order to get
back remittances, or to relieve the pressure on the land. Therefore,
it is through such mechanisms that the farm household system is
dependent also on the broader urban economy, and that through
these exchanges the virus has the possibility to move into the
rural areas and to spread. So I just wanted to make this clear
before we started. This is the real area of concern. We are concerned
for a way of reducing the vulnerabilities both of the farm system,
which is more open to macro kinds of approaches, and to the farm
household system, which is more open to micro through extension
agents, etcetera. The combination of reducing these two different
levels of vulnerabilities could have an impact in the chain of
events which lead people to expose themselves to the risk of infection.
I wanted to say this to start.
414. Thank you very much indeed. That is useful.
I think you make reference to this in your papers as well: that
you are concerned with the impact on the multi-faceted nature
of the farm in rural areas. We wanted to be certain because you
make reference to this in your papers about the availability of
statistics. I think you conclude that basically there are none
that are available. On the other hand, I wonder if you could make
clear what statistics you do have available, that you can rely
on at all.
(Mr du Guerny) We rely mainly on the statistics which
are produced by UNAIDS.
415. But they are extrapolations, are they not?
(Mr du Guerny) Well, they have a rather complex sentinel
surveying system, which focuses for developing countries a lot
on hospitals or the health care centres. They try to estimate
rates of prevalence through the pregnant women and deliveries.
So there are all kinds of methods to try to estimate through this
kind of surveillance, correcting through the age structure as
mothers tend to be younger, things like that. There are significant
improvements in the collection of data but it is still rough,
particularly for rural areas, which are often less well covered
by all the medical infrastructure; and also because the epidemic
disseminates itself in rural areas through a process which we
call "leopard skin". That is, it tends to be concentrated
like the leopard's spots in certain areas. So certain communities
can be highly infected. Others will be much less so. It is because
of this heterogeneous distribution that it becomes quite difficult.
However, there is absolutely no doubt that it is there and that
it is devastating in a number of countries. That we see through
our own small surveys and things like that. The mortality of young
adults, whether it is a true figure or not, is obviously extremely
high in a number of rural areas. Its destruction is clearly visible.
The exact mortality levels in a European country for certain causes
of death is, of course, more difficult, but the trends and the
rough levels cannot be disputed now.
416. How important do you think it is that any
information deficit be remedied?
(Mr du Guerny) I am a demographer so, of course, I
tend to think that data is very important. We need to follow the
epidemic but also to make projections and to try to understand
the mechanisms through which it evolves: both whether it is spreading;
or, hopefully, how will we know when the epidemic is stabilising
and eventually diminishing? For this, certainly we need to have
data collection systems, but there tends to be —" perhaps
a little bit unavoidably at this stage —" an urban
bias. But because in many African countries the bulk of the population
is still in rural areas. Therefore, it would be important to make
specific efforts to improve data collection in rural areas, since
60 to 70 per cent of the total population of many African countries
are there.
Mr Worthington
417. You are a demographer but you will be a
bit of a sociologist and an anthropologist as well.
(Mr du Guerny) Yes, unavoidably.
418. We use these terms like HIV/AIDS. How do
the village people, the rural people, explain what is happening
to them? You talked about the leopard's skin. Concentration in
some areas rather than others. How do they explain what are the
causes of what is happening to their population, where suddenly
unexpected people are dying in much greater numbers than they
would expect?
(Mr du Guerny) There tend to be cultural responses,
so each culture will see it in a certain way. It is often syndromic.
That is why it was called "slim disease", for example,
because people tended to waste away. There are also explanations
due to upsetting spirits; curses by some enemies. All kinds of
reasons are given. Many of these rural areas until the late 1950s,
early 1960s, were quite used to high levels of mortality. Then
mortality declined, including in rural areas, so they do not have
a very long experience of lower mortality. What is different,
however, in this case, is that it is not the usual categories
of people who die: the infants, the children and the elderly.
It is the young adults who normally would die through conflicts
or accidents or things like that. So there is an incomprehension,
in many ways, as to what is the cause of this. They often see
it as imported from the urban areas, because they see the rural
migrants go to urban areas and when they begin to fall sick they
come back home to die there. So in many areas they see the diseases
coming back from the cities. In many countries there have been
prevention and information campaigns going on for a number of
years. People are familiar in many cases with the word, AIDS,
or sida, or whatever it is they use in their local language.
When it comes from outside like that, through these information
campaigns, it tends to remain sometimes an outside concept; something
which they do not necessarily integrate.
419. Let me give you an example of how people
might react. It used to be said that one of the reasons why we
had large families was in order to ensure that some of them survived
to take over the farm or the family trade and so on, to look after
the old people in their retirement. Here you find people having
moved to a smaller number of children in many cases than in the
past —" not always but often. Now they find that the
children or teenagers are not surviving. What is the logical response
of people in rural areas to that when people come along and say,
"use a condom"?
(Mr du Guerny) First, the fertility has not declined
that much in many African countries. It is beginning to decline,
particularly in some parts of East Africa, but it has not reached
the lower levels that one finds in South East Asia, places like
that. Then the mortality due to this is not so much small children,
it is the young adults, so they are already parents. It is people
dying between the ages of mostly 20 and 34, around there, with
a difference between women and men. The deaths of these young
adults could have an impact on fertility levels because the normal
fertility a woman would have is interrupted. Now the difficulties
with condoms are multiple but the rural populations could question
their demographic strategies. We have not really seen that happen
at this stage, as far as I know, because when fertility begins
to decline, it declines often when one is entering different kinds
of economies, etcetera. The rationale is different. One looks
more at the cost of children rather than the benefits they will
bring. Therefore, the problems with condoms in rural areas is,
first, the availability. Then the cost, because even if it might
not appear very expensive, it might be for a rural family. Plus
the difficulty that there is very little privacy in rural areas.
There is also the difficulty of keeping them within the household.
They are sensitive to temperature and things like that. There
is the difficulty of maintaining them in good condition. Plus
all the traditional beliefs about relations between men and women,
sexual relations, things like that. This is not my area of expertise
but it appears that in Africa these sorts of barrier methods do
create problems and can be in conflict with some of the traditional
beliefs.
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