Select Committee on International Development Minutes of Evidence

Examination of Witnesses (Questions 420 - 439)



  420. Can you say a little bit more about that.
  (Mr du Guerny) The issue of impregnation is important in many African countries because the number of children, the fact that women are fertile, is important for their status. Traditionally, a woman's status was, to some extent, related to the number of children she could produce; and for a man it was also important to show that he could produce many children. Of course, any barrier method comes into conflict with this.

Barbara Follett

  421. I would like to ask you what role, if any, the traditional healers, the so-called witch doctors, might play in raising people's awareness of HIV/AIDS or, in fact, making people's awareness of it less clear.
  (Mr du Guerny) This is a very interesting issue because there were some studies in francophone Africa a few years ago, which tended to show that AIDS has put into question so-called western or modern medicine —" doctors with the white blouse and the hospital kind of set-up —" which is one of the symbols of the modernisation process. It is urban based. It is knowledge based, etcetera. Of course, this had created problems for traditional medicine and those who practised it. The failure of modern medicine in the field of AIDS to cure that, has been seen by some of the traditional healers as an opportunity to reassert themselves, particularly because, of course, they have a more holistic approach, which is directly understandable in their communities and to the people they deal with. It is not something which is foreign and incomprehensible like western or modern medicine can be. So they are much more attuned to the needs of the local communities and are able to provide much more psychological support, even through rituals and things like that. Even if they do not, from a scientific perspective, provide any demonstrable result, they still provide comfort and support to the family and to the sick person. This is an area where, of course, modern medicine is often weak. It is very instrumental. We can give you your injection and your pills and this is it. Any sort of relation, which is supposed to exist in theory, often in practice does not happen. However, besides this, there are probably many opportunities to co-operate, a bit like in family planning programmes. There was a debate, many years ago, about what to do about traditional midwives: whether one would enter into conflict with them or not. The strategy which was decided in many family planning programmes, often in South East Asia, was to co-opt, to bring in the traditional midwives by giving them training, so as to make allies out of them and have barefoot agents. It is possible that some kind of development like this could be done.

  422. Has anything like this been done with the traditional healers in HIV/AIDS?
  (Mr du Guerny) Frankly speaking, I am not aware of this kind of development. One point I would like to stress is that traditional medicine is not cost-free. This is often not sufficiently recognised. The traditional healers may not be paid in cash but through forms of sacrificing animals, offerings, etcetera. It can amount to significant cost. So one of the burdens on the family is that there are medical and care costs, even if there is no modern medicine involved.


  423. Can we explore the relationship between the urban areas and the rural areas, which you do in your paper: the prevalence of HIV/AIDS in urban areas and rural areas.[1] Do we have any reliable information that you can quote in comparison? Is the prevalence thought to be greater in urban areas or less than in rural areas? What do we know about it?

  (Mr du Guerny) As a general rule, the prevalence is higher in urban areas. Often in rural areas, especially a few years ago, it was very low. But it is increasing in rural areas. In some cases like rural areas, which are sometimes on borders, or borders between countries' crossing points where there are market activities, things like that, there can be very high rates of prevalence; or in some of the mining areas; so these are special cases. However, generally the prevalence is higher in urban areas. It is increasing in rural areas but the problem is that as the urban areas represent roughly 30 to 35 per cent of the total population, even lower rates of prevalence in rural areas can have a much larger impact on the total numbers and, therefore, on the national level. This is one of the reasons why the rates for the national levels have appeared to increase rapidly, because first the urban areas had quite high levels, but when it is 30 per cent of the national level it still remains much lower; but as it moves up into the rural areas, then the national level moves up faster.

  424. I understand. That is the way statistics work. Given this difference between the urban and rural areas, should prevention strategies in rural areas be planned and implemented differently from those in urban areas?
  (Mr du Guerny) One of the difficulties with these epidemics is that is why I often use the term pandemic, which is the sum total of all the epidemics and interface —" because it is not just one epidemic. For example, you can have one epidemic, which is linked to the fisher folk communities. You can have an epidemic which is linked to "pastoralists". You can have a plantation economy epidemic, etcetera. They can all have their own specific characteristics and their own dynamics. Therefore, it is extremely important to develop strategies, which are tailored to each of these specific epidemics. One of the problems now is that one has tended to view rural populations in rural areas as sort of homogeneous, and tended to have blanket approaches. I do not think this will be possible in the future if one wants to have an impact but, of course, this makes it much more difficult and expensive. Dealing with the rural areas, one has to take into account the cultural patterns and things like that. They can be different according to the people we are dealing with. Fishing communities often work in a rather different way from sedentary, agricultural, etcetera. In semi-arid zones there is a lot of population movement —" much more than South East Asia, the central plain of Thailand or wherever. Therefore, one has to adjust these strategies because in some cases one will have to emphasise much more the rural/urban migrant; and in other cases one will have to emphasise how the farm household works. To make effective strategies does require rather good knowledge of various populations we are dealing with, but also knowledge of the meeting points between these populations. That is like what happens at festivals, temple fairs, things like that. This is why we always feel that holistic strategies are necessary because one cannot just approach it in a simplistic way. That does not work. This is because it is linked to human behaviour and human behaviour is such a complex and diversified area.

  425. Do you conclude, therefore, that HIV/AIDS programmes, both in their design and expenditure, are inadequately targeted on rural communities and the diversity of the rural communities you have described?
  (Mr du Guerny) I certainly think so, yes. There have been a number of efforts but they tend to be small-scale like NGOs, etcetera. They have very limited access and resources. Up to now there has been a tendency to focus more on urban areas. We need to balance it more because since urban and rural areas are so interlinked, it does not make sense just to work on one side. One has to think carefully in each case about how and where one distributes one's effort.

  Chairman: The "how" is important. I am going to ask Barbara Follett to lead us on the impact on farm households.

Barbara Follett

  426. I am interested to know to what extent the shock of HIV/AIDS on rural households differs from other shocks which might hit those households and be equally impoverishing. For example, deaths due to malaria, TB or war.
  (Mr du Guerny) In Africa, often when one dies of AIDS, in fact, one dies of TB or of malaria. Because it suppresses your immune system one dies of something else. TB is one of the leading causes in such a case. Now war: Of course, war is a total disaster, so it is a bit difficult to classify or rank such a disaster. One of the problems is that there is often no discrete separation. One thing tends to lead to another. Just like if you go back to medieval Europe, famine, pestilence and war were often mingled together. In some cases this is the thing in Africa. It is certain that various conflicts, which are there, are creating the conditions for future epidemics. That is something which has to be kept in mind. One can see this in a country like Rwanda or Ethiopia. We are now seeing increases in the levels of AIDS. At the farm household, the problem is the resilience of the system. This depends very much in what kind of farming system it is located. For example, if there are rather regular abundant rains, one can be more sure of producing the minimum quantity of agricultural products. In the Sahel area or more northern Kenya, which are semi-arid areas, where rain is much more uncertain, then one tends to become vulnerable. Among the farm households, of course, the wealthier ones are less vulnerable. They have more resilience. When a member of the household is sick it is possible to hire casual labour, whereas in a poor household this is not possible. On the contrary, if they were hoping to be hired out as casual labour, it does not work any more. This is where poverty comes in. At the farm household level, where there is very little margin for security, then anything which happens can be a disaster. Now the problem with AIDS is that it takes a long time. A sudden death is more easily absorbed as a shock because these systems are traditionally more used to it. It is protracted disease which stops people earning income and they require expenditure. That is one of the very insidious aspects of AIDS. Also, in these very traditional communities, when they are in the beginning phases of disease, since they can be quite common diseases, they do not associate it with what is really going to happen. So they will make all the investments necessary to try to get care, etcetera. In poor households, one of the problems also is the time which is taken up in care and things like that. Since basically these households' main assets are often their labour, anything which is deducted from that can have quite a serious impact.

Mr Rowe

  427. In rich developed countries the opportunity to bring holdings together has actually been seized with readiness —" I assume it depends very much where you are in the world —" but where families can no longer run their plot, is there a move to amalgamate them with others, or do they simply fall into disuse as we saw in Rwanda?
  (Mr du Guerny) This is where the land tenure systems come into play. If you have a system of private property, then there could be consolidation. But, for example, in a lot of Africa, they are community-based systems of land tenure. Therefore, theoretically it is the ancestors who own the land. It is handed out to a lot of families, according to their size and requirements. So your issue then does not work in such a context. But also there is another point. As I mentioned, the epidemic is concentrated more in certain areas than in others. In a community, on which it has impacted quite severely, the wealthier farmers would also be affected. Therefore, they would not necessarily be in a position to buy the land, which would be for sale. So everybody is hit and the question of winners and losers is not quite the same.

Barbara Follett

  428. Just to continue with what you were saying, when people become ill, do they make any changes in their agricultural arrangements? For example, do they move to crops that are less time and labour consuming? Do they make adjustments in their lives?
  (Mr du Guerny) Certainly. That is one of the first things we noted when we did these surveys of agriculture. They tended to abandon the more intensive crops like coffee, for example. They also tended to drop the cultivation of fields which took more time because they were more distant. This goes back to the previous question. One of the important things would be to look into how land is distributed, even under a communal system, so as to save time in going to the field and coming back. They do tend to retrench to subsistence crops, cassava and things like that. Therefore, this has an impact on the nutrition of the family. On the one hand, there is less cash with which to buy possibly other foods. They also revert to less nutritious foods because they are generally easier to produce. Like cassava they require less work. One also has to take into account what is happening to other household members at the same time. We do not have that information but we suspect that there are interesting and important effects. Is it the husband who is sick first? Is it the wife who is sick first? Things like that. Because of the division of labour, this would have differential impacts. It is something which would be worthwhile looking into. For example, the wife also tends to look after the homestead and the garden and things like that. If she falls sick that could be abandoned. That is an important part of what goes into the pot. Whereas if the husband abandons looking after the coffee, then it is the cash variable which is affected; the cash which was available to buy other food. These kinds of things should be looked into but we have not had the opportunity yet.

Mr Worthington

  429. You have been partly answering the question that I was going to ask. What about the impacts on girls and boys of the deaths in families? What is it doing to their lives, as they grow up, in terms of access to education or what is seen as the division of labour within the family? Have you any ideas on that?
  (Mr du Guerny) We have a certain amount of information on that. The impact is on the function of the gender roles. The division of tasks and on whom the family is ready to invest, more or less. The impact, of course, is different for boys and girls. One of the major impacts is that women, in general, have to do the caring functions. Therefore, the daughters will be brought into this in order to support the mother. This can mean that they might drop out of school. They also will have to help the mother more in the house with cooking and things like that. There is that impact. If we are dealing with a pastoral society, there the boys play a significant role in looking after herds. The sickness of the father would then put this onus on them. One thing is that children, both boys and girls, tend to drop out of school. Also, they tend to become less good farmers because the transmission of knowledge is done through working with the parents. Therefore, this process can be interrupted and they can be less skilful or knowledgeable in the tasks they have to carry out. This is one of the serious consequences for the future: that, basically, the various epidemics mortgage the future of these children. One could very well see that instead of having a development process, not only would development be stopped but a reverse process might be happening because the children could be less educated, less skilful than their parents.

  430. Could I ask about migration and migrant labour. First of all, we are talking about sub-Saharan Africa, so it is a huge area. How significant is migrant labour to rural life on a general basis, or is it just in some locations that it is significant?
  (Mr du Guerny) Migration is extremely important in Africa. These populations are extremely mobile, particularly in western Africa, all the north/south migration from this Sahel zone towards the coastal areas and the plantations into the more humid zones. That has been going on for a long time and is well entrenched. There are ethnic groups like the Mossi in Burkina Faso where you can have more people outside a country than inside at any one time. The migration is, for example, so entrenched a way of life that it is part of becoming an adult for boys. It is a ritual. In east Africa the situation is a bit diverse because it is more rural-urban than inter country, although recently with political changes there has been a lot of international movement. But in West Africa it has been transboundary, which also creates complications, because you cannot then have a national programme or a national response when you have to deal with all these mobile populations. It requires co-ordination between the countries if they want to be effective.

  431. Could you see an impact on the traditions of migration already occurring because of HIV?
  (Mr du Guerny) The changing flows or patterns?

  432. Changing flows. The obvious one that you point out in your paper is that a major part of village income comes in migrant labour. Men have to return home because they can no longer work. Then the burden falls on the poor community. You point that out. I wonder if there are changes occurring because of this taking out a large part of the active population who will be migrant.
  (Mr du Guerny) Agriculture is at the bottom of the scale. Therefore, when there are gaps in the urban labour market, this will always be like a pump. It will absorb the people from rural areas. So the urban gaps will tend to be filled, particularly if they are more-or-less unskilled labour. But then there is nobody there at the rural end. This is why you can have changing age structures in certain rural communities; where you have relatively many more elderly and children in the population than you used to.


  433. What is the impact of HIV/AIDS on casual and landless labour? We understand that in some areas there are pools of landless labour who would be hired normally by a landed family and that possibly, because of the reduction in prosperity, the casual labourer is no longer hired. Therefore, this reduces their capacity to earn their living.
  (Mr du Guerny) When you look at it from a systems perspective, every group tries to pass on the costs to somebody else. Therefore, it tends to be the weakest in the society who have nobody else to whom they can pass on the cost, who end up by bearing the brunt because the others will try to find some other way. So the poorest might not find opportunities for casual labour in some cases. However, we do not really know what the situation is. We would need to look into this more carefully but these are rather difficult surveys to do, because particularly if you are landless they are difficult populations to identify and to survey. So the landlessness question might eventually turn out to be more important in other regions than in Africa, because landlessness is also linked to the land tenure systems. Therefore, it might be something which was more important in India, for example, and parts of South East Asia. That, to my knowledge, has not been looked into yet.

  434. One other perverse reaction, it seems to me, that might take place, is that you would get a population increase because most human societies, faced with a large number of deaths among their working population, will seek to increase the number of children that they have if they can possibly do that. This is certainly a feature of periods after large wars in Europe; and I had the impression in Malawi, when we went there, that the reaction of the rural poor to the reduction in the number of children surviving into adult ages was to increase their fertility.
  (Mr du Guerny) The recuperation phenomenon after wars is well known. We have observed it also in Rwanda, where I am told that women even share the men, since men are in short supply; so women tend to share the men available in certain rural areas. However, in the case of AIDS, I am not sure this can happen. This is for one simple reason because the young women get infected at young ages, 15 plus, so they tend to fall sick and die before they can complete what would be the normal fertility history. One would have to do simulation models to work that out really.

Mr Colman

  435. I have a related question and perhaps it comes in here. You talk about the women sharing the men that are available. Is there a major legal or discriminatory problem which is faced by women who have lost adult male household members to HIV/AIDS? And is the problem one of lack of legal rights or protection, or rights of enforcement?
  (Mr du Guerny) Many countries have passed laws to protect women's rights but the problem is often, particularly in rural areas, that they are not necessarily enforced, or they come into conflict with customary laws. Therefore, the customary laws tend to be enforced instead. Sometimes there are also misunderstandings like, as I mentioned, the land belonging, in fact, to the ancestors. Therefore, neither the husband nor the wife is, in a western sense, the owner of the land. The land reverts back to the ancestors and de facto a woman is deprived of any right of access. That is a very important issue and something which should be looked into, how to protect the surviving widows. However, one has to be aware that often this would be only a temporary measure because many of these widows would themselves die after a few years. So the strategy there and the concern would be to have a kind of holding operation in order to protect the children's interest as much as possible. If the widow is going to die afterwards —" we do not know, of course, the widow may not die afterwards —" then the key thing is what happens to the children. One should, for example, review perhaps some of the education policies and strategies in order to try and give the children marketable skills at younger ages than is done presently in case disasters happen. I think this whole issue of protection of the widow's rights is something which sometimes should not exist in theory but does exist in practice.

  436. Are we looking at polygamy becoming the norm perhaps through this or is this an informal arrangement?
  (Mr du Guerny) No, no. Many of these societies are still polygamous so that is why the issue if a wife dies is not the same for the husband in a polygamous case because there are already other wives or it is easier for the husband to remarry. But in the case of the widows this is different, whether they are or are not in a polygamous relationship, they do not have the same kind of fallback position that their husbands do.

  437. You are saying that the land rights go to the nearest male relative rather than on to the wife?
  (Mr du Guerny) Yes, because it can belong to the male clan. So this is where, for example, the well known levirate system with widow cleansing exists which originally was conceived as a kind of social security in order to look after the widow but in the age of AIDS it is a disaster. There you can see how societies try to adjust their norms because now instead of the husband's brother remarrying the widow, they will try to find a young boy, for example, so that there are no sexual relations in order to avoid this kind of thing because the other wives in the polygamous set-up often are aware of the risk and are very much afraid then of AIDS entering into their family through this practice.

Mr Rowe

  438. You said something very interesting I thought, that we may need to look again at our education programmes.
  (Mr du Guerny) Yes.

  439. Do you get the impression that all the multitude of NGOs and the World Health Organisation and the United Nations operations and so on have really taken seriously the impact of AIDS on the planning of their strategies or do you get the impression that they are really trying to persevere with the strategies they had before?
  (Mr du Guerny) I figure it is difficult to generalise but one thing needs to be made clear, when you talk about the UN system, WHO or FAO etc, we answer to the requests and instructions of the Member States.

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