The impact of HIV/AIDS extends far beyond human health—it also has profound effects on households, communities, agriculture, land use, and conservation efforts, to name only a few. In many parts of the developing world, families affected by AIDS are forced to juggle assets to adjust to lost land or labor; while the conservation sector struggles to transfer knowledge as employees die or fall ill. Yet, despite its far-reaching and varied impact, AIDS remains largely managed by the public health sector. Richard Skolnik of Population Reference Bureau, Lori Hunter of the University of Colorado at Boulder, and World Wildlife Fund's Judy Oglethorpe came together on January 17, 2007, to discuss the impact of HIV/AIDS, and to call for multi-sectoral approaches to tackling the deadly disease. The meeting was co-sponsored by the Environmental Change and Security Program and the Global Health Initiative.

"Relatively little progress is being made in stemming the [AIDS] epidemic," said Richard Skolnik, director of international programs at the Population Reference Bureau. "The number of new infections continues to increase in most countries." Around the world, more than 39 million people live with HIV/AIDS—sub-Saharan Africa accounts for 63 percent of the world's infections. In countries heavily affected by the disease, the burden extends from the top level of government down to households. Countries with high infection rates can count on declining labor forces—either from direct deaths, or from absenteeism due to illness or to care for relatives. "HIV/AIDS will increase costs to governments and decrease the prospects for economic growth, even as society will need and demand more assistance from government because of the epidemic," he said, estimating that life expectancy in many countries is 20 to 35 percent lower than it would be without the disease.

AIDS and Families

"We all manage a suite of assets to meet our goals," said Lori Hunter, associate professor of sociology and environmental studies at the University of Colorado, Boulder. Different forms of capital—human, financial, natural, physical—will be traded and shuffled to accommodate needs and wants. Households with higher socio-economic status are less vulnerable to shocks—job loss or death in the family, for example—because they have more assets at their disposal. But the situation is more challenging for families at the subsistence level, particularly those affected by AIDS.

Households in which a family member has died of AIDS are often forced to trade assets to manage short-term needs. In parts of South Africa, for example, households affected by the disease are heavily reliant on wood, said Hunter: "They no longer have money to buy electricity, so they use natural capital because they have no financial capital, because they have lost human capital." But this trade-off can have serious long-term consequences: deforestation from excessive wood collection contributes to soil erosion, which, in turn, contributes to declining agricultural yields. Since crops are the main source of revenue for the rural poor in the developing world, the short-term gain of firewood for heat generates a larger and longer-lasting loss of financial capital.

Hunter also noted that the ways in which households adjust their assets depends on whether a male or female family member has died. In agricultural areas where women raise grain crops for consumption, the loss of a female can have serious implications for food security. The loss of a man, in comparison, impacts the household's financial well-being because men are usually responsible for cash crops like cotton. Similarly, families dealing with AIDS are impacted by land inheritance laws: "The prevailing practice with regard to land inheritance is patriarchal," she said. "Women can lose access to land if the male head of household dies."

Impact on Conservation

According to Judy Oglethorpe, director of community conservation at the World Wildlife Fund, HIV/AIDS has widespread impacts on conservation efforts and practices. People simply have less time for conservation because they are spending more time taking care of the sick. The disease also contributes to the decline of institutional memory. "AIDS hits the middle-active generation that helps transfer indigenous knowledge," she said. "Land is being used in less appropriate ways because children don't know how to use it." As a result of these two factors, the conservation sector finds itself devoid of community champions—those who will advocate and generate support for conservation practices.

Oglethorpe believes that AIDS' heavy impact on the conservation sector is in part due to the structure of the sector itself. Employee numbers have declined because conservationists often work in remote areas and cannot bring their families with them, creating a problem for families trying to manage disease. Additionally, funds are often diverted from training or knowledge-transfer programs to medical care or funeral services for staff and their families. And national parks and wildlife reserves are also becoming high-risk areas, where rangers often have sex with prostitutes, spreading the disease.

Yet, despite the sector's problems, Oglethorpe believes there are simple and realistic solutions, including:

• Posting staff closer to their families;
• Providing condoms for employees, and offering antiretroviral drugs to HIV-positive staff; and
• Including HIV/AIDS awareness in planning, training, and fundraising activities.

Moving Forward

The strict focus on AIDS as a health issue can keep donors from seeing the forest for the trees. On a recent trip to Tanzania, Skolnik visited a medical clinic funded by the President's Emergency Plan for AIDS Relief where antiretroviral (ARV) drugs had been made available to 18 children. But because the funding prohibited combination treatments, two of the children on the ARV drugs died of malaria. "We need to sit down and decide if this is how we want people to live or die in the future," he said. "We need harmonize our activities."

Harmonizing activities, the speakers agreed, means that "stovepiping" needs to end. Efforts to reduce the negative impacts of AIDS must be multi-headed, addressing the disease itself, while also tackling the enabling conditions, environmental aspects, and economic constraints that prevent disease-affected households from rising above subsistence level. Yet Hunter urged extensive research and planning before jumping on a multi-sector bandwagon: "We can't just transplant programs from one region to another without thought. We need to think about how issues in the Caribbean are going to be different from those in Africa."

Comprehensive approaches to AIDS have a real chance at success, said Oglethorpe. Fighting AIDS requires action on more than one level; the various sectors—conservation, health, education, and agriculture—must learn to work together. "One approach won't solve all the problems. The health sector can't do everything. We need to take a multi-sectoral approach."

Drafted by Alison Williams.