Thinking with the livelihoods framework in the context of the HIV/AIDS epidemic

What insights can the livelihoods framework reveal about the impact of HIV/AIDS? What are the linkages between health issues and other livelihoods issues in the context of HIV/AIDS? This paper continues on-going work using the Sustainable Livelihoods framework to explore how HIV/AIDS affects livelihoods, and how impact mitigation strategies can be improved by drawing on these insights. Such insights would be relevant to work not only in sub-Saharan Africa, but also in East Africa and Asia. Focusing only on health issues obscures the diverse effects HIV/AIDS has on all aspects of livelihoods. Similarly, treating those affected by AIDS only as patients obscures their continuing roles in decision-making and livelihoods maintenance.

A step-by-step analysis using the livelihoods framework reveals the following issues around the impact of HIV/AIDS:

• sickness from HIV/AIDS itself is one of a number of 'vulnerabilities' to which livelihoods are subject. HIV/AIDS compounds problems posed by other shocks, trends, and seasonality
• HIV/AIDS affects human capital not only in terms of the health of sufferers, but also the psychological and physical health of carers, and in terms of time and labour lost to caring from other work or education activities
• natural capital is affected by changing and reduced land use due to household labour shortages. Natural resources close to home may be over-used; and land may be sold to cover medical expenses
• access to financial capital in the form of credit is severely restricted for those affected by HIV/AIDS, as sufferers and their families are considered high-risk defaulters
• physical capital - housing, community and farm infrastructure - becomes degraded in HIV/AIDS affected communities / households due to labour shortages and priority shifts. Physical capital can also be sold to pay associated expenses
• death and sickness erode the social networks essential to social capital. Cultural and social events diminish, and may be inaccessible to those affected due to social stigma and misplaced fear of infection
• policy and institutional contexts play a key role in how HIV/AIDS affects livelihoods: good public information on HIV/AIDS is crucial, along with laws and campaigns against practices which help spread the virus. Local government, non-government and church organisations may be important institutions for mitigating impact.

The impact of HIV/AIDS can be seen at every point of the livelihoods framework - and hence policy for mitigating impact should address each aspect of it.Implications of this approach for policy include:

• awareness of those affected by HIV/AIDS as people with diverse livelihoods - not just as patients - should be integrated into all development interventions
• impact mitigation strategies should aim to rebuild all forms of assets, build on structures and processes that are flexible in sustaining diverse livelihoods, and share experience of successes
• research is needed on the effects of a variety of policies - for example land tenure, reproductive health, and education provision - on those affected by HIV/AIDS
• documentation of existing and future experience of the impact of HIV/AIDS on livelihoods needs to be developed, and knowledge shared.