Select Committee on International Development Minutes of Evidence

Examination of Witnesses (Questions 413 - 419)




  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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