Over the past three decades, HIV has emerged from an unknown virus, to a pandemic of

astronomical proportions. Millions of people worldwide have already succumbed to this virus
and millions more lives have been disrupted because of the pain and suffering of loved ones.
Today there are approximately 40.3 million people living with HIV/AIDS and the number looks
set to only rise. Entire societies will be feeling the effects of the pandemic for decades to come,
most notably in Sub-Saharan Africa where the epidemic is most advanced. The virus itself is
relatively difficult to contract when compared to others such as Influenza, but a myriad mix of
social issues has allowed the virus to gain a major foothold in every nation around the world. The
immense nature of this epidemic has led to mass fear and hysteria and many misconceptions of
the virus. This has led to stigma and discrimination of those infected around the world as people
seek to explain what they do not understand. Unfortunately, this only hinders the fight against the
global pandemic and actually makes populations more vulnerable to infection. In order to
effectively combat HIV/AIDS around the world, stigma and discrimination must be adequately
addressed.
HIV/AIDS has had devastating impacts in many countries, Uganda in particular. However,
Uganda is depicted as one of the most successful countries in fighting HIV/AIDS. Among others,
Uganda's success story is attributed to the open general environment which allows open
discussions surrounding HIV/AIDS when other countries such as South Africa and Kenya denied
the existence of the disease in their countries. In addition, the success is attributed to the policy
which allowed many actors to participate in the fight against the disease. The primary focus of
this article is to map the process of social capital generation by NGOs and how social capital
benefits enhance mitigation of HIV/AIDS challenges in Uganda.
The key to social capital is nurturing relationships. In this regard, HIV/AIDS NGOs play a
central role in the way individuals, groups and communities interact, and how various kinds of
social relations are forged with people living with HIV/AIDS and especially for those who are
HIV infected. NGOs' success in reducing the number of HIV/AIDS cases in Uganda is based on
their abilities to generate social capital. This involves inclusion and building social networks and
empowerment at the individual and community levels, and disseminating information to reduce
social stigma as well as discrimination.

The interplay of a wide range of socio-economic problems resulting from HIV/AIDS often
pushes AIDS widows and their families below the poverty threshold, directly threatening the
survival and well-being of their families. Even more importantly perhaps, female-headed
households afflicted by AIDS become entrenched in poverty, as, in addition to the loss of
labor and cash income, women have fewer legal rights than men, are often less literate than men,
and have limited access to support services, credit, and inputs. The result is a marked increase in
poverty among AIDS widows. This feminization of poverty, a key characteristic of the socioeconomic impact of HIV/AIDS, has far-reaching consequences for rural societies, and
particularly youths, with girls/young women being most affected. Given the scale of the
HIV/AIDS epidemic in Uganda, the marked increase in poverty among young women and their
dependent children is likely to have a profound impact on the nation as a whole, particularly on
food security (as it is the women who are responsible for food production). For this reason, it is
critical that HIV/AIDS interventions address this trend to mitigate its impact and arrest the
crippling effect on Uganda's predominantly agricultural economy.
The AIDS stigma, in particular, can sever the access widows would otherwise have to assistance
from the extended family and the community. Much depends on how the husband's family reacts
to the death of a son. Often, the widow is blamed for transmitting the disease to the son and is
accused of promiscuity and immorality. Stigmatization may result in loss of respect within the
extended family and the community, abuse and repression. Several young widows in Kabarole,
Tororo and Gulu noted that their husbands' families could have helped them if they wanted to,
implying that the problem was not lack of resources but contempt and Stigmatization. Some
widows are harassed and forced to leave their village and migrate to the towns where they can
escape from the stigma, earn their living as petty traders and remarry in anonymity. The situation
is worse for widows who only have girl children, as the latter do not inherit land and property.
Youths whose parents die of AIDS in the towns are usually taken back to the village. Very often,
the youths have to adjust at once to being orphans as well as to adapting to village life. In some
cases, they may have never lived in the village and feel estranged from their new surroundings.
The return to agricultural work is often looked down upon by city youths. In addition, the
security and stability of family life is abruptly disrupted and there is no social net or mechanism

to help youths through this transition. Family life education often ceases, thereby increasing risk
behaviour among youths.
In some cases, orphans may run away from home or from the extended family home to escape
the AIDS stigma and the poverty that AIDS-afflicted and affected families are subjected to. A
case in point is Toro's 20-year-old son, Richard, (see AIDS Profile 1), who left home to escape
from the AIDS stigma and from poverty. He is now unemployed and his mother fears he may
become a delinquent.
For example, Richard, a 19-year-old youth in Nyankuku, Kabarole, moved back to the village
one year ago, after his-father's death. A driver in Kampala, his father died five days after burying
his two-year-old daughter who some suspected had AIDS. He also died of a "long illness."
Richard fives alone in his father's house. His grandmother, a widow in her early 60s, lives nearby
but has virtually no control over him. His half-sister, Rosette, who is 15, divides her time
between the homes of Richard and her paternal uncle.
Losing a parent to AIDS means that orphans have to assume new roles and responsibilities
within the nuclear as well as extended family. One AIDS widow in Bwabya, Kabarole, who has
six orphans, expressed grave concern about the impact of HIV/AIDS on her family: "The
children are lonely and sad without any family around the house while I work in the fields. I do
not know how to comfort them. I tell them they have to be self-reliant from now on, that they
cannot even rely on me as I also fear I am infected. I know I am asking them to grow up before
their time, but I see no other alternative if they are to survive."
Traditional roles, duties and responsibilities of family members become blurred, as AIDS places
additional demands and pressures on orphans, particularly economic uncertainty, stigmatization
and emotional insecurity. Girls appear to be carrying the brunt of the burden within the home and
are given more responsibilities and duties than boys. They are taken out of school to work at
home and on the farm and to sell produce in the market.
Some young women may be forced to break up their families to assist their AIDS-afflicted
parents. Jane Helen (AIDS Profile 1) left her husband behind in January 1993 in order to take
care of her mother who is suffering from AIDS. She is very torn by this decision because on the
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one hand she wants to take care of her mother, but on the other hand, she fears she may not have
a marriage or family to go back to, as her husband may decide to take another wife. Even if he
does not take another wife, however, Jane Helen fears he may be engaging in high risk behaviour
now that she is away but feels she does not have the right to confront him with it as she has
"abandoned" him.
Loss of access to labour in the shamba may result in declining agricultural productivity which in
combination with loss of cash income often leads to a deterioration of the quality of household
diet and a reduction in the number of meals. Malnutrition is on the rise in Gulu among AIDS
afflicted families. Lacor Hospital's Assistant Medical Superintendent said that kwashiorkor,
which was never a problem in the past, had since three years ago become the main reason for
child admission in the hospital, especially during the "hungry season".
AIDS-afflicted families may have reduced the number of meals per day and resorted to a less
varied diet but they still had enough to eat. This may be due to the fact that land is more fertile
and farming systems are more resistant than those in Tororo and Gulu. Farming systems in
Tororo (with the exception of lyolwa county) and Gulu are more fragile. In Tororo, the soil is less
fertile and food crops like cassava, sorghum and millet are more labour-intensive and need more
attention. The seasonality of crops is also an important factor. In Kabarole, for instance, matoke
can be harvested all year round. This is not the case with sorghum and millet in Tororo. Tororo is
also suffering from drought and its sandy soils may be affected more severely. The district has a
high population density and the land is cultivated beyond carrying capacity. In addition, the diet
in Tororo is poorer because fresh vegetables are not readily available throughout the year.
Vegetables (greens, tomatoes, eggplant, okra and pumpkin) are only available during the rainy
season. In addition, vegetables need extra preparation, oil-and-spices which poor people cannot
afford. Lastly, people in Tororo are not aware of the nutritional value of vegetables.
Land tenure and land transactions. Recent case studies have also revealed the impact of
HIV/AIDS on land tenure. In rural Africa, land is considered to be an important asset that will
sustain the livelihood of future generations, and it is the main generator of income through crops,
livestock, and/or rental to others. Affected households are more likely to lose their land than their
counterparts, with land holdings being transferred to in-laws, clan members, or creditors . Land
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inheritance rights in sub-Saharan Africa generally follow the male lineage. Thus, widows and
orphans often lose rights to land tenure, with the late husbands extended family claiming land
and other assets. While land is frequently intended to be held in trust for male orphans by male
caretakers from the extended family, land is not always returned when the oldest son comes of
age. Widows may also be reluctant to rent out land to others for fear of losing land tenure rights.
HIV/AIDS may exacerbate tensions over property ownership that already exist because of
population pressures, poverty, and gender inequality.
Social status and social connections; In many societies, AIDS is seen as a shameful disease,
and PLWAs experience stigma that results in reduced participation in community life, exclusion
from social networks, and less access to information, education, counseling, and other support
services. Stigma can affect not only the individual PLWA, but also the entire household. PLWAs
and their family members may withdraw from participation in agricultural clubs, where
information on new agricultural technologies is often shared, and this may reduce the
households knowledge and farming skills. In addition, lack of participation in agricultural clubs
reduces engagement in wider debates on community development that influence policy processes
and other broader agricultural objectives. HIV-related stigma may also limit food marketing
opportunities and interactions with agricultural extension workers, and may decrease
participation in community development activities. In short, the critical support provided by
social and economic networks may decrease at the times when it is most crucially required.
However in some societies HIV/AIDS is not seen as a social problem as discussed below;
By killing off mainly young adults, AIDS seriously weakens the taxable population, reducing the
resources available for public expenditures such as education and health services not related to
AIDS resulting in increasing pressure for the state's finances and slower growth of the economy.
This results in a slower growth of the tax base, an effect that will be reinforced if there are
growing expenditures on treating the sick, training (to replace sick workers), sick pay and caring
for AIDS orphans. This is especially true if the sharp increase in adult mortality shifts the
responsibility and blame from the family to the government in caring for these orphans.[2]

On the level of the household, AIDS results in both the loss of income and increased spending on
healthcare by the household. The income effects of this lead to spending reduction as well as a
substitution effect away from education and towards healthcare and funeral spending. A study in
Cte d'Ivoire showed that households with an HIV/AIDS patient spent twice as much on medical
expenses as other households.
With economic stimulus from the government, however, HIV/AIDS can be fought through the
economy. With some money, HIV/AIDS patients will have to worry less about getting enough
food and shelter and more about fighting their disease. However, if economic conditions aren't
good, a person with HIV/AIDS may decide to become a sex trade worker to earn more money.
As a result, more people become infected with HIV/AIDS.
Household health expenses; Households may expend substantial resources caring for a PLWA
through all stages of illness. These expenses may reduce the households available capital, since
cash is required for drugs, health care, hospital stays, and special highly-nutritious foods that are
recommended to be eaten with HIV drugs. The burden of direct health care costs, transportation
costs, lost time and wages due to waiting at health centers, and side effects can reduce adherence
to antiretroviral drug regimes and contribute to negative treatment outcomes. Deaths are
generally associated with substantial expenses, including funeral ceremonies, burials, and
potentially even travel and support costs for mourners. A death may further increase demands for
cash and erode the remaining household income, inducing sales of livestock, farm equipment,
and other assets. Despite these demands, survivors will try to protect valuable assets such as land
and trees to ensure the survival of the household. Non-affected households may also provide
assistance to members of other households after the death. However, reductions in household
incomes are found for HIV-affected households, particularly for poor and female-headed
households. Children may also be taken out of school to supplement the household labor force
and/or due to lack of funds for school fees, further eroding human capital in years to come.
Agricultural production and cultivated area; Beyond changes in cropping patterns, reductions
in household labor and resources can be expected to lead to reductions in agricultural cultivation
and output. With less labor, household farms may be reduced to a more manageable size or left to
fallow. In other cases, the time demands of caring for the PLWA may lead to delays or to
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skipping of weeding, tillage, or planting, further reducing agricultural productivity. The death of
an adult male head of household is particularly associated with declines in cultivated area, since
adult males are generally responsible for land clearing and cultivation. Beegle, citing reductions
in the production of food crops (maize, cassava, and beans), makes the important point that
reductions in agricultural output may be expected following a death, since household nutritional
and subsistence needs have fallen. This hypothesis makes sense for subsistence producers, but
may not hold for those who produce for the market and purchase food. Other authors report
reductions in agricultural output and land productivity, especially following the death of a male
head of household and for poorer households.
Market participation; Demands for caretaking and the need to replace the lost labor of the
PWLA can theoretically reduce off-farm and income-generating labor activities. Women are
likely to have income-earning activities curtailed due to care-giving responsibilities. Affected
households may reduce off-farm labor supply in some cases, but may also hire other unskilled
labor to replace lost household labor in others. Beegle found significant reductions in
participation in non-farm self employment and wage employment for adult men in the six
months preceding a death.
Differential vulnerability and food security effects; The range of literature reviewed
demonstrates how HIV/AIDS adversely affects household living standards and how structural
changes within the household system result in a loss of agricultural production. Actual household
impacts will be highly dependent on (1) the age and position of the affected household member,
with the death of an adult male head of household potentially having the most financial impact,
and the death of an adult female negatively affecting childrens educational opportunities and
participation in household labor; (2) the financial condition of the households, with poor
households being much more vulnerable; (3) the type of agriculture practiced in the region; (4)
the current limiting factors (land, labor, or capital) in the agricultural systems; and (5) whether
formal markets for labor and agricultural outputs exist, and the extent of participation in these
markets by households. Reductions in household agricultural output and income and changes in
cropping patterns can reduce households food security, reducing the nutritional quality of the
diet, and decreasing the number of meals per day
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REFERENCES
Bell C, Devarajan S, Gersbach H (2003). "The Long-run Economic Costs of AIDS: Theory and
an Application to South Africa" (PDF). World Bank Policy Research Working Paper No. 3152.
Retrieved 2012-04-17.
Greener R (2002). "AIDS and macroeconomic impact". In S, Forsyth (ed.). State of The Art:
AIDS and Economics. IAEN. pp. 4955.

Risley CL, Drake LJ, Bundy DAP (2012) Economic Impact of HIV and Antiretroviral Therapy
on Education Supply in High Prevalence Regions. PLoS One vol 7 issue 11
http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0042909