ECONOMIC AND SOCIAL RESEARCH COUNCIL END OF AWARD REPORT

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1 ECONOMIC AND SOCIAL RESEARCH COUNCIL END OF AWARD REPT For awards ending on or after 1 November 2009 This End of Award Report should be completed and submitted using the grant reference as the subject, to reportsofficer@esrc.ac.uk on or before the due date. The final instalment of the grant will not be paid until an End of Award Report is completed in full and accepted by ESRC. Grant holders whose End of Award Report is overdue or incomplete will not be eligible for further ESRC funding until the Report is accepted. ESRC reserves the right to recover a sum of the expenditure incurred on the grant if the End of Award Report is overdue. (Please see Section 5 of the ESRC Research Funding Guide for details.) Please refer to the Guidance notes when completing this End of Award Report. Grant Reference RES Grant Title Livelihood Trajectories and HIV and AIDS in South West Uganda a longitudinal study of rural households (follow-on funding) Grant Start Date 1 st July 2009 Total Amount 80, Grant End Date 30 th June 2010 Expended: Grant holding Institution University of East Anglia Grant Holder Professor Janet Seeley Grant Holder s Contact Details Address School of International Development, University of East Anglia, Norwich, NR4 7TJ Co-Investigators (as per project application): Institution j.seeley@uea.ac.uk Telephone

2 1. NON-TECHNICAL SUMMARY Please provide below a project summary written in non-technical language. The summary may be used by ESRC to publicise your work and should explain the aims and findings of the project. [Max 250 words] This project builds on the ` Livelihood Trajectories and HIV and AIDS in South West Uganda a longitudinal study of rural households (Trajectory) study. The research site is in Kalungu (formerly part of Masaka) District, a study area of the Medical Research Council/Uganda Virus Research Institute Research Unit on AIDS in Uganda. Further analysis of the Trajectory study data has been undertaken and the impact of the epidemic in Uganda on demographic structure, agriculture and rural livelihoods over the last 20 years explored. Analysis of new data generated from a study with the same population (funded by SIDA, through FAO) which looks particularly at the impact on agricultural livelihoods, is being undertaken for this project. By using the data from both the Trajectory and FAO studies we can look in more depth at the impact HIV-related infection and AIDS-related deaths have had on broader livelihoods in individual households and wider family groups. The study contributes to building an understanding of the long-term impact of HIV and AIDS and the design of policies and programmes for impact mitigation. The project has facilitated data sharing and discussion on the impact of HIV on demographic change with researchers working with population cohorts in Tanzania and Malawi, as well as a population cohort in Rakai District, Uganda. 2. PROJECT OVERVIEW a) Objectives Please state the aims and objectives of your project as outlined in your proposal to the ESRC. [Max 200 words] The overall objective is to analyze the trajectories of individuals, households and communities affected by HIV and AIDS and the impact of HIV and AIDS in Uganda on demographic structure, agriculture and rural livelihoods over the last 20 years, in order to understand the long-term impact of the epidemic and to contribute to the design of policies and programmes for impact mitigation. The specific objectives are to: Understand the impact of the AIDS epidemic on household demographic structure and what implications this has had for household human capital (labour availability, skills, education, health) and individual well-being. Examine the implications of illness and deaths on social and economic well-being of surviving household members (especially vulnerable groups such as orphans, widows, and the elderly). Describe how individuals/households/communities have responded to the epidemic and what the livelihood trajectories have meant in terms of household and community viability over time. Explore how the availability of Anti-Retroviral Therapy may have modulated the impact of the epidemic on households, and if so, explain how this has been accomplished. Anticipated outputs included briefings to local/national government officials and participants; conference papers; policy briefs as well as peer-reviewed journal articles. 2

3 b) Project Changes Please describe any changes made to the original aims and objectives, and confirm that these were agreed with the ESRC. Please also detail any changes to the grant holder s institutional affiliation, project staffing or funding. [Max 200 words] The aims and objectives have remained the same. Progress on the categorisation of households in the General Population Cohort has been slower than expected, as has been reported in the quarterly reports. However, this painstaking work has been partly integrated into a PhD which Pamela Nasirumbi (the statistician on the previous ESRC funded trajectory study) is undertaking at the London School of Hygiene and Tropical Medicine (funded by MRC), which is yielding interesting results. Discussion on her findings has already resulted in a change in the way the annual survey data are collected, which is reported below under `impact. c) Methodology Please describe the methodology that you employed in the project. Please also note any ethical issues that arose during the course of the work, the effects of this and any action taken. [Max. 500 words] The General Population Cohort (GPC) of the MRC/UVRI was established in 1989 in a subcounty in Masaka district in south-western Uganda. The total population covered is about 20,000 people of all ages. Since the first survey round in 1989/90 annual data have been collected by the use of three questionnaires: the household survey on residential house characteristics and household items; the individual census covering residency and individual characteristics; and the medical survey that asks questions on illness/treatment, pregnancy/births, sexual behaviour etc. Individuals are also asked to give blood for HIV (and selected non-communicable disease) testing (approximately 70% of adults consent in a survey round). Every four years additional socio-economic data are collected. The 20 years of data available consists of information on family structures, assets of households and demographic changes, such as marriage and migration as well as health. In 1989/90 and 2008/09 additional information on crops and livestock was collected. The survey data are augmented by substudies, including the Trajectory study in 2006/2007, when more detailed information on agricultural livelihoods was collected. Using this wealth of data, local statisticians have undertaken detailed analysis to link the data on demographic change/rural livelihoods with HIV infection in households. We have explored, for example, the changes in household composition attributable to deaths and HIV-related illness. We have looked at the impact of changes in household composition (due to children growing up, older people ageing, migration and individual and household movements etc.) and changes in land use and cropping patterns. Changes in movable assets, as well as access to external support, are being tracked across time. In addition to the statistical analysis, a post-doctoral researcher has assisted in the in-depth analysis of qualitative data from the Trajectory study through which we are exploring how people s livelihoods have been affected by the epidemic. With a local health economist we have also used calendar data from 144 households interviewed for the Trajectory study to examine changes in their agricultural livelihoods. This project has also benefited from new data collection in the GPC (and also in a neighbouring population cohort in Rakai District, not described here) which was funded through FAO. A stratified random sample of 200 households was selected to explore changes in farming systems from 1989 to 2009, and the possible impact the HIV epidemic and other adverse events(such as drought) have had on crops grown, animals kept/reared and amount of land cultivated. Data have been collected using a modified version of the household calendar, successfully used in the Trajectory study. A sub-sample of 10 percent of the households was 3

4 selected for in-depth qualitative data collection (this continues until December 2010). These households were purposively sampled to represent households directly affected by HIV and those that have not had anyone living with HIV in the household over the 20 year period. No unexpected ethical issues arose, although we were careful about asking questions about land; an increasingly emotive issue in Uganda. Ethical clearance is up-to-date. d) Project Findings Please summarise the findings of the project, referring where appropriate to outputs recorded on ESRC Society Today. Any future research plans should also be identified. [Max 500 words] Findings on the `household categorisation are summarised in a draft report by Nasirumbi on `Household survival and changes in characteristics of households in rural South-western Uganda through the period of When this is finalized (December 2010), the summary will be put on ESRC Society Today. We focus this report on one part of our analysis: the impact of the HIV-epidemic on households in the GPC. We found that not only are household specific circumstances, including links to social networks, important in determining the possible impact of the epidemic but there are wider circumstances and other drivers of change in the rural economy that need to be factored into building an understanding of household specific cause-effect relations related to AIDS impact. A further complication was that many of the households to be `HIV-infected had reformed after the person with HIV had died and had not had anyone with HIV living in the household for many years. A summary of some of our key findings: roughly half the population has been below 15 years throughout the study period. It is not surprising, therefore that the dependency ratio is high, it was142 at baseline in 1990, 135 in However we found differences, with dependency ratios in HIV-infected households rising to become consistently above the dependency ratio in HIVuninfected households from 1996/97 to 2003/04. This was surprising but may be related to external support received. With respect to household size the evidence does not point to major changes or differences due to HIV-infection. Findings on school dropouts, fostering and socio-economic status show a mixed picture (Bukenya et al. 2010). The patterns of school dropouts and fostering show no direct link to HIV-infection. We analysed the overall trend taken by acreage cultivated for all households and then compared HIV-infected and HIVuninfected households. The average land under cultivation was higher in HIV-infected households at baseline. However the average area under cultivation for infected households decreased over time and in 2008 it was the same as the average acreage under cultivation in HIV-uninfected households. While our findings suggest some link between HIV-infection and crops grown which may be related to labour constraints, the picture is not clear. Loss of labour could be as much due to household members migrating to urban areas or to Lake Victoria for work, as to illness and death due to HIV. We suggest that the evidence does not show a direct linear connection between HIV and AIDS and outcomes across all the factors we have explored. What this indicates is that the wider context is important, with HIV being one factor among many that has shaped household livelihood trajectories. Households, and more particularly the wider social networks which link different households, may be much more resilient on the whole than had been expected (Seeley et al. 2010). We now wish to explore these questions in more depth not only in Uganda (in two cohorts) but also with population cohorts in Tanzania and Malawi. 4

5 e) Contributions to wider ESRC initiatives (eg Research Programmes or Networks) If your project was part of a wider ESRC initiative, please describe your contributions to the initiative s objectives and activities and note any effect on your project resulting from participation. [Max. 200 words] N/A 3. EARLY AND ANTICIPATED IMPACTS a) Summary of Impacts to date Please summarise any impacts of the project to date, referring where appropriate to associated outputs recorded on ESRC Society Today. This should include both scientific impacts (relevant to the academic community) and economic and societal impacts (relevant to broader society). The impact can be relevant to any organisation, community or individual. [Max. 400 words] In GPC rounds 1-20 households were identified by location such that when a household relocates to another location it takes the village and house number of the new location. This makes tracing a household as a social-group between rounds difficult unless the household remains in the same location. In Round 21 this was changed as a direct result of this project to enable the tracing of households over time. Now households have been uniquely identified as social groups and the building has a separate number for the geographical location. This saves further reclassification in future, which we have done for Rounds The Director of the MRC/UVRI Uganda Research Unit on AIDS has agreed to make studying the longitudinal impact of HIV a theme for the next 5 year plan for the Unit ( ). In addition to other outputs on ESRC Society Today we have: a paper reflecting on the relationship between health and agricultural livelihoods under review with Tropical Medicine and International Health; nine draft chapters for a proposed book on the longitudinal impact of HIV in south western Uganda; a draft paper on methods; two draft policy briefs and a report for FAO (to be completed in October 2010); Pamela Nasirumbi s report (listed above) and a chapter in press on HIV and livelihoods in a book shortly to be published by Earthscan. We shared selected results at a dissemination workshop with local District officials (including department heads of health and agriculture) on 16 th September Feedback from participants was very favourable. We have shared summary findings with local councillors in the study sub-county as well as visited participants to share preliminary findings. Once the FAO study data collection and analysis is fully complete we will host an open-day in the study area to share and discuss this and the FAO study findings. We hosted a workshop in May 2010 with representatives from population cohorts from Rakai district (Uganda), Tanzania and Malawi and shared approach and findings. An outcome of that workshop was an agreement to do further research together on this topic comparing and contrasting the longitudinal impact across cohorts. A proposal has been submitted to the current ESRC/DFID call. We shared findings with FAO (Uganda) office. As a result they requested a proposal for an 5

6 international conference on the topic of HIV-impact and agricultural livelihoods. This was done and FAO is now seeking funding. b) Anticipated/Potential Future Impacts Please outline any anticipated or potential impacts (scientific or economic and societal) that you believe your project might have in future. [Max. 200 words] Further publications will come out over the next 12 months. Pamela Nasirumbi will finish her PhD in We hope another local statistician might begin his PhD in A dissemination workshop for government officials for this and two projects on the impact of HIV on older people is planned for Kampala in December We anticipate the international conference, noted above, will take place in February/March Among the invitees will be Dr Jonathan (Tim) Williams, who with colleagues has undertaken research on the non-cancer aspects of mycotoxins and anaemia during pregnancy which shows it is promoted by chronic aflatoxicosis. They have data showing the same for TB in HIV+ people and a publication which shows immunity being synergistically suppressed by HIV and aflatoxicosis. This team is interested in doing collaborative research on the role of crop pests and diseases in facilitating HIV-infection/progression in Africa. Janet Seeley is in discussion with them over research proposals and funding applications. Janet Seeley is giving a public lecture based on results from this project in London on 25 th November Discussions will continue with researchers from other population cohorts in Africa with whom we hope to do collaborative research. You will be asked to complete an ESRC Impact Report 12 months after the end date of your award. The Impact Report will ask for details of any impacts that have arisen since the completion of the End of Award Report. 6

7 4. DECLARATIONS Please ensure that sections A, B and C below are completed and signed by the appropriate individuals. The End of Award Report will not be accepted unless all sections are signed. Please note hard copies are NOT required; electronic signatures are accepted and should be used. A: To be completed by Grant Holder Please read the following statements. Tick ONE statement under ii) and iii), then sign with an electronic signature at the end of the section. i) The Project This Report is an accurate overview of the project, its findings and impacts. All coinvestigators named in the proposal to ESRC or appointed subsequently have seen and approved the Report. ii) Submissions to ESRC Society Today Output and impact information has been submitted to ESRC Society Today. Details of any future outputs and impacts will be submitted as soon as they become available. This grant has not yet produced any outputs or impacts. Details of any future outputs and impacts will be submitted to ESRC Society Today as soon as they become available. This grant is not listed on ESRC Society Today. X X iii) Submission of Datasets Datasets arising from this grant have been offered for deposit with the Economic and Social Data Service. Datasets that were anticipated in the grant proposal have not been produced and the Economic and Social Data Service has been notified. No datasets were proposed or produced from this grant. X 7