HIV, Food Security and Nutrition:
What we know, and what we should do
Stuart Gillespie
International Food Policy Research Institute
Regional Network on AIDS, Livelihoods and Food Security
Irish Aid, World AIDS Day seminar, 26 November 2008, Dublin
Contents
• Interactions between HIV, food security and nutrition• Responses• Food prices and food crises• Operational and research challenges• RENEWAL approach
HIV AIDSHIV AIDS
Food insecurity and malnutritionFood insecurity and malnutrition - chronic- chronic
- acute- acute
HIV and Poverty in Africa
0%
5%
10%
15%
20%
25%
0 10 20 30 40 50 60 70 80
Percentage below $1 per day
HIV
Pre
va
len
ce
BotswanaLesotho
NamibiaZimbabwe
Zambia
Malawi
Mozambique
Sierra Leone
Tanzania
Central African Republic
Ethiopia
Côte d'Ivoire Uganda
Kenya
Rwanda
South Africa
Mali
NigeriaCameroon
NigerMadagascar
Gambia
BurundiGhana
Burkina FasoSenegalMauritania
Southern AfricaR squared = 0.0996not significant
E&W AfricaR squared = 0.0307not significant
HIV and Income Inequality in Africa
R2 = 0.4881p=0.005%
0%
5%
10%
15%
20%
25%
30%
35%
0.25 0.35 0.45 0.55 0.65 0.75
GINI Coefficient
HIV
Pre
vale
nce
Botswana
Lesotho
NamibiaZimbabwe
Zambia
Malawi
Mozambique
Tanzania
Central African Republic
Ethiopia
Côte d'IvoireUganda
Kenya
Rwanda
South Africa
Mali
Nigeria
Cameroon
Niger
BurundiGhana
Senegal
Swaziland
Upstream vulnerability (exposure to HIV)
Risks HIV AIDS Impacts
Poverty? Wealth?Food insecurityMobilityGender inequalitiesSocial cohesionHope?
Midstream vulnerability (susceptibility to disease)
Risk HIV AIDS Impacts
STIs (especially HSV-2)
Malnutrition
Food insecurity (time, resources for care)
Downstream vulnerability (to impacts of AIDS)
Risk HIV AIDS Impacts
• Depends on quantity, quality and mix of assets at household and community levels, institutional context and processes.
• Intra-household effects (women, children)• In general, AIDS impoverishes (directly and indirectly)
In sum….Pathways and interactions are complex.
Relationships are dynamic and few, if any, are linear
Upstream• Inequalities (socio-economic, gender, age) are fundamental drivers of
HIV transmission• “Food insecure” women are also particularly vulnerable• Social cohesion and individual hope are under-researched
Midstream• Malnutrition and coexisting STIs are important
Downstream• AIDS impoverishes households, but severity and type of effects depend
on configuration of assets and capabilities• Women and children particularly affected
How to respond?
Livelihood/food insecurity
HIV & AIDS
Malnutrition
Agriculture
Social protection
HIV programs
Nutrition/health programs
Food and nutrition along the HIV timeline
Risk HIV AIDS Impacts
Prevention Care & treatment Mitigation
At each point, what are the key roles of food and nutrition research and programming?
Prevention
Risk HIV AIDS Impacts
Prevention Care & treatment Mitigation
• Strengthen women’s food security• Explore alternatives to migration• Improve maternal nutrition (MTCT)
The Vicious Cycle of Malnutrition and HIV
Insufficient dietary intakeMalabsorption , diarrheaAltered metabolism and
nutrient storage
Increased HIV replication
Hastened disease progression
Increased morbidity
Increased oxidative stress
Immune suppression
Nutritional deficiencies
Source:Semba and Tang, 1999
Care and treatment
Risk HIV AIDS Impacts
Prevention Care & treatment Mitigation
• Ensure adequate nutrition (pre- and during ART) - malnutrition and immune function decline (pre-
ART)- malnutrition and survival on ART initiation- nutrition and treatment adherence- nutrition and treatment effectiveness
Mitigation
Risk HIV AIDS Impacts
Prevention Care & treatment Mitigation• Address real constraints (cash, labor?)• Ensure access to land and finance• AIDS-responsive social protection• Preserve knowledge• Focus on women and children (food, health, care)
• Inheritance rights• Child schooling and care
Operational challenges and research questions
• Equity (who is vulnerable?, who is eligible?)
• Operationalizing food and nutrition support in resource limited settings– Therapeutic feeding
– Food/cash transfers to affected households
– Livelihood incentives and support
• AIDS-sensitive pathways out of poverty– Microfinance plus empowerment generates income and reduces risk
• Building bridges between agriculture and health– Linking small-scale agric with health and education services
• Community resilience/capacity and state-led support
“No general approach will work everywhere and……
…no single-component intervention will work anywhere” (Wellings et al 2006)
Food prices and food crises
• Such interactions are more common and more severe• RENEWAL/UNAIDS/ NAP+ eastern and southern Africa• Additional problems due to “tipping points” being
broached e.g. children denied schooling, ARV treatment stopped….
• Requires:– Tracking vulnerability– Proper integration of food/nutritional assistance in HIV response– Social protection systems (community-government partnerships)
The Regional Network on AIDS,
Livelihoods and Food Security (RENEWAL)Regional Network on AIDS, Livelihoods and Food Security
Facilitated by IFPRI, RENEWAL brings together national networks of
researchers, policymakers, public & private
organizations, and NGOs
to address the interactions between HIV, AIDS and food and nutrition security.
IMPACT
Research: scientific, operational
Action:policy
interventionslocal responses
Capacity Communications
Livelihood/food security
HIV & AIDS
Nutrition
Lessons and Challenges• Use different lenses (HIV lens, food/nut lens) not filters
• Think livelihoods, not agriculture
• Link food security with nutrition (nutrition security)
• Beware “either/or” mentality– ARVs are not the (single) answer
• Be comprehensive, but also focused
• Diversity, context-specificity…but need for scale-up
• Use/adapt tools to link understanding with responding
• Evidence-based action (but sail the ship while building it!)
• Learn by doing (action research), by monitoring, evaluating and by communicating
• Innovate, document and disseminate
• Balance quality, speed, and capacity