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

Livelihood/food insecurity

HIV & AIDS

Malnutrition

Three coexisting/interacting crises

HIV AIDSHIV AIDS

Food insecurity and malnutritionFood insecurity and malnutrition - chronic- chronic

- acute- acute

HIVHIV

Food insecurityFood insecurity

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?

HIV AIDSHIV AIDS

Midstream vulnerability (susceptibility to disease)

Risk HIV AIDS Impacts

STIs (especially HSV-2)

Malnutrition

Food insecurity (time, resources for care)

AIDSAIDS

Food insecurityFood insecurity

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