Linking ARVs with Nutrition, Food Security and Livelihoods:

RENEWAL in Africa

Stuart GillespieInternational Food Policy Research Institute

International AIDS Conference, Toronto, 15 August 2006

HIV and AIDSHIV and AIDS

Food and nutrition insecurityFood and nutrition insecurity - chronic- chronic

- acute- acute

Loevinsohn and Gillespie 2003

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

The Regional Network on HIV/AIDS, Rural

Livelihoods, and Food Security (RENEWAL)

Facilitated by IFPRI, RENEWAL brings together national networks of researchers, policymakers, public & private

organizations, and NGOs to focus on the interactions between HIV/AIDS and food and nutrition security.

Core pillars/processes of RENEWAL

Action research

CommunicationsCapacity

Why link nutrition with treatment?

Because malnutrition and disease interactMany PLWHAs are often malnourishedBecause PLWHAs and families often demand food firstNutritional support leads to:• Better drug bioavailability and efficacy of treatment• Better tolerance/ fewer side effects leads to better

adherence, which in turn leads to delays in development of drug resistance

• May prolong period before ARVs are requiredBetter nutritional status at start of treatment increases

survival (by a factor of six)

…but nutrition security is the goal

• Targeted nutrition interventions may provide useful short-term support for people living with HIV, so long as stigma and other barriers are dealt with….

• ….but ultimate aim should be to promote sustainable livelihoods which will ensure household and community-level nutrition security

Community-driven approaches are key

• Communities are responding to HIV and AIDS• They have incentives, local information, transparency,

accountability, latent capacity -- but they lack power and resources.

• AIDS is crosscutting, multisectoral, horizontal....

..…just like people’s lives.• Experience to build on (nutrition, CDD)• Community-government partnerships

Pillars of community–driven development

Local governmentCommunities and NGOS

Sectors

Can formal nutrition interventions complement local support networks?

A case study of AMPATH’s Nutrition Supplementation Program for Individuals on ARV treatment, in western Kenya

Elizabeth Byron, Stuart Gillespie and Mabel Nangami

Methodology

• Data Collection:1. Qualitative Research (Dec. ’05 – Feb. ’06)

• Key Informant Interviews (18)• Focus Group Discussions (9)• In-depth Interviews (80)

2. Modular household survey (March-Sept. ’06)

3. Clinical data from AMPATH Medical Records System

4. Data from HAART & Harvest Initiative on food distribution

Sources of support to PLWHA

• Formal Support – narrow and focused– ARV treatment– HHI/WFP food supplements – short-term– FPI- loans, skills training, employment– Patient support groups

• Informal Support – irregular, reciprocal– Family and relatives – informal transfers– Borrow from neighbours/friends– Religious institutions– Community (Harambee, merry-go-rounds)

Factors determining support

• Stigma and attitude toward PLWHA• Disclosure (awareness of needs vs. discrimination)• Social relationships (family, in-laws)• Competing needs and availability of resources• Seasonality (demand/supply)• Marital status• Gender• Children• Health status, duration of sickness

Interactions between nutrition intervention and informal social support networks

• Positive impact– Improved health status Catalyst for greater support – Balanced diet becomes accessible– Reallocation of household resources to other needs

• No change– No prior support (formal program fills gap)– Support remains constant

• Negative impact – Stigma, initially with food collection, declining – “Weaning” preparation not integrated – Dependency and expectation of support

Lessons1. Stigma remains a barrier to accessing community support2. Formal nutrition intervention acts as temporary relief and often

replaces overstressed informal networks.3. Observable health improvements in PLWHA can serve as a

catalyst for additional sources of support from community/family.4. Seasonal patterns of food availability imply a greater need for

formal support at different times of year.5. Large variation in individual access to support and ability to

successfully transition off food support at 6 months6. AMPATH Patient Support Groups fill unmet psychosocial needs

that family/friends may be unwilling to provide.7. Need for better local and external linkages and partnerships re:

livelihood support