AIDS and Hunger in Africa: Challenges and Responses
November 20, 2006
As the multi-faceted impact of the AIDS hyper-epidemics across southern Africa continues to intensify, we are witnessing the development of dangerous new interactions that threaten the trajectory of national social and economic development. Recognition of the complex, long-wave aspects of the AIDS crisis has been slow to dawn. We now know how AIDS epidemics are fundamentally shaped and driven by people’s livelihood strategies, and by their constraints and opportunities. We know that the epidemics are essentially multi-sectoral both in cause and consequence. And finally, we know that much of what is happening and what needs to be done depends critically on understanding local context and dynamics.
Among the many interactions at play, the vicious cycle between AIDS and food insecurity is particularly disturbing. There are in fact several cycles at different levels. One, between malnutrition and disease, gets straight to work in the human body directly after an individual has become infected with HIV. The importance of nutrition for immune function was understood forty years ago when the term NAIDS (“Nutritionally Acquired Immune Deficiency Syndrome”) was first used.
Another vicious cycle revolves around a household’s degree of access to the food it needs. On the upstream side of viral transmission, food insecurity may put poor people at greater risk of being exposed to HIV – for example through forced migration to find work, or through poverty-fuelled adoption of transactional sex as a “survival” strategy. And on the downstream side, the various impacts of chronic illness and premature mortality on household assets and resources are well documented. Throughout, it is the poor, and especially poor women, who are least able to respond.
The primary livelihood base of most people globally infected or affected by HIV and AIDS is agriculture. In eastern and southern Africa, the AIDS epidemic is already having serious consequences for agriculture by affecting adults at the height of their productive years, making it difficult for poor people – and again especially poor women -- to provide food for their families. The critical constraint may not be labor power – it may be a lack of cash due to the new financial demands brought by the illness. Some studies show a limited current impact on agriculture, but it is important to realize that this may change when young adults, who are disproportionately at risk from HIV, are expected to become household heads. Moreover, we know very little of the long-term impacts that AIDS imposes through fracturing the intergenerational transfer of knowledge and skills from farmers to their children. The agricultural impact wave is only beginning in southern Africa.
Despite the limited, albeit growing, understanding of these interactions, and the increasing lip service paid to them, multi-sectoral responses remain thin on the ground. Responses that match the size of the problem are overwhelmingly sectoral and vertical, with a few scatterings of mostly small-scale innovation. Rhetoric abounds, but most development organizations remain locked in comfortable systems and timelines that simply do not align with the dynamics of AIDS. Against the backdrop of the epidemic, it is easy to succumb to a convenient state of denial or a creeping sense of professional paralysis.
To the agriculture professional who asks “why should I bother about AIDS?” the answer is in fact simple – if the agricultural sector in Africa fails to proactively take HIV and AIDS into account, it will not be able to achieve its primary objective of improving food production and access. Similarly, international agricultural organizations supporting African agriculture need to mainstream AIDS to remain relevant, or the first Millennium Development Goal – eradicating extreme poverty and hunger – will remain a hopeless dream. First and foremost, the rationale for bothering about AIDS is one of professional self-interest.
Another reason for the agricultural professional to be engaged is that developments important to the professional – and to Africa’s poor and hungry – are in fact happening in many places in Africa. Communities are responding, community-based, non-governmental organizations are actively innovating, and governments are beginning to go beyond declarations on paper to put in place AIDS-responsive programs. The recent conferences organized by the International Food Policy Research Institute in Durban in 2005 and the Africa Forum organized by Project Concern International in Lusaka earlier this year, not only demonstrated the huge demand for knowledge, but also the plethora of grassroots innovations aimed at stemming the “dual epidemics” of AIDS and hunger.
Applying a context-specific “HIV lens” to food and nutrition programming often reveals simple modifications to programs that can improve their impacts on both hunger and AIDS. Vicious cycles can be reversed and become virtuous. Improving rural livelihoods and agricultural production can help reduce both the spread of HIV and the impacts of AIDS. Programs that reduce the need for poor people to migrate to look for work (e.g. by restoring degraded land) can reduce their risk of being exposed to the virus.
On the flip side, applying a “food and nutrition lens” to the core AIDS program strategies of prevention, care, and treatment can likewise reveal potential synergies. For example, we know that individuals who are malnourished when they start antiretroviral therapy are six times more likely to die in a given period than well-nourished new patients. We know that good nutrition improves the efficacy of the drugs, reduces their side-effects, and improves adherence with treatment regimens. Such effects will generate both short-term benefits to the patient as well as major long-term benefits as better adherence slows the development of drug-resistant strains. The U.S. Presidential Emergency Program for AIDS Relief (PEPFAR) is beginning to address these implications, but responses need to go beyond “wrap-around programming.” They must be founded on an active link between agriculture and health programming, with livelihood security as the pivotal interface.
Overriding all this new activity however is the clear and present need to increase the scale of effective responses to match the scale of the epidemic in order to generate a true, sustained impact. At the same time, it is important to identify which community-driven responses are working before looking at ways to bolster them, and to provide additional support where local response capacity is exceeded. Governments and international organizations need to work together to develop strategies for simultaneously strengthening community resilience and creating synergistic forms of state-led social protection.
“Learning by doing” is a well-worn adage, and it is a useful mode of response when time is constrained. But for any “doing” to be accompanied by real learning, simple actionable systems of monitoring and evaluation – woefully neglected in the past -- need to be put in place. And for the learning to be widespread, stakeholders must become better connected. Networks like RENEWAL have sprung up in recent years to catalyze and scale up such learning in real time.
Three years ago the United Nations recognized Africa’s “triple threat” of AIDS, food insecurity and diminishing capacity; and in June of this year, Article 28 of the UN General Assembly Political Declaration on AIDS was agreed, explicitly calling for “all people at all times to have access to sufficient, safe, and nutritious food…as part of a comprehensive response to HIV/AIDS.” We now have the evidence and the mandate – what we need now is more effective action.
Stuart Gillespie is Senior Research Fellow, International Food Policy Research Institute; and Director, Regional Network on AIDS, Livelihoods and Food Security (RENEWAL).
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