HIV, Food Security and Nutrition:

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• 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

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Contents

• Interactions between HIV, food security and
  nutrition
• Responses
• Food prices and food crises
• Operational and research challenges
• RENEWAL approach

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Three coexisting/interacting crises
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HIV AIDS Food
insecurity and malnutrition - chronic
- acute
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HIV Food
insecurity
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HIV and Poverty in Africa
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HIV and Income Inequality in Africa
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Upstream vulnerability (exposure to HIV)

• Risks HIV AIDS Impacts
• Poverty? Wealth?
• Food insecurity
• Mobility
• Gender inequalities
• Social cohesion
• Hope?

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HIV AIDS
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Midstream vulnerability (susceptibility to
disease)

• Risk HIV AIDS Impacts
• STIs (especially HSV-2)
• Malnutrition
• Food insecurity (time, resources for care)

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AIDS
Food insecurity
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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)

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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

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How to respond?
Nutrition/health programs
Social protection
Agriculture
HIV programs
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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?

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Prevention

• Risk HIV AIDS Impacts
• Prevention Care treatment Mitigation
• Strengthen womens food security
• Explore alternatives to migration
• Improve maternal nutrition (MTCT)

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The Vicious Cycle of Malnutrition and HIV
Insufficient dietary intake
Malabsorption
, diarrhea
Altered metabolism and
nutrient storage
Increased HIV
Nutritional
replication
deficiencies
Hastened disease
progression
Increased morbidity
Increased oxidative
stress
Immune suppression
Source
Semba
and Tang, 1999
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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

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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

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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)

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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)

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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.

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IMPACT
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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-specificitybut 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