The Cycle of AIDS and Hunger in Africa
As the impact of the AIDS hyper-epidemics in southern Africa continues to grow, we are witnessing the development of dangerous interactions that threaten the trajectory of national social and economic development. Recognition of the multidimensional aspects of the AIDS crisis has been a slow dawn.
Among the many interactions at play, the vicious cycle between AIDS and food insecurity is particularly disturbing. There are several cycles. One, between malnutrition and disease, gets to work in the human body immediately after an individual has become infected with HIV. The importance of nutrition for immune function was understood forty years ago when the term Nutritionally Acquired Immune Deficiency Syndrome (NAIDS) was first used.
Another cycle revolves around a household’s access to the food it needs. Food insecurity puts poor people at greater risk of being exposed to HIV—for example through migration to find work or through the adoption of transactional sex as a survival strategy. The impact of chronic illness on household assets is well documented. It is the poor, and especially poor women, who are least able to respond.
The base with the greatest number of people globally affected by HIV and AIDS is agriculture. In eastern and southern Africa, the AIDS epidemic has serious consequences for agriculture by affecting adults at the height of their productive years, making it difficult for poor people to provide food for their families.
The critical constraint may be a lack of cash due to the new financial demands brought by the illness. Some studies show a limited 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 head a household. Moreover, we know little about the long-term impacts that AIDS imposes through breaking the transfer of knowledge and skills from farmers to their children.
Despite the growing understanding of these interactions, multisectoral responses remain thin. Responses are overwhelmingly vertical, with a smattering of mostly small-scale innovation. Most development organizations remain locked in comfortable systems that fail to align with the dynamics of AIDS. Against this backdrop, it’s easy to succumb to a creeping sense of professional paralysis.
Agriculture professionals may ask, “Why should I bother about AIDS?” The answer is simple: If the agricultural sector in Africa fails to take HIV/AIDS into account, it will fail to achieve its primary objective of improving food production and access. Similarly, international organizations supporting African agriculture need to consider AIDS to remain relevant, or the first Millennium Development Goal will remain a distant dream. The rationale is professional self-interest.
Some progress is being made: Communities are responding. Nongovernmental organizations are innovating. Governments are beginning to go beyond declarations to put in place AIDS-responsive programs. The 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 demonstrated the demand for knowledge, as well as the grassroots innovations aimed at stemming the dual epidemics of AIDS and hunger.
Applying an HIV lens to food and nutrition programming often reveals simple modifications to programs that can improve their impact on both hunger and AIDS. Vicious cycles can be reversed and become virtuous. Improving rural livelihoods and agricultural production can help reduce the spread and impact of HIV/AIDS. Programs that reduce people’s need to migrate for work, by restoring degraded land for example, can reduce the 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 reveal potential synergies. Individuals who are malnourished when they start antiretroviral therapy are six times more likely to die in a given period than are well-nourished new patients. Good nutrition improves the efficacy of 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 United States President's Emergency Program for AIDS Relief (PEPFAR) is beginning to address these implications. But responses need to go beyond “wrap-around” programming between NGOs and governments. They must link agriculture and health programming, with livelihood security as the pivotal interface.
Above all, the scale of responses must match the scale of the epidemic in order to generate a true impact. 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 is successful.
“Learning by doing” is a well-worn adage. But for any doing to be accompanied by learning, actionable systems of monitoring and evaluation need to be put in place. For the learning to be widespread, stakeholders must become better connected. Networks like RENEWAL have sprung up in recent years to scale up such learning.
Three years ago the United Nations recognized Africa’s “triple threat” of AIDS, food insecurity, and diminishing capacity. In June of this year, Article 28 of the UN General Assembly Political Declaration on AIDS was adopted:
Resolve to integrate food and nutritional support, with the goal that all people at all times will have access to sufficient, safe and nutritious food to meet their dietary needs and food preferences, for an active and healthy life, as part of a comprehensive response to HIV/AIDS;
We have the evidence and the mandate—what we need now is more action.
A variation of this article first appeared in the CSIS Africa Policy Forum. blog comments powered by Disqus