From Durban to Lusaka

Ensuring Food and Nutrition Security in the Time of AIDS

Stuart GillespieInternational Food Policy Research Institute

Africa Forum, Lusaka, 8 May 2006

HIV and AIDSHIV and AIDS

Food and nutrition insecurityFood and nutrition insecurity - chronic- chronic

- acute- acute

Vulnerability of Livelihood Systems

Vulnerable Groups - Orphans, Elderly and Youth Headed Households,

Effect on InstitutionsCommunity-based, Civil society, Market, State, Global

OutcomesNutrition, Food Security, Education, Community Cohesion, Income

Effect on AssetsHuman, Financial, Social, Natural, Physical, Political

ResponsesIndividual, Household, Community

Susceptibility

HIV

Stigma and Discrimination

HIV/AIDS and Foodand Nutrition Security

From Evidence to Action

An international conference

Durban, South Africa

14–16 April 2005

PART ONE:INTERACTIONS AND IMPACTS

• Upstream: does food and nutrition insecurity hasten the spread of HIV?

• Downstream: does HIV/AIDS exacerbate or precipitate food and nutrition insecurity?

What determines susceptibility to HIV infection?

“The microbe is nothing, the terrain everything” (Louis Pasteur, 1850)

“In fact it is hunger that is leading to the rise in HIV infections in this area”

(Religious leader in Vizimba, from CARE Malawi/RENEWAL 2004

“Poverty leads to hunger that leads to unprotected sexual encounters that leads to HIV/AIDS that leads to an increased number of orphans that leads to hunger again. This is a vicious cycle we are enclosed in.”

(Dzama VAC, FGD, from CARE Malawi/RENEWAL 2004)

Food and nutrition insecurity HIV

• May increase exposure to the virus• Increases mobility/migration (“looking for food”)• Exacerbates gender inequality• HIV/AIDS as an occupational hazard

– Shifting livelihoods in Malawi (ganyu and sex)

• Ag. development may create nodes of risk (e.g. evening markets, trading centers)

• HIV/AIDS as a domestic hazard– Intra-household clustering of infection

– Parasitic infestation when collecting water

• Reduced access to, and ability to use, information• Food insecurity increases risk of malnutrition which may increase

risk of infection

Malnutrition HIV infection

Malnutrition compromises immune function increases risk of genital ulcers, STDs, mastitis increases risk of mother-to-child transmission

Vitamins B, C and E and immune function Intergenerational transmission of malnutrition (LBW,

prematurity) reduces infant gastrointestinal integrity and increases MTCT risk

HIV/AIDS Food and nutrition insecurity

• Who is impacted?• Why?• Vulnerability to AIDS impacts determined by status,

conditions and inability to adapt to change• Multiple, entwined processes of change lead to dynamic

vulnerability• Mortality x Vulnerability = Impact• Impacts are revealed in responses that people make• Is this “coping”?

Impacts of HIV and AIDS on agriculture

Subsistence, commercial, and agricultural extension

Resource (e.g. cash, labor) shortages and reduced productivity

- affects land use (crops, diversity, yields, livestock)- move to low input/low output farming- natural resource mining- child labor

Loss of farm-specific knowledge

- less intra-household learning (inexperienced farmers)- greater risk aversion to new technology- less appropriate farming practices in more hostile environment(less schooling due to dropout & teacher mortality)

Institutional capacity and organizational change

-loss of formal and informal institutional capacity- weaker rural organizations- changes in cultural norms, property rights

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

HIV/AIDS, poverty and inequality

• Mismatch between micro and macro impacts• For food and nutrition security, should we be so

concerned about macro-level aggregates or means?• Focus on poverty and inequality• AIDS and poverty are converging, though HIV still

spreads in higher-income groups.• AIDS is worsening inequality (socio-economic, gender)• Even AIDS programs can worsen inequality

– Free formula to AFASS mothers

Stigma, poverty and disclosure

• Stigma and poverty mutually reinforcing• As social networks in poorest communities erode and

collapse, stigma is becoming a distress response of the overwhelmed, a ‘survival strategy’ for some affected households

• Depending on social environment, disclosure of HIV status may be a gateway to positive coping, or to social exclusion

PART TWO: RESPONSES

Simultaneously:

1. Strengthen household and community:- resistance to HIV and

- resilience to AIDS

2. Preserve and enhance livelihood options and strategies- incentives for community mobilisation and development

- address real constraints (labor-saving or cash-saving?)

3. Social protection- more than “safety nets”- children affected by HIV and AIDS

Dynamics of the epidemic

Prevalence

Impacts

Time

Impacts

Prevalence

Focus: resistance Focus: …+ resilienceprevention mitigation

Development - Relief - Rehabilitation

Development

RehabilitationRelief

Community-driven approaches

• Communities are responding• They have incentives, local information, transparency,

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

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

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

Pillars of local and community–driven development

Local governmentCommunities and NGOS

Sectors

Mainstreaming HIV/AIDS• Why?

– To increase the scale of the response to HIV/AIDS– To reverse AIDS-induced capacity decline– HIV epidemics are endogenous to livelihood systems, not

exogenous– Many sectors both affect, and are affected by, AIDS– To exploit positive synergies between prevention, care, treatment

and mitigation– Because original food and nutrition goals (and MDGs) will not be

achieved unless implications are taken on board.• How?

– Embed core HIV indicators in M&E plans of development programs– Develop/refine tools for undertaking HIV-literate assessments, and

developing HIV-responsive policies and programs.

Bifocal lens

Lens checklist

1. How does this policy affect community, household or individual:

• Susceptibility to HIV exposure?• Vulnerability to the impacts of AIDS?

2. How serious and widespread are these effects?3. Is policy still relevant and appropriate?4. Are there unexploited opportunities to enhance:

• Resistance to HIV?• Resilience to the impacts of AIDS?

5. How can this be done?

Interventions

• ARVS are not the (single) answer– Impending ARV resistance– 5-10 window of opportunity…for those who can access drugs– Malnutrition may be narrowing this window– Need to innovate faster than the virus mutates

• Agriculture• Community-based natural resource management• Bio-structural interventions• Home/community gardening• Water, sanitation and environmental health• Food aid• Nutrition (links to WHO consultation)

Scaling Up

LARGE-SCALE IMPACT

CAPACITY ELEMENTS

INSTITUTIONAL ARRANGEMENTS

QUANTITATIVE

FUN

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PROJECT ACTIVITIES

Sparks

CONTEXT;- local- wider

CONTEXT;- local- wider

From data to wisdom (Selvester and McLean)

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

RENEWAL active in Kenya, Uganda, Malawi, South Africa, Zambia

The Effects of HIV/AIDS on Agricultural Production Systems in Zambia: A Restudy

CARE International ZambiaInternational HIV/AIDS Alliance, FAO

HIV/AIDS and Community Resilience in Zambia: Understanding the Implications for Food and Nutrition Policies

Farming Systems Association of ZambiaMinistry of AgricultureMichigan State UniversityIFPRI Washington DC

HIV/AIDS, Food and Nutrition Security in South Africa: Understanding and Responding

University of Western Cape, South AfricaIFPRI, Washington DC

Promoting agricultural innovation in AIDS affected rural households in KwaZulu-Natal, South Africa

Farmer Support Group, KwaZulu-NatalVrije Universiteit, Amsterdam

HIV/AIDS, land reform and land-based livelihoods in 3 provinces in South Africa

Human Sciences Research Council, South Africa

Impact of HIV/AIDS on inter- and intra-generational information flows among smallholder farmers, Malawi

Chancellor College, MalawiICRISAT-Malawi

HIV/AIDS, rural livelihoods and depeasantisation in Malawi: finding pathways to social recovery

CARE International MalawiCenter of Social Research, MalawiUniversity of Leiden, Netherlands

Farming Systems and Resilience to HIV/AIDS in Malawi

Institute for Policy Research and Analysis for Dialogue, Blantyre, Chancellor College

First Phase RENEWAL Studies (2004-2006)

Dealing with vulnerability: parents efforts to secure the future of their children (regional)

University of Cape Town, University of KwaZulu Natal, IFPRI, Southern Africa Vulnerability Initiative (SAVI)

Tuberculosis: An Additional Tipping Stress to Poor Households in South Africa and Zambia

Stellenbosch University, S.Africa; University Teaching Hospital, Zambia

HIV/AIDS, Food and Nutrition Security and Urban-Rural Linkages in Southern Africa

IFPRI, RENEWAL, Southern African Migration Project

Impact of a Nutrition Program for AIDS Patients and its role in their Coping Strategies in Western Kenya

Moi University, AMPATH, IFPRI, Columbia University, USA, World Bank

HIV/AIDS Mortality and the Role of Woodland Resources in the Maintenance of Household Food Security in Rural Limpopo Province, South Africa.

SUNRAE Program; University of Witwatersrand, University of Colorado at Boulder, USA

Gender Issues in HIV/AIDS and Food/Nutrition security among Internally Displaced People’s Camps in Uganda

Makerere University

Land Ownership and Food Security in Uganda: A Study of the Use and Control of Land Among Households of Women Affected by HIV/AIDS in Four Districts

Makerere University and National Community of Women Living with HIV/AIDS

The Effects on Rural Livelihoods of Increasing Rates of HIV/AIDS-related Illness and Death in Zomba South, Malawi

Kennedy School of Government, Harvard University, Bunda College of Agriculture, Zomba

Second Phase RENEWAL Studies (2006-2008)

Lessons and Challenges• Beware AIDS exceptionalism

– Use an HIV lens, not a filter• Think livelihoods, not agriculture• Beware “either/or” mentality

– ARVs are not the (single) answer• Face challenge of diversity, complexity, context-specificity• Use/adapt tools to move from understanding to responding• Evidence-based action (but don’t wait for last 5%!)• Learn by doing (action research)….• …and by monitoring, evaluating and communicating• Don’t use yesterday’s blanket solutions (“installed capacity”)• Innovate, document and disseminate• Balance quality, speed, capacity, but….…..think big! • Scale up:

– Focus on the process beyond the project, think about capacity and incentives. Aim for transformation, not exit strategies.

• Link research with action, both ways