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Transcript of From Durban to Lusaka Ensuring Food and Nutrition Security in the Time of AIDS Stuart Gillespie...
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
Prevalence
Impacts
Time
Impacts
Prevalence
Focus: resistance Focus: …+ resilienceprevention mitigation
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
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.
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
CTIO
NA
L
PO
LIT
ICA
L
OR
GA
NIZ
ATI
ON
AL
PROJECT ACTIVITIES
Sparks
CONTEXT;- local- wider
CONTEXT;- local- wider
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.
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