HIV/AIDS and Food Crises

Stuart GillespieStuart Gillespie

International Food Policy Research InstituteInternational Food Policy Research Institute

Tivoli, 23 September 2003Tivoli, 23 September 2003

Key questions

How do crises affect:How do crises affect: susceptibilitysusceptibility to HIV exposure and to HIV exposure and

transmissiontransmission vulnerabilityvulnerability to post-infection AIDS to post-infection AIDS

impacts?impacts? What does this imply for the type of actions What does this imply for the type of actions

required at different levels to strengthen required at different levels to strengthen household and community household and community resistanceresistance and and resilienceresilience??

Content

Key questionsKey questions ConceptsConcepts

Susceptibility and resistanceSusceptibility and resistance Vulnerability and resilienceVulnerability and resilience

Type of impacts (new variant famine?)Type of impacts (new variant famine?) Using an HIV/AIDS lensUsing an HIV/AIDS lens RENEWALRENEWAL

HIV INFECTION

Other diseases

Virus subtypes

Viral load

Malnutrition

MICRO-BIOLOGY

Treat during pregnancy

Improve nutrition

KnowledgeAutonomyBehavior

Gender

Movement

MICRO-ENVIRONMENT

Situations of risk

Promote behavior change

Modify risk situations

Violence

Farming systems

Livelihoods

Community institutions

MESO-ENVIRONMENT

Enhance understanding

Improve food security & livelihood options Strengthen

local institutions

Regional disparities

Wealth and distribution

Infrastructure

MACRO-ENVIRONMENT

Climate

Terrain

Culture

Policies

POSSIBLE RESPONSES TO STRENGTHEN RESISTANCE TO HIV

Promote supportive policies

Encourage leadership

WIDER IMMEDIATE

HIV/AIDS EPIDEMICS: DETERMINANTS AND GENERIC RESPONSES

How do crises affect HIV susceptibility?

Malnutrition increases risk (MTCT, STDs)Malnutrition increases risk (MTCT, STDs) Food insecurity and breakdown of support Food insecurity and breakdown of support

systems can lead to transactional sexsystems can lead to transactional sex Increased risk of rapeIncreased risk of rape Food distribution or emergency response systems Food distribution or emergency response systems

may create nodes of enhanced riskmay create nodes of enhanced risk Displacement or acute food insecurity may force Displacement or acute food insecurity may force

migration to find workmigration to find work Poor policy/program responsesPoor policy/program responses

HIV INFECTION

Other diseases

Malnutrition

MICRO-BIOLOGY

Treat diseases

Death

AssetsLabor Knowledge Attitude

Gender

MICRO-ENVIRONMENT

Orphan care

MESO-ENVIRONMENT

Livelihoods

Farming systems

Community institutions

Enhance understanding Improve food security and livelihood options

MACRO-ENVIRONMENT

Wealth and distribution

TradeInstitutional breakdown

InfrastructureStigma Policies

Promote supportive policiesEncourage leadership

POSSIBLE RESPONSES TO STRENGTHEN RESILIENCE TO AIDS IMPACTS

ARV therapy

Improve nutrition

Terms of trade

Entitlement

Feeding

Strengthen local institutions

IMMEDIATE

HIV/AIDS EPIDEMICS: IMPACTS AND GENERIC RESPONSES

WIDER

How do crises affect vulnerability to AIDS impacts?

Malnutrition hastens onset of AIDS Malnutrition hastens onset of AIDS following HIV infection, and increases following HIV infection, and increases likelihood of severe opportunistic infectionlikelihood of severe opportunistic infection

Social networks, caring systems disruptedSocial networks, caring systems disrupted Income-earning opportunities reducedIncome-earning opportunities reduced Women particularly overburdenedWomen particularly overburdened

Underlying Susceptibility/Vulnerability of

Livelihood Systems

Vulnerable Groups- Orphans, Elderly and Youth Headed Households

Stigmatization and Discrimination

Effect on InstitutionsCommunity Based, Service Delivery, Participation

OutcomesNutrition, Food Security, Education, Community Cohesion, Income

HIV/AIDSEffect on AssetsHuman, Social, Financial, Physical, Natural

ResponsesIndividual, Household, Community

HIV/AIDS devastates livelihoods Human capitalHuman capital

Mortality, morbidity-related labor lossMortality, morbidity-related labor loss Loss of knowledge transferLoss of knowledge transfer Time diverted from production to caringTime diverted from production to caring

Financial capitalFinancial capital High expenses (e.g. health, funerals)High expenses (e.g. health, funerals) Sale of assetsSale of assets Reduced access to creditReduced access to credit

Social capitalSocial capital Fewer incentives for collective actionFewer incentives for collective action Exclusion due to stigma Exclusion due to stigma

Physical capitalPhysical capital Sale of equipmentSale of equipment Property rights (widows)Property rights (widows)

Natural capitalNatural capital Land use declinesLand use declines Shift to low input, low output croppingShift to low input, low output cropping Natural resource miningNatural resource mining

0

5

10

15

20

1985 1990 1995 2000 2005 2010

HIV

Prev

ale

nce

(%

) Resistance

Resilience: Household level

0

20

40

60

80

100

0 2 4 6 8

Year

Mon

ths

wit

h >

2 m

eals

/day More

Less

Resilience: Community level

0

10

20

30

40

0 10 20 30 40

Adult mortality in past 5 years (%)

Incr

ease

in

unde

rwei

ght

child

ren

(%)

Emergence of a “new variant famine”?

““concurrent generalized HIV/AIDS epidemic and concurrent generalized HIV/AIDS epidemic and episode of acute food insecurity”episode of acute food insecurity” (De Waal)(De Waal)

Hypothesis: Hypothesis: AIDS increases vulnerability to other shocks and AIDS increases vulnerability to other shocks and

undermines resilienceundermines resilience NVF threatens a vicious cycle of increasing NVF threatens a vicious cycle of increasing

mortalitymortality NVF threatens to precipitate ‘AIDS-related NVF threatens to precipitate ‘AIDS-related

national crises’national crises’

New variant famine: what’s different?

Heightened dependency ratiosHeightened dependency ratios Particular impacts on womenParticular impacts on women ‘‘Double burden’ of care (returnee sick)Double burden’ of care (returnee sick) ‘‘Belt-tightening’ not viableBelt-tightening’ not viable Lethal ‘survival’ strategiesLethal ‘survival’ strategies Reduced life expectancy:Reduced life expectancy:

Children inherit debts, not assetsChildren inherit debts, not assets Fractured knowledge transferFractured knowledge transfer

Can “coping” cope?

HIV and famine

highhigh

HIVHIV

low low

No No Acute food insecurityAcute food insecurity Yes Yes

Increased vulnerability Increased vulnerability to chronic/acute food to chronic/acute food insecurity. insecurity.

Reduced coping Reduced coping capacity and options.capacity and options.

““New variant famine”New variant famine”

Collapse of ‘coping’.Collapse of ‘coping’.

Long-term impact Long-term impact (inability to recover)(inability to recover)

------

““Normal” famineNormal” famine

Famine coping strategies Famine coping strategies may work (as in 1992)may work (as in 1992)

Likely implications of NVF

Better surveillance, data, new/additional indicators Better surveillance, data, new/additional indicators to reflect changes in vulnerability profiles, and for to reflect changes in vulnerability profiles, and for targeting relevant actions (e.g. targeting relevant actions (e.g. effectiveeffective dep. ratio) dep. ratio)

Food aid: increase nutrients in food basketFood aid: increase nutrients in food basket Dependency-reductionDependency-reduction Livelihood security (low labor intensity)Livelihood security (low labor intensity) Network strengthening (financial incentives for Network strengthening (financial incentives for

fostering?)fostering?) Mentoring (Mentoring (JuniorJunior Farmer Field Schools?) Farmer Field Schools?)

What’s constraining action?

Gaps in awareness (denial)Gaps in awareness (denial) Gaps in understanding and research biasesGaps in understanding and research biases

Over-emphasis on AIDS impactsOver-emphasis on AIDS impacts Limited, over-concentrated, dataLimited, over-concentrated, data Individuals seen as victims, not innovatorsIndividuals seen as victims, not innovators

Limited capacity to actLimited capacity to act Lack of evidence of ‘what works’Lack of evidence of ‘what works’

Using an HIV/AIDS lens

1.1. To better understand the dynamic To better understand the dynamic interactions of HIV infection and AIDS interactions of HIV infection and AIDS impacts on different sectoral concernsimpacts on different sectoral concerns

2.2. To identify appropriate policy and To identify appropriate policy and program modifications in the face of program modifications in the face of HIV/AIDS realitiesHIV/AIDS realities

3.3. Facilitate mainstreaming (AIDS audits)Facilitate mainstreaming (AIDS audits)

Characteristics of lens

Bifocal (susceptibility and vulnerability)Bifocal (susceptibility and vulnerability) Use internally (workplace) and externallyUse internally (workplace) and externally Focus on re-viewing both the problem and Focus on re-viewing both the problem and

the conventional responsesthe conventional responses Context-specificContext-specific Evolving over time (as knowledge grows)Evolving over time (as knowledge grows) Reveals costs, benefits, trade-offs, Reveals costs, benefits, trade-offs,

dilemmasdilemmas

Assessment Of food insecurity and

of HIV/AIDS

Analysis Of problem

interactions and capacity to respond

Action Based on the analysis

and capacity to act

Scope of lens use

InternalInternal

(workplace)(workplace)

ExternalExternal

(policy, programs)(policy, programs)

Suscep.Suscep. Vuln.Vuln. Suscep.Suscep. VulnVuln

AssessAssess

AnalyzeAnalyze

ActAct

Structure of lens

Current distortions in the lens

AIDS seen as external, rather than affected AIDS seen as external, rather than affected by sectoral actionsby sectoral actions

Neglect of livelihood impacts on HIV Neglect of livelihood impacts on HIV spreadspread

Seen as pandemic, not differing epidemicsSeen as pandemic, not differing epidemics Over-emphasis on “coping” at expense of Over-emphasis on “coping” at expense of

actor-oriented/innovation perspectiveactor-oriented/innovation perspective ““New problem, new program” mentalityNew problem, new program” mentality

Regional Network on HIV/AIDS, Rural Livelihoods and Food Security

Objectives of Phase II

To improve understanding of dynamic interactions To improve understanding of dynamic interactions between AIDS and other factors in food crisesbetween AIDS and other factors in food crises

To thus enable more effective responses, linked To thus enable more effective responses, linked with preventive measureswith preventive measures

To promote convergence and communication To promote convergence and communication between humanitarian and development workers between humanitarian and development workers and researchersand researchers

To link people and networks facing similar To link people and networks facing similar challenges within region, and beyond.challenges within region, and beyond.

Structure and content

• Network of research-policy-program networksNetwork of research-policy-program networks• IFPRI and ISNAR act as co-facilitatorsIFPRI and ISNAR act as co-facilitators• Capacity development, communication, researchCapacity development, communication, research• Malawi, Uganda, Zambia and South AfricaMalawi, Uganda, Zambia and South Africa• National steering committeesNational steering committees• National network coordinatorsNational network coordinators• Local Action Research Funds (ARFs)Local Action Research Funds (ARFs)• Linked action research studies, driven by local Linked action research studies, driven by local

consensus building and priority settingconsensus building and priority setting

Common ActivitiesCore principles

IFPRI/ISNAR

Core activities

Zambia S.Africa

Uganda network

t

Malawinetwork

Action research priorities

Policy and program assessment (HIV lens)Policy and program assessment (HIV lens) Identifying and supporting innovationIdentifying and supporting innovation Exploring new community response optionsExploring new community response options Identifying livelihood systems that confer HIV Identifying livelihood systems that confer HIV

resistance and/or AIDS-resilienceresistance and/or AIDS-resilience Clarifying household/community level impactsClarifying household/community level impacts Access to resourcesAccess to resources Long term effects on economy and societyLong term effects on economy and society AIDS and knowledgeAIDS and knowledge