Linkages between HIV/AIDS and food insecurity

A review

The April 2001 Greater Horn of Africa Food Security Update presents the most recently available regional data on the HIV/AIDS pandemic. It reviews linkages between HIV/AIDS and livelihoods, food security and nutrition and summarises important policy challenges. Key points made in the update are the following.

Eastern and Southern Africa are at the epicentre of the AIDS pandemic. More than two thirds of all HIVinfected people live in Sub-Saharan Africa - some 25 million people. Four countries in eastern Africa reported prevalence levels above 10% in late 1999. While the pandemic was primarily perceived as a health crisis in its early years, linkages are now widely acknowledged between HIV/AIDS and a broad range of other concerns - not least of which is food security.

HIV/AIDS attacks the most productive and economically active members of society, often killing both parents in a household while leaving children and the elderly behind in extreme conditions of vulnerability. It also erodes institutional capacity to respond because of the loss of human resources. Furthermore, it increases pre-existing social and economic vulnerability; while it kills the rich and poor alike, it is the poor who are most vulnerable. Women are at greatest risk of exposure and are biologically more vulnerable, particularly young women and girls.

Infection rates tend to be higher in densely populated areas which also tend to be the most productive agricultural areas. Over time, HIV/AIDS may be expected to define significant new geographical areas of vulnerability.

The principal ways that HIV/AIDS exacerbates food insecurity and poverty are outlined as follows:

• Impoverishing families of infected people in the short to medium term, e.g. through loss of incomeearning labour in agriculture and other livelihoods as sufferers grow sick and eventually die. There is also the loss of other productive or financial assets as households are forced to cope with loss of income and increased expenses (e.g. medical bills or transport to health facilities)
• Increasing longer term vulnerability, e.g. forcing young children, especially girls, to stop schooling to work or to care for a sick parent or relative
• Through diverting public health resources away from other common diseases
• Poverty increases the risk of AIDS. For example, labourers forced to migrate to different areas to earn money may be at increased risk of exposure as prevalence rates are usually higher, particularly in urban areas. Secondly, poverty-linked malnutrition leads to the earlier on-set of AIDS and increases the likelihood of opportunistic infection.

Other links between HIV/AIDS and food security exist. Emergency situations lead to increases in HIV transmission. Rapid increases in rates of transmission are frequently associated with the presence of armies. In situations where people are displaced there is often a high level of sexual violence with women forced to trade sex for food, protection or other basic needs.

This update highlights many challenges to breaking the vicious cycle between HIV/AIDS and food insecurity including making HIV/AIDS awareness and prevention a top priority in emergency responses. Developing an understanding of the benefits and dangers of development interventions on the prevalence and transmission of AIDS (e.g. benefits and potential harm of promoting migrant labour, etc.) is essential.

Several recommendations are outlined, including vigorously promoting prevention of infection and the protection of women and girls during emergencies, particularly in situations resulting in displacement of people.

Information and documents relating to the April 2001 update can be obtained from: Nick Maunder at nmaunder@fews.net or Dan Maxwell at maxwell@care.org.