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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