HIV/AIDS and Food Crises

1. HIV/AIDS and Food Crises Stuart Gillespie International Food Policy Research Institute Tivoli, 23 September 2003

2. Key questions • How do crises affect: • susceptibility to HIV exposure and transmission • vulnerability to post-infection AIDS impacts? • What does this imply for the type of actions required at different levels to strengthen household and community resistance and resilience?

3. Content • Key questions • Concepts • Susceptibility and resistance • Vulnerability and resilience • Type of impacts (new variant famine?) • Using an HIV/AIDS lens • RENEWAL

4. HIV/AIDS EPIDEMICS: DETERMINANTS AND GENERIC RESPONSES WIDER IMMEDIATE Regional disparities Violence Wealth and distribution Knowledge Autonomy Behavior Farming systems Other diseases Infrastructure Climate Gender Livelihoods Virus subtypes Viral load Malnutrition Terrain Movement Community institutions Culture Policies Situations of risk MICRO-ENVIRONMENT MACRO-ENVIRONMENT MESO-ENVIRONMENT MICRO-BIOLOGY HIV INFECTION POSSIBLE RESPONSES TO STRENGTHEN RESISTANCE TO HIV Treat during pregnancy Improve nutrition Promote supportive policies Encourage leadership Enhance understanding Improve food security & livelihood options Strengthen local institutions Promote behavior change Modify risk situations

5. How do crises affect HIVsusceptibility? • Malnutrition increases risk (MTCT, STDs) • Food insecurity and breakdown of support systems can lead to transactional sex • Increased risk of rape • Food distribution or emergency response systems may create nodes of enhanced risk • Displacement or acute food insecurity may force migration to find work • Poor policy/program responses

6. HIV/AIDS EPIDEMICS: IMPACTS AND GENERIC RESPONSES IMMEDIATE WIDER Wealth and distribution Assets Labor Knowledge Attitude Farming systems Trade Livelihoods Institutional breakdown Death Community institutions Gender Infrastructure Other diseases Terms of trade Stigma Policies Entitlement Malnutrition MICRO-ENVIRONMENT HIV INFECTION MICRO-BIOLOGY MESO-ENVIRONMENT MACRO-ENVIRONMENT POSSIBLE RESPONSES TO STRENGTHEN RESILIENCE TO AIDS IMPACTS Treat diseases Orphan care Enhance understanding Improve food security and livelihood options ARV therapy Feeding Promote supportive policies Encourage leadership Improve nutrition Strengthen local institutions

7. How do crises affect vulnerability to AIDS impacts? • Malnutrition hastens onset of AIDS following HIV infection, and increases likelihood of severe opportunistic infection • Social networks, caring systems disrupted • Income-earning opportunities reduced • Women particularly overburdened

8. Effect on Assets Human, Social, Financial, Physical, Natural Effect on Institutions Community Based, Service Delivery, Participation Outcomes Nutrition, Food Security, Education, Community Cohesion, Income Responses Individual, Household, Community Underlying Susceptibility/Vulnerability of Livelihood Systems HIV/AIDS Vulnerable Groups- Orphans, Elderly and Youth Headed Households Stigmatization and Discrimination

9. HIV/AIDS devastates livelihoods • Human capital • Mortality, morbidity-related labor loss • Loss of knowledge transfer • Time diverted from production to caring • Financial capital • High expenses (e.g. health, funerals) • Sale of assets • Reduced access to credit

10. Social capital • Fewer incentives for collective action • Exclusion due to stigma • Physical capital • Sale of equipment • Property rights (widows) • Natural capital • Land use declines • Shift to low input, low output cropping • Natural resource mining

11. Resistance

14. Emergence of a “new variant famine”? • “concurrent generalized HIV/AIDS epidemic and episode of acute food insecurity”(De Waal) • Hypothesis: • AIDS increases vulnerability to other shocks and undermines resilience • NVF threatens a vicious cycle of increasing mortality • NVF threatens to precipitate ‘AIDS-related national crises’

15. New variant famine: what’s different? • Heightened dependency ratios • Particular impacts on women • ‘Double burden’ of care (returnee sick) • ‘Belt-tightening’ not viable • Lethal ‘survival’ strategies • Reduced life expectancy: • Children inherit debts, not assets • Fractured knowledge transfer

16. Can “coping” cope?

18. HIV and famine high HIV low No Acute food insecurity Yes

19. Likely implications of NVF • Better surveillance, data, new/additional indicators to reflect changes in vulnerability profiles, and for targeting relevant actions (e.g. effective dep. ratio) • Food aid: increase nutrients in food basket • Dependency-reduction • Livelihood security (low labor intensity) • Network strengthening (financial incentives for fostering?) • Mentoring (Junior Farmer Field Schools?)

20. What’s constraining action? • Gaps in awareness (denial) • Gaps in understanding and research biases • Over-emphasis on AIDS impacts • Limited, over-concentrated, data • Individuals seen as victims, not innovators • Limited capacity to act • Lack of evidence of ‘what works’

21. Using an HIV/AIDS lens • To better understand the dynamic interactions of HIV infection and AIDS impacts on different sectoral concerns • To identify appropriate policy and program modifications in the face of HIV/AIDS realities • Facilitate mainstreaming (AIDS audits)

22. Characteristics of lens • Bifocal (susceptibility and vulnerability) • Use internally (workplace) and externally • Focus on re-viewing both the problem and the conventional responses • Context-specific • Evolving over time (as knowledge grows) • Reveals costs, benefits, trade-offs, dilemmas

23. Scope of lens use

24. Structure of lens

25. Current distortions in the lens • AIDS seen as external, rather than affected by sectoral actions • Neglect of livelihood impacts on HIV spread • Seen as pandemic, not differing epidemics • Over-emphasis on “coping” at expense of actor-oriented/innovation perspective • “New problem, new program” mentality

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

27. Objectives of Phase II • To improve understanding of dynamic interactions between AIDS and other factors in food crises • To thus enable more effective responses, linked with preventive measures • To promote convergence and communication between humanitarian and development workers and researchers • To link people and networks facing similar challenges within region, and beyond.

28. Structure and content • Network of research-policy-program networks • IFPRI and ISNAR act as co-facilitators • Capacity development, communication, research • Malawi, Uganda, Zambia and South Africa • National steering committees • National network coordinators • Local Action Research Funds (ARFs) • Linked action research studies, driven by local consensus building and priority setting

29. Malawi network Uganda network Common Activities Core principles IFPRI/ISNAR Core activities Zambia S.Africa t

30. Action research priorities • Policy and program assessment (HIV lens) • Identifying and supporting innovation • Exploring new community response options • Identifying livelihood systems that confer HIV resistance and/or AIDS-resilience • Clarifying household/community level impacts • Access to resources • Long term effects on economy and society • AIDS and knowledge