HIV, Food Security and Nutrition: What we know, and what we should do Stuart Gillespie

1. HIV, Food Security and Nutrition: What we know, and what we should do Stuart Gillespie International Food Policy Research Institute Regional Network on AIDS, Livelihoods and Food Security Irish Aid, World AIDS Day seminar, 26 November 2008, Dublin

2. Contents • Interactions between HIV, food security and nutrition • Responses • Food prices and food crises • Operational and research challenges • RENEWAL approach

3. Three coexisting/interacting crises

4. HIV AIDS Food insecurity and malnutrition - chronic - acute

5. HIV Food insecurity

7. HIV and Poverty in Africa

8. HIV and Income Inequality in Africa

9. Upstream vulnerability (exposure to HIV) Risks HIV AIDS Impacts Poverty? Wealth? Food insecurity Mobility Gender inequalities Social cohesion Hope?

10. HIV AIDS

11. Midstream vulnerability (susceptibility to disease) Risk HIV AIDS Impacts STIs (especially HSV-2) Malnutrition Food insecurity (time, resources for care)

12. AIDS Food insecurity

13. Downstream vulnerability (to impacts of AIDS) Risk HIV AIDS Impacts • Depends on quantity, quality and mix of assets at household and community levels, institutional context and processes. • Intra-household effects (women, children) • In general, AIDS impoverishes (directly and indirectly)

15. In sum…. Pathways and interactions are complex. Relationships are dynamic and few, if any, are linear Upstream • Inequalities (socio-economic, gender, age) are fundamental drivers of HIV transmission • “Food insecure” women are also particularly vulnerable • Social cohesion and individual hope are under-researched Midstream • Malnutrition and coexisting STIs are important Downstream • AIDS impoverishes households, but severity and type of effects depend on configuration of assets and capabilities • Women and children particularly affected

16. How to respond? Nutrition/health programs Social protection HIV programs Agriculture

17. Food and nutrition along the HIV timeline Risk HIV AIDS Impacts Prevention Care & treatment Mitigation At each point, what are the key roles of food and nutrition research and programming?

18. Prevention Risk HIV AIDS Impacts PreventionCare & treatmentMitigation Strengthen women’s food security Explore alternatives to migration Improve maternal nutrition (MTCT)

19. The Vicious Cycle of Malnutrition and HIV Insufficient dietary intake Malabsorption , diarrhea Altered metabolism and nutrient storage Increased HIV Nutritional replication deficiencies Hastened disease progression Increased morbidity Increased oxidative stress Immune suppression Source: Semba and Tang, 1999

20. Care and treatment Risk HIV AIDS Impacts PreventionCare & treatmentMitigation Ensure adequate nutrition (pre- and during ART) - malnutrition and immune function decline (pre-ART) malnutrition and survival on ART initiation nutrition and treatment adherence nutrition and treatment effectiveness

21. Mitigation Risk HIV AIDS Impacts PreventionCare & treatmentMitigation Address real constraints (cash, labor?) Ensure access to land and finance AIDS-responsive social protection Preserve knowledge Focus on women and children (food, health, care) Inheritance rights Child schooling and care

22. Operational challenges and research questions • Equity (who is vulnerable?, who is eligible?) • Operationalizing food and nutrition support in resource limited settings • Therapeutic feeding • Food/cash transfers to affected households • Livelihood incentives and support • AIDS-sensitive pathways out of poverty • Microfinance plus empowerment generates income and reduces risk • Building bridges between agriculture and health • Linking small-scale agric with health and education services • Community resilience/capacity and state-led support “No general approach will work everywhere and…… …no single-component intervention will work anywhere” (Wellings et al 2006)

23. Food prices and food crises • Such interactions are more common and more severe • RENEWAL/UNAIDS/ NAP+ eastern and southern Africa • Additional problems due to “tipping points” being broached e.g. children denied schooling, ARV treatment stopped…. • Requires: • Tracking vulnerability • Proper integration of food/nutritional assistance in HIV response • Social protection systems (community-government partnerships)

24. The Regional Network on AIDS, Livelihoods and Food Security (RENEWAL) Regional Network on AIDS, Livelihoods and Food Security Facilitated by IFPRI, RENEWAL brings together national networks of • researchers, • policymakers, • public & private organizations, and • NGOs to address the interactions between HIV, AIDS and food and nutrition security.

25. IMPACT

26. Lessons and Challenges • Use different lenses (HIV lens, food/nut lens) not filters • Think livelihoods, not agriculture • Link food security with nutrition (nutrition security) • Beware “either/or” mentality • ARVs are not the (single) answer • Be comprehensive, but also focused • Diversity, context-specificity…but need for scale-up • Use/adapt tools to link understanding with responding • Evidence-based action (but sail the ship while building it!) • Learn by doing (action research), by monitoring, evaluating and by communicating • Innovate, document and disseminate • Balance quality, speed, and capacity