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when medicine IS NOT ENOUGH

Enlisting food and nutrition in the fight against HIV/AIDS Jennifer Weeks


hen peasant households in Malawi need extra cash, members often

leave their own fields temporarily to work for wealthier families, a system known as ganyu labor. Ganyu helps rural households meet urgent needs for food, but during the widespread famine that struck much of Africa in 2001 and 2002, it took an ominous twist. Women who visited trad- ing centers in search of food came under increasing pressure to offer sex as part of the bargain, which put them at risk of becoming infected with HIV.

IFPRI recently concluded a 10-year re- search program focusing on interactions between HIV/AIDS and food and nutri- tion security, such as these instances of transactional sex in Malawi. Te Regional Network on AIDS, Livelihoods, and Food Security (RENEWAL) was de- signed to deepen understanding of how food insecurity and economic inequality contribute to the spread of HIV and, in turn, are made worse by HIV-related illness and deaths.

“Tere was a lot of research and think- ing about livelihoods and food systems and agriculture in Africa, but no one bothered to mention HIV/AIDS. Tat was strange considering how out of control the disease was, especially in southern Africa,” says Stuart Gillespie, IFPRI senior research fellow and director of RENEWAL. “It has a huge impact on people’s ability to work, especially in labor-intensive sectors like agriculture.”

In 2001 Gillespie and his colleagues launched RENEWAL as a “network of


networks” that would link up organiza- tions focused on agriculture, food, and nutrition with partners active in HIV/ AIDS and public health. By bridging these fields, the program forged connec- tions and broadened the scope of many HIV care programs in the region.

RENEWAL initially focused on analyz- ing interactions between HIV/AIDS and livelihoods, especially for communities that depend on agriculture. “Medical approaches were not yielding the kinds of results that people wanted to see. We thought that there had to be other factors placing people at risk,” said Suneetha Kadiyala, a research fellow in IFPRI’s Poverty, Health, and Nutrition Division.

To understand how agriculture may have been contributing to the spread of HIV and how it was affecting livelihoods, RENEWAL commissioned studies from local researchers in par- ticipating countries (Kenya, Ma- lawi, South Africa, Uganda, and Zambia). One survey looked at poor households in rural Zambia and urban South Af- rica that were struggling with dual epidemics of AIDS and tuberculosis. It found that although these illnesses were costly in both settings, the economic burden was greater in Zambia because patients lived farther away from healthcare providers. Moreover, no local nongov- ernmental organizations working on

TB or HIV in Zambia provided food aid, even though TB drugs increase patients’ appetites. Households coping with TB and HIV in Zambia were thus especially vulnerable to debt and food shortages.

During RENEWAL’s second phase re- searchers increasingly focused on ways to help households resist HIV and cope with AIDS stresses through food and nutri- tion programs. Ten, in 2007 and 2008, high energy prices, population growth, and other factors converged to produce a global spike in food prices.

“Tere was a lot of concern about vulner- ability, but not a lot of focus on HIV,” Kadiyala said. RENEWAL made the connections, showing that food insecurity often causes people to move in search of food or work and to engage in transac- tional sex—behaviors that increase risks of contracting HIV. Additionally, people who are HIV-positive need more daily calories for adequate nutrition, so food shortages can degrade their health and speed up the onset of AIDS. For people fortunate enough to be under treatment, an adequate diet mini- mizes the side effects

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