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

Key questions How do crises affect: 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? What does this imply for the type of actions required at different levels to strengthen household and community resistance and resilience?

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

HIV INFECTION Other diseases Virus subtypes Viral load Malnutrition MICRO-BIOLOGY Treat during pregnancy Improve nutrition Knowledge Autonomy Behavior 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 systems can lead to transactional sex Food insecurity and breakdown of support systems can lead to transactional sex Increased risk of rape Increased risk of rape Food distribution or emergency response systems may create nodes of enhanced risk Food distribution or emergency response systems may create nodes of enhanced risk Displacement or acute food insecurity may force migration to find work Displacement or acute food insecurity may force migration to find work Poor policy/program responses Poor policy/program responses

HIV INFECTION Other diseases Malnutrition MICRO-BIOLOGY Treat diseases Death Assets Labor 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 Trade Institutional breakdown Infrastructure Stigma Policies Promote supportive policies Encourage 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 following HIV infection, and increases likelihood of severe opportunistic infection Malnutrition hastens onset of AIDS following HIV infection, and increases likelihood of severe opportunistic infection Social networks, caring systems disrupted Social networks, caring systems disrupted Income-earning opportunities reduced Income-earning opportunities reduced Women particularly overburdened Women particularly overburdened

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

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

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

Resistance

Emergence of a “new variant famine”? “concurrent generalized HIV/AIDS epidemic and episode of acute food insecurity” (De Waal) “concurrent generalized HIV/AIDS epidemic and episode of acute food insecurity” (De Waal) Hypothesis: 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’

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

Can “coping” cope?

HIV and famine highHIVlow No Acute food insecurity Yes Increased vulnerability to chronic/acute food insecurity. Reduced coping capacity and options. “New variant famine” Collapse of ‘coping’. Long-term impact (inability to recover) --- “Normal” famine Famine coping strategies may work (as in 1992)

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) 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 Food aid: increase nutrients in food basket Dependency-reduction Dependency-reduction Livelihood security (low labor intensity) Livelihood security (low labor intensity) Network strengthening (financial incentives for fostering?) Network strengthening (financial incentives for fostering?) Mentoring (Junior Farmer Field Schools?) Mentoring (Junior Farmer Field Schools?)

What’s constraining action? Gaps in awareness (denial) Gaps in awareness (denial) Gaps in understanding and research biases 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 Limited capacity to act Lack of evidence of ‘what works’ Lack of evidence of ‘what works’

Using an HIV/AIDS lens 1. To better understand the dynamic interactions of HIV infection and AIDS impacts on different sectoral concerns 2. To identify appropriate policy and program modifications in the face of HIV/AIDS realities 3. Facilitate mainstreaming (AIDS audits)

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

Scope of lens use

Internal(workplace)External (policy, programs) Suscep.Vuln.Suscep.Vuln Assess Analyze Act Structure of lens

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

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

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

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

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

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