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. Livelihood/food insecurity HIV & AIDS Malnutrition Three coexisting/interacting crises

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

5. HIV HIV Food insecurity 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 AIDSImpacts STIs (especially HSV-2) Malnutrition Food insecurity (time, resources for care)

12. AIDS AIDS Food insecurity 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? Livelihood/food insecurity HIV & AIDS Malnutrition Agriculture Social protection HIV programs Nutrition/health programs

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

18. Prevention Risk HIV AIDSImpacts Prevention Care & 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 replication Hastened disease progression Increased morbidity Increased oxidative stress Immune suppression Nutritional deficiencies Source:Sembaand Tang, 1999

20. Care and treatment Risk HIV AIDSImpacts Prevention Care & 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 AIDSImpacts Prevention Care & 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 Livelihood/food security HIV & AIDS Nutrition

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