Food Security

Thursday, March 17, 2005

Empowering rural households: New strategies for helping farmers fight HIV/AIDS with food security

With more money and political interest being directed towards AIDS than ever before, it is important to bring agriculture to the centre stage of the response to the disease. Most people in AIDS-ravaged parts of Africa live in rural areas, and rely on subsistence agriculture. Agricultural productivity and food security in sub-Saharan African are precarious due to AIDS, and there is an urgent need to reduce the debilitating grip of HIV/AIDS on rural livelihoods. Empowering smallholder farmers to be food secure is vital to preventing rural households slipping into a spiral of HIV and poverty.

According to the UN Food and Agriculture Organization (FAO), the epidemic is undoing decades of economic and social development and causing rural disintegration. In areas where the disease is highly prevalent, the impact goes beyond the already incredible suffering and loss of life, undermining food security in many dimensions. HIV/AIDS primarily affects those aged 15 to 50 years – the core of the labour force. This has a direct impact on the ability of households to either produce sufficient food or to attend work in order to receive a wage and have the ability to purchase food.

Food insecurity increases vulnerability to HIV infection – poor nutrition contributes to poor health, low labour productivity, low income, and livelihood insecurity. As productive family members fall sick or die, the quantity and quality of food available to the household declines. The additional burden of caring for orphans and unproductive individuals can impact upon food security.

The agricultural sector is in a strong position to assist in both prevention and mitigation of the consequences of HIV/AIDS.

According to FAO, possible agriculture sector responses include:

**Labour-saving technologies. These include low-input agriculture; lighter ploughs and tools that can be used by older children, women and the elderly; improved seed varieties that require less labour for weeding; intercropping; minimum tillage; access to potable water; and provision of fuel-efficient stoves that can free women for more economically productive activities.

**Knowledge preservation and transmission. This includes ensuring that basic agricultural skills are transmitted through formal and informal community institutions, such as extension services and schools, as well as einforcing community-based mechanisms to preserve local knowledge, including biodiversity and gender-specific agricultural skills

**Rural institutions and capacity-building. All rural service providers – for education, health, agricultural extension, credit and finance, women’s associations, nutrition groups, irrigation committees and terrace maintenance associations – need to be strengthened, in addition to local informal community networks, which provide most assistance to AIDS-affected households.

**Gender equality. Efforts must be made to reduce gender-based differences in access to and control of resources and livelihood assets – in particular, inequalities in access to land, credit, employment, education and information.

**Improving nutrition. Strategies here include: nutritional home gardens; use of improved crop management and plant varieties with higher yields; emphasis on staple crops; use of small ruminants for consumption, sale and manure; education and labour exchange arrangements.

**Social and economic safety nets. Efforts must be made to strengthen community-based initiatives, especially safety nets that are essential for food security.

**Monitoring and evaluation. Response strategies need to be appropriately monitored and evaluated to assist in the design and implementation of more effective programmes, to alleviate the impacts of HIV/AIDS on rural livelihoods and food security. In addition, participatory monitoring systems should be developed so that the people themselves can measure progress.

**Mainstreaming HIV/AIDS. The experience of all partners, from all sectors, in addressing the HIV/AIDS epidemic must be built upon, in order to develop an effective agricultural strategy. Advocacy is necessary to increase political commitment and influence national policies.


HDN Key Correspondent
Correspondents@hdnet.org

(July 2004)

Monday, March 14, 2005

Nutrition: An integral part of any comprehensive care package for PWHA

According to a recent Indian national conference on HIV/AIDS care, people living with HIV/AIDS need access to food and micronutrient supplements to improve their health status and extend their lives.

In India (and many other countries) many people living with HIV (PWHA) have limited or no access to clean water and nutritious food, which devastates their overall health status and accelerates the onset of AIDS-related conditions.

Compounding this reality for many PWHAs, access to life-saving antiretroviral drugs are also out of reach, making the need for other life-extending treatments, such as nutritious foods, all the more crucial. It has also been shown that death from nutritional complications is more likely for those who are not receiving antiretroviral therapy . Clearly, there is an urgent need for renewed focus and use of resources for nutrition as a fundamental part of any comprehensive HIV/AIDS care package to be scaled up.

While adequate nutrition is vital for health and survival for all people regardless of their HIV status, for people with HIV, access to nutritious foods is central in order to delay the onset of HIV-related symptoms, such as wasting. For a PWHA, it is estimated that energy requirements increase by 10% in order to maintain a healthy body weight and physical activity. This is the same for maintaining healthy growth among asymptomatic children living with HIV.

When a person has crossed the threshold into symptomatic AIDS-related conditions, energy requirements increase by approximately 20% to 30% just to maintain adult body weight. For children with HIV experiencing weight loss, energy intakes need to be increased by 50% to 100% over normal requirements to maintain proper body weight.

Speaking at the workshop ‘Food Security, Nutritional Care and HIV’, at the Community Care Conference in Mumbai, (7-9 December 2004), Dr Sai Subhasree Raghavan discussed the physiological aspects of nutritional complications for people living with HIV, who for various reasons are not taking antiretroviral therapy. These include wasting, loss of body mass, low albumin levels, low hemoglobin, low levels of steroid hormones, low cholesterol, high triglycerides and various micro-nutrient deficiencies.

Dr Raghavan is the founder and Executive Trustee of SAATHI (Solidarity and Action Against HIV Infection in India), a non-profit organization that aims to stablize and reduce the spread of HIV in the country.

According to Dr Raghavan, wasting is the third most common AIDS indicating symptom, and can include loss of weight through deceases is muscle tissue, fat and bone tissues. Men lose body mass disproportionatly to fat whereas women lose fat disproportionate to body mass. Gender-specific metabolic and hormonal differences account for these changes. Patients with a history of drug use have much lower body fat and mass than people who do not have a history of substance use.

Additional factors that fuel HIV-associated wasting in developing countries is the lack of access to medical care and treatment, such as antiretroviral therapy. Compounding this, many people live under the poverty line and therefore do not have access to adequate hygiene or safe water. Moreover, many refuse to even access care and treatment when it is available because of the ubiquitous and pervasive HIV-related stigma that exists in the very health care settings set up to care and treat people living with HIV/AIDS.

Recent data from Thailand and Uganda suggest that HIV malnutrition is one of the top three causes of mortality and morbidity in the developing world and is erasing previous advances made in treatment of malnutrition in developing countries.

Micronutrient deficiencies including Vitamin A, B6, B12, C, E, folic acid, selenium, and zinc levels have shown to be associated with disease progression and death (1). In India, plenty of related data exist for people who are HIV negative, however, there is very limited data specific to people living with HIV. These data are needed urgently in order to determine the type of vitamin-mineral supplements that could most effectively be provided to PWHAs.

HIV-associated malnutrition results in decreased productivity and more absence from work, decreased household income and consequently lower quality of life. Further, malnutrition is associated with slower wound healing and higher morbidity and mortality rates, which result in longer hospital stays and higher medical costs.

Nutritional health can be maintained by ensuring adequate intake of macro- and micro-nutrients; ensuring adequate access to food; ensuring water safety; maintaining body weight and body mass; increasing food supply; providing enteral or parenteral nutrition; and by providing appetite stimulants. Micronutrient supplements in the form of multivitamins with minerals can also be provided. Use of protein calorie supplements are necessary to increase the nutrient intake for prevention and treatment of weight loss. Supplements made from locally available ingredients in India need to be identified and evaluated.

Despite some gaps in scientific knowledge, there is a growing body of evidence that suggests much can be done to improve the health and lives of people living with HIV/AIDS by ensuring proper nutrition. Improving access to nutritious foods and clean water must be seen as an urgent priority related to care and support for people living with HIV. In late 2004, (December 16), the government of India took a step in the right direction when it announced that it had signed an agreement with the United Nations World Food Programme to provide food aid for people living with HIV. Hopefully the government will continue to recognize the important role nutrition plays in care and support for people living with HIV and incorporates evidence-based nutrition interventions into the national AIDS control and treatment programmes.

HDN Key Correspondent
Email: correspondents@hdnet.org

(December 2004)

Notes:

1. See http://www.aegis.com/pubs/iapac/2002/JI020401.html