HIV/AIDS and Food Security
Summary of meeting
Child-headed households benefiting from a home based care project
Action Against Hunger (AAH) and Oxfam GB hosted an inter-agency meeting in London on Food security and HIV/AIDS on December 1, World AIDS Day. The aim of the meeting was to build consistency and coherence in international non-governmental organisation's (INGOs) response to food insecurity in HIV/AIDS affected areas. The objectives were:
- to share practical experiences of food security programmes aimed at HIV/AIDs affected communities
- to share lessons learnt, innovative approaches, and planned programming or research
- to look at key theoretical documents and discuss how they are utilised by INGOs
- to discuss specific challenges faced in programming
- to decide on the need for a HIV/Food Security (FS) working group to be established to co-ordinate information/activities.
Paul Harvey from the Overseas Development Institute (ODI) opened proceedings by presenting key findings of a recent review1. Describing how HIV/AIDS has an impact across the whole spectrum of livelihoods, not just food security, he highlighted the need for greater clarity on the type of interaction between HIV and livelihoods. There are many examples of food security programmes geared towards HIV/AIDS affected populations, e.g. new types of food for work activities, but these are mostly based on assumptions that labour is a big constraint and that there is community cohesiveness. However, there is little monitoring and evaluation of these projects and there are numerous issues around these approaches, for example, an over-focus on agriculture and food aid, and AIDS 'exceptionalism', i.e. AIDS is assumed to be the only factor contributing to food insecurity.
Cathy Mears outlined the thinking and activities of the International Federation of the Red Cross (IFRC) with regard to HIV/AIDS and food security. Within the IFRC, food security has an important role in the strategy to prevent HIV/AIDS and also, as an integrated part of care and treatment. The IFRC are implementing a programme in Zimbabwe (set up in 1992), which aims to prevent transmission, provide care and support for people living with HIV/AIDS (PLWHA), and undertake advocacy work2. The IFRC are also piloting a food security project to support affected households in Swaziland involving skill development to generate new income generating activities.
Cathy outlined a number of issues and constraints to HIV community-based home care programmes which included the need for multi-sectoral programming and consideration of medium and longer term vulnerability, difficulties monitoring programme impact, how to increase the volunteer base, the need for more research on appropriate diets, and the challenges of targeting HIV/AIDS affected households where there is a stigma.
Celia Petty from Save the Children UK (SC UK) presented the agency's newly adapted approaches to the assessment of the economic impact of HIV/AIDS, which separate out the effects of other shocks (such as climate, market liberalisation) at a macro and household level. The SC UK approach is based on Household Economy Analysis, involving detailed information from a representative sample of households, and is being developed to understand the way households can reallocate labour in response to shock. The main challenge is understanding how HIV has changed vulnerability of households to other shocks. Work is ongoing to determine what interventions will reduce this altered vulnerability through targeted assistance, and directing resources to sustain or promote collective assistance and community support roles
Home worker talking to home based care group at communal garden
Oxfam's project in Malawi, presented by Laura Phelps, is an integrated approach to improving food security and protecting livelihoods in Mulanje and Thjolo district, an area with a high incidence of infected /affected households. Since 2001, the programme has concentrated on food aid (mainly to protect livelihoods), and provision of seeds and cuttings, fertiliser, vegetable seed, livestock, and technical support. Programmes are operated through Village Development/ Relief Committees and the Ministry of Agriculture. The modality of assistance has been both free and through loans, using a short and medium term approach. Extension support has included manure making, crop diversification, intercropping, bank fixing, soil and water conservation, kitchen gardens and livestock production.
Successes have included a reduction in the hunger gap reduced from 5 to 3 months, dietary diversification, links between humanitarian and development approaches, and flexibility of approach (e.g. did not demand repayment for seeds). However, there was no evidence of activities being translated into improved income. Furthermore, although there were higher crop yields, there was no evidence of a labour saving. Overall, the cost per person was higher due to targeting of vulnerable households and strategic partnership development. Major challenges were targeting vulnerable households that were fluid in nature and building the capacity of extension workers due to absences and deaths. The Oxfam team learnt that adolescents were often not interested in agricultural activities, but were more motivated by income generating opportunities.
Oxfam also presented information on their Global strategy (2002 - 2005), the Oxfam GB HIV/AIDS workplace policy, and development of a tool kit to assist in mainstreaming in Food Security/ Livelihoods (currently in draft).
Carer working in home based care project
Action Against Hunger's (AAH) HIV-related work in Malawi was presented by Rebecca Brown, who described three profiles of HIV affected households in Malawi.
- A large population of healthy, HIV-affected people
- A large population affected by premature death in the household
- A small number of households caring for those with full blown AIDS
Strategies that could be considered for these three groups include boosting income and livelihoods, moving the focus of activities away from agriculture so that households are more resilient when individuals become ill. Labour saving and sharing interventions, as well as free food aid, home based care, medical intervention, and food security support to families are included in their programming. Strategies improving nutritional status will hopefully delay the onset of full blown AIDS. The types of intervention AAH have been implementing include homestead local farming, root crops as alternatives to maize (also vegetable and pulses), alternative agricultural techniques to improve yields without fertilizers, and provision of small livestock to households with low labour capacity.
In terms of targeting affected households, AAH have considered ways of getting around stigmatisation. A pilot programme in Ntchishi district used a food/labour ratio as a proxy indicator, which effectively measures dependency ratio. In this method, the age/gender profile of all households is assessed, leading to a theoretical daily energy requirement for each household. The household labour capacity is also estimated (adult male = 1, female = 0.8, young child capacity rises from 12-20 years, whereas contribution of elderly falls from 56-68 years). This allows calculation of a food/labour ratio and assessment of household vulnerability. AAH found that high food/labour ratios occur frequently in elderly-headed households, female-headed households and in households with orphans. One weakness of this approach is that it does not take into account wealth groups and different livelihood groups, or receipt of remittances. There is a need to crosscheck this targeting methodology with other, more traditional approaches.
Some of the recurrent problems that AAH faces are stigmatisation and reluctance to discuss HIV at all levels, and an apparent lack of successful programmes from which to learn. AAH are currently developing research protocols with the Institute of Child Health, London to look at the suitability of current therapeutic feeding protocols for HIV positive children with severe malnutrition, are investigating alternative nutritional treatments for children with HIV, e.g. lactose free products, and are looking into the need for alternative antibiotics. They are also working with the Ministry of Health in Malawi to improve quality of care and follow-up for HIV-affected individuals/households.
Summary of key issues raised
The afternoon session was devoted to a plenary group discussion of the issues raised in the presentations. Frances Mason from Oxfam summarised the main points to emerge from the presentations and the afternoon discussion.
- Labour constraints, as a result of loss of 'productive' adults, is obviously a major factor that needs to be considered in programming, but its importance in terms of impact on household food insecurity is still unclear.
- All presentations referred to the difficulty of finding alternatives to agricultural activities.
- Targeting of households is a huge challenge for a variety of reasons: stigmatisation, constant change in the composition of households, 'broad-brushing' of the characteristics of HIV-affected households (e.g. female-headed, elderly / child-headed, hosting orphans, etc.).
- How sustainable are the current programme approaches? AIDS is obviously a long-term issue and therefore, the programmes to address this should be long-term - what local links are we making to ensure the necessary sustainability of our programming?
- Most of the literature and debate focuses on programming in sub-Saharan Africa - there is also a need to consider programming outside of Africa.
- Are we just re-packaging 'standard' food security programmes? There is a danger that HIV could be an easy 'sticker' to justify intervention and to attract donor interest.
- All agencies need to consider issues of HIV/AIDS in relation to their own staff, ministry/partner staff, in terms of treatment/ prevention of HIV infection. There are issues around implementation of programmes in high prevalence areas, where many staff are infected, i.e. knowledge retention, investment in training, etc.
- There is very little information available on successes and failures of programmes. There is an urgent need to determine the effectiveness of programmes designed to mitigate the impacts of HIV/AIDS on food security. How do we monitor this? And what do we monitor to measure the impact? What indicators should be used?
The plenary agreed that there is a need for a working group on HIV/AIDS and Food Security, which should become part of the UK HIV consortium. The consortium has since been approached and is very keen to host the working group (including hosting meetings and a space on their website). The working group's broad remit would be to consider how food security programmes need adapting in relation to HIV/AIDS, and to plan actions, research, and programming accordingly. The group should encourage field-based agencies/staff to contribute experiences via media like Field Exchange.
If you are interested in joining the working group, contact Laura Phelps, email: email@example.com or Rebecca Brown, email: firstname.lastname@example.org
1Harvey, P. HIV/AIDS: What are the implications for humanitarian action? A Literature Review (draft). July 2003, ODI HPN. See HIV/AIDS, food security and humanitarian action: a resource guide, http://www.odi.org.uk/hpg/aidsresources.html
2Field Exchange Issue 19, HIV/AIDS Home Based Care in Zimbabwe, p4-6
More like this
FEX: Targeting Vulnerable Households Within the Context of HIV/AIDS in Malawi
Summary of evaluation1 By Maja Munk and Dr. Neil Fisher Maja Munk has been working in the food security sector for ACF/AAH in Africa and Asia since 2002. Her photographs have...
FEX: HIV/AIDS Home Based Care in Zimbabwe
By Hisham Khogali Hisham Khogali is currently the Senior Food Security Officer of the International Federation of the Red Cross and Red Crescent. Prior to this, Hisham worked...
FEX: Update from Food Security, Livelihoods & HIV/AIDS Working Group
An AIDS orphan collects her food ration A second meeting of the Food Security, Livelihoods & HIV/AIDS Working Group (WG), co-chaired by Rebecca Brown (AAH) and Laura Phelps...
FEX: Impact of HIV/Aids on Acute Malnutrition in Malawi
By Susan Thurstans, AAH and Mary Corbett, ENN Susan Thurstans is HIV Adviser with Action Against Hunger, based in Malawi This article developed from an interview by Mary...
FEX: Issue 25 Editorial
This special issue of Field Exchange focuses on the food aid component of HIV related programming and was made possible through additional funding from DFID RSA. How the ENN...
FEX: Integrated Approach to Supporting Chronically Ill in Malawi
Interview by Mary Corbett with Mrs Nellie Nyang'wa, Oxfam For the past three years, Nellie Nyang'wa has been the Country Programme Manager for Oxfam in Malawi. Her previous...
FEX: Determining eligibility (Special Supplement 1)
Children are often a group targeted in emergencies Eligibility criteria, i.e. the characteristics of those individuals or households to be targeted with food, arise from the...
FEX: Three Ingredients of Success: Targeting Food Assistance in Western Kenya
By Karine Garnier, Ruth Situmu and Ben Watkins, WFP Kenya Karine Garnier (MPA) is a consultant now working with FAO Ruth Situma (MSc Public Health and Nutrition) is a...
FEX: WFP HIV/AIDS Programming in Malawi
By Jeremy Shoham, ENN Households headed by the elderly may be vulnerable This article was written based on a WFP consultation to Malawi in February 2005. The WFP Malawi...
FEX: WFP policy on HIV/AIDS
A policy document, 'Programming in the era of AIDS : WFP's response to AIDS/HIV', submitted in February 2003 to the World Food Programme (WFP) Executive board1 has been...
FEX: Review of targeting methods in HIV programmes
By Josh Colston Josh Colston studies demography and public health at the London School of Hygiene and Tropical Medicine. In the past he has worked as lecturer in British...
FEX: Income and employment support (Special Supplement 3)
5.1 Introduction The provision of cash as an emergency response has the potential to impact on all elements of the livelihoods framework by providing the means to protect or...
FEX: Issue 19 Editorial
This issue of Field Exchange is dedicated to Prof. John Kevany (ENN Director) who died on 20th April 2003. John was instrumental in establishing the ENN. Given John's...
FEX: Introduction (Special Supplement 3)
Glossary AAH Action Against Hunger ACF Action Contre la Faim ACF-E ACF-Spain ALDEF Arid Lands Development Focus AREN Association pour la Revitalisation de l'Elevage...
FEX: HIV/AIDS and Humanitarian Action
Summary of published report1 The Humanitarian Policy Group (HPG) have just published a report which examines the implications of HIV/AIDS for understanding crisis and the role...
FEX: Integrating CTC and HIV/AIDS Support in Malawi
By Saul Guerrero, Paluku Bahwere, Kate Sadler, and Steve Collins, Valid International Saul Guerrero is a Social and Community Development Advisor. Dr. Paluku Bahwere (PhD) is...
FEX: Issue 22 Editorial
The more cynical amongst us in the emergency nutrition sector may sometimes be heard complaining that there is nothing new in this profession and that we just keep re-inventing...
FEX: Addressing urban food security through electronic cash transfer in Kenya
By Sumananjali Mohanty Sumananjali Mohanty has been working with Oxfam Kenya programme for the past four and half years, initially as the Urban Food Security and...
FEX: Impact of HIV/AIDS on household food security and quality of life in Malawi
Summary of evaluation1 By Shannon Senefeld, Catholic Relief Services Shannon Senefeld is the Regional Technical Advisor, HIV/AIDS with Catholic Relief Services for the...
FEX: Integration of CTC with strategies to address HIV/AIDS (Special Supplement 2)
By Paluku Bahwere, Saul Guerrero, Kate Sadler & Steve Collins (Valid International) The district health officer of Dowa, Malawi, briefs clinic and community workers about the...
Reference this page
HIV/AIDS and Food Security. Field Exchange 21, March 2004. p21. www.ennonline.net/fex/21/hiv