Hunger and HIV go hand in hand, experts warn

After five days of high-profile debate about the latest scientific developments in HIV prevention and treatment, talk at the International AIDS Conference in Toronto turned on Thursday to one of the major drivers of the epidemic in Africa - hunger.

Stuart Gillespie, director of the Regional Network on HIV/AIDS, Rural Livelihoods and Food Security (RENEWAL), a project by the International Food Policy Research Institute, described how food insecurity not only created greater biological susceptibility to HIV by weakening the immune system, but encouraged behaviour - such as commercial or "survival" sex, or migration to higher prevalence areas - that put women, in particular, at greater risk.

A vicious cycle was set up, as families affected by HIV experienced a drain not only on their financial resources but also on the labour needed to grow food. Results of a study of 15,900 households in southern Africa, presented by Robin Jackson of the World Food Programmes's HIV/AIDS unit, demonstrated that HIV-affected households were more likely to experience food insecurity: they borrowed more money and sold more productive assets, and those headed by women experienced the most severe food shortages.

According to Gabriel Rugalema, of the UN Food and Agriculture Organisation (FAO), women's lack of property and inheritance rights in many African countries have made them and their children even more vulnerable to HIV, poverty and poor nutrition.

Leonider Amollo Akeye, founder of GROOTS (Grassroots Organisations Operating Together in Sisterhood), a community-based organisation in rural Kenya, explained how women who lost their husbands to HIV often experienced a second blow when in-laws confiscated their land and property. Akeye's organisation works with local chiefs to persuade them to intervene on the women's behalf.

As part of its response to HIV and food insecurity, the FAO has been working with governments to change legislation that barred women from owning property. In countries not enforcing existing legislation, the FAO was training NGOs to provide women with legal support.

The FAO has also been running agricultural training programmes for AIDS orphans, who have missed the opportunity of learning these skills from their parents. The goal is to move from short-term interventions, such as the distribution of food aid or nutritional supplements, to helping affected communities restore agricultural production and develop alternative livelihoods.

Other initiatives promoting food security and economic empowerment for people living with HIV/AIDS were mostly community-based and small-scale. Siphiwe Hlophess described how the organisation she co-founded, Swaziland Positive Living (Swapol), was supporting people living with HIV to grow food for consumption and sale. Their major constraint was lack of funding. "Donors want to give us food handouts, but we want to be empowered to grow our own food," she said.

The need to translate such programmes into wide-scale interventions was urgent but still not viewed as a priority by governments and donors. "Even today, it is difficult to persuade donors that food security is vital to HIV," said Rugalema. "That's why we're only operating in seven countries - much more investment is needed in this area."

National and international HIV policies have yet to catch up with evidence supporting the links between HIV/AIDS and food insecurity. UN Special Envoy for HIV/AIDS in Africa Stephen Lewis, who moderated the one session on the topic at the conference, commented that there had so far been no action to implement a UN declaration calling for "all people at all times to have access to sufficient, safe, and nutritious food ... as part of a comprehensive response to HIV/AIDS". The declaration was signed by 150 countries at the UN General Assembly's Special Session on AIDS in June.

Many governments have yet to provide short-term interventions, like nutritional supplements for patients on free antiretroviral treatment. The drugs should be taken with food to avoid toxic side effects, but in many parts of Africa HIV-infected people could not afford a square meal every day. According to media reports, lack of nutritional support had resulted in some patients in Kenya selling their drugs to buy food.

Festus Ilako, head of programmes for the African Medical and Research Foundation in Kenya, said the fundamental role of food security in relation to HIV had been largely overlooked. Countries should be held to account on the UN declaration, with targets that were monitored, he said. "Until we do that, we're in for a rough ride."