Two years after Southern Africa's humanitarian crisis exposed the destructive relationship between hunger and HIV/AIDS, still not enough is known about the actual impact of the epidemic on rural households.
Now, new research from the recent international conference on 'HIV/AIDS and Food and Nutrition Security', held earlier this month in Durban, South Africa, has provided greater insight into how farming communities have been affected.
The three-day conference, organised by the Washington-based International Food Policy Research Institute (IFPRI), brought together policymakers, donors and researchers to develop strategies for improving and expanding the response to HIV/AIDS and food security.
While some of the research presented at the conference supported conventional wisdom on the massive impact of HIV/AIDS on livelihoods, "more research put on the table [during the conference] is forcing us to change the way we look at things," Stuart Gillespie, conference director and senior research fellow at IFPRI, told PlusNews.
In his keynote address Dr Tony Barnett from the London School of Economics questioned current thinking on the effects of the epidemic and called for more evidence on what was happening to farming systems. He warned that "one size will not fit all" when developing responses to HIV/AIDS in rural communities, and there was a need to recognise the complex nuances involved.
More evidence on impact
CARE International's Michael Drinkwater presented the preliminary findings of one of the few longitudinal studies of the impact of HIV/AIDS on rural livelihoods, conducted at three sites in Zambia.
The longitudinal study, done at 10-year intervals, analysed 'clusters' - a group of households with complex interrelationships - and found that not all clusters were experiencing adverse effects. Active links between urban and rural household members, as well as the position of the deceased in the household, could influence the impact of the disease.
The cluster methodology used in the longitudinal study created a more "refined understanding" of how gender, age and social economic status were affected by AIDS and would allow for "a more holistic programmatic approach", Drinkwater said.
He noted that programmes would need to reconsider the formulation of rural prevention strategies, as the survey found that "happy couple" HIV/AIDS prevention messages targeting the family were "totally inappropriate for rural areas", where the cultural context of marriage was different.
The bigger picture
HIV/AIDS could not be isolated as a poverty-inducing factor - in most cases, animal diseases and official agricultural policies had caused greater shock to the households, the study noted.
This was later reiterated by a Michigan State University report on HIV/AIDS and the agricultural sector in Eastern and Southern Africa, which also found that the initial wealth of the households, the sex of the deceased, and the ability of the household to attract new members mitigated the effects of HIV/AIDS.
Professor Thomas Jayne from Michigan State University pointed out that "it's difficult to disentangle the AIDS impact from everything else affecting agriculture". The cassava 'boom' in Southern Africa was a case in point: according to the 'new variant famine hypothesis', the impact of HIV/AIDS had caused high-value, highly nutritious crops, such as cereals and oilseeds, to be replaced by less nutritious ones like cassava. But the new variant famine had failed to take into account that "major changes in agricultural policy have occurred ... [and] veered some farming systems in the region toward tuber crops".
These policy changes had reduced the "financial profitability of growing maize ... and had shifted cropping incentives towards other food crops, such as cassava", Jayne said in his study.
The report argued that "conventional wisdom encouraging prioritisation of labour-saving technology or crops has been over-generalised, although labour-saving agricultural technologies may be appropriate for certain types of households and regions."
"We realise we are going to tread on a lot of toes ... this new information might not be compatible with current programmes, but this implies a shift is needed," Jayne told PlusNews. Existing thinking, which viewed cassava as a "non-nutritious" food crop, had also ignored local community responses, said Dr Linley Chiwona-Karltun from the Swedish University of Agricultural Sciences. Karltun's study of community responses to cassava in Malawi revealed that the communities were making use of the whole plant - not just the root.
"No-one has looked at how communities are using this so-called poor source of nutrition, and the nutritional benefits of the whole cassava plant," she told PlusNews.
Hunger was also driving rural households into engaging in risky sexual practices to survive, a study of smallholder farmers in three rural villages in Malawi's Lilongwe district revealed.
During the pre-harvest lean months, smallholder farmers traditionally relied on 'ganyu' labour - the exchange of their labour for goods or cash from better off households. However, the study discovered that ganyu opportunities were increasingly hard to find in rural communities, and women were often forced to venture into the outskirts of the capital, Lilongwe, to work in gardens and factories, and sometimes selling themselves.
The pressures of caring for terminally ill family members, while trying to make ends meet in a country staggering under the impact of the HIV/AIDS epidemic and food shortages, had forced many poor Zambian households to discriminate against the AIDS patient without even realising it.
"There's only so much people can cope with - these decisions are based on limited resources and their actions are driven by this - but people living with HIV/AIDS are experiencing it as stigma," Virginia Bond, principal investigator for a study on stigma in Zambia, commissioned by the International Centre for Research on Women (ICRW), told PlusNews.
The dimensions poverty brought to stigma had been largely ignored, Bond noted. "The concept [of stigma] should not be isolated from other social, political and economic processes and phenomena; stigma occurs within these," she told delegates at the three-day conference.
Acting despite inadequate evidence
On the final day of the conference, AIDS activist Hans Binswanger warned that a lack of evidence could no longer be used as an excuse for not designing effective programmes or holding back on action.
"Of course there are uncertainties, but these are being manipulated, and distracting from the obvious things that are required," he said. Binswanger stressed that local, community-driven development was crucial in programmes targeting HIV/AIDS and food security.
"Only at this level can programmes be adapted to local conditions by those who know them," he added. Although there had been small-scale community-driven success stories dealing with food and nutrition security and the epidemic, there was "not enough large-scale action," said Gillespie from IFPRI. He noted that "we are not talking about starting from scratch with new programmes", but there was still a need for more knowledge of what the actual situation was on the ground.
Governments could do something as simple as applying an "HIV/AIDS lens" when looking at existing agricultural policies to review what they were doing from an AIDS perspective. Nevertheless, he admitted, "there is no blueprint; there is no standard magic bullet intervention."
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