HIV/AIDS has shaped the crisis in the region

The impact of the HIV/AIDS epidemic on Southern Africa has shaped the current humanitarian crisis in the region, where more than 6 million people will need food aid to survive the beginning of next year. The UN has warned that this part of the world faces the triple threat of food insecurity, weakened government capacity and the impact of HIV/AIDS. Mark Sterling, UNAIDS intercountry team leader in the region, told PlusNews on World AIDS Day that "HIV tends to slip off the agenda in terms of public attention and decision-making around food security". Yet food security and HIV/AIDS are inextricably linked in this, the worst HIV/AIDS-affected area in the world, according to the latest UNAIDS AIDS Epidemic Update. A UN policy document says a "new kind of humanitarian crisis is emerging in Southern Africa". "It is a deadly triad consisting of a lethal epidemic, deepening food insecurity and a hollowing out of government capacity. The HIV epidemic, having reached hitherto unimaginable prevalence levels - bordering on 40 percent of adults in some countries - is now entering the phase of massive death from AIDS," the UN said. The policy document notes that "22,000 people are dying every week in the mainland SADC [Southern African Development Community] region". "Fuelled in part by impoverishment and lack of essential public services, the epidemic continues to worsen, bringing in its wake new patterns of food insecurity, destitution and vulnerability," the UN added. Southern Africa was plunged into a humanitarian crisis in 2002, when food shortages affected 14 million people in six countries - Lesotho, Swaziland, Malawi, Zambia, Mozambique and Zimbabwe. Aid agencies said the shortages were brought on by adverse weather conditions and governance failures, worsened by the prevalence of HIV/AIDS. The UN policy document notes that "AIDS undercuts the resilience which households and communities draw upon to cope during periods of difficulty. In the face of an external shock, poor households respond with a variety of strategies, including altering income-generating activities and consumption patterns, as well as calling upon family and community support". "But AIDS strikes at productive adults, the asset most likely to help during a crisis. Infected adults may be unable to work. The burden of care increases, in both financial and social terms... The impoverishment that results in all households as they use assets and savings during a crisis is amplified in HIV/AIDS-affected households," the UN said. In such households, food security is undermined. And when adults die, the household may be headed by a child or elderly adult, "or may even disintegrate completely". HIV/AIDS MAY ERODE RECENT GAINS Aid efforts by UN agencies, governments and NGOs averted a humanitarian catastrophe in 2002, and while some of the six affected countries have managed to stage a remarkable short-term recovery, there is concern that the long-term impact of HIV/AIDS could erode recent gains. "Faced with the challenge of needing to do more to preserve lives and livelihoods, governments of the region are finding their principal asset - human resources in their institutions - is being eroded at an increasing rate [by HIV/AIDS]," the UN observed. The current crisis was the continuation of a "vicious cycle". In a setting of poverty and chronic hunger, the UN said, any external shock could undermine a household's ability to deal with pre-existing challenges. "Whether it is a poor family hit by an HIV infection, or an already HIV-affected household hit by drought, the addition of AIDS to the mix of development challenges increases the chances that households will simply not have the means to escape poverty and benefit from development opportunities." The bottom line, Sterling told IRIN, was that "concerns around poverty and AIDS need to be made real in all of our discourse". HIV/AIDS was both a cause and an effect of food insecurity, as families weakened by HIV/AIDS were usually unable to work and produce either crops or income to sustain themselves. It also meant that children were often "forced into transactional sex", thus fuelling the HIV/AIDS epidemic. "The vulnerability assessments show the linkage with AIDS ... compared to five years ago, we are now seeing real evidence of how orphans and children in families affected by HIV/AIDS are affected in terms of nutrition and health status, schooling, property rights, and abuse," Sterling said. He noted that a recent UN Children's Fund (UNICEF) report on orphans in the region was important as "it's the first time we have on the table evidence that shows that extended families and communities ... are severely overstretched and are unable to meet the needs of children [affected by HIV/AIDS]". There were immediate challenges, such as ensuring children's food security was guaranteed through school feeding schemes, which had to be addressed. "A number of things ... must be done in the broader context of poverty reduction, and a massive effort is needed to reduce [HIV] infections," Sterling said. There had to be "better contingency planning" and disaster management and response. "Many plans of dealing with HIV have been derailed by floods and droughts. We need to minimise the way in which these [natural] disasters derail other issues, and how we address poverty in medium- to long-term," he added. The UN's policy document notes that "the threat that AIDS may reverse decades of development, undermine economic growth, and unravel the social fabric that has held communities together during previous crises, demands a retooling of UN responses". This included implementation of simultaneous humanitarian and development action, and acknowledging the fact that HIV/AIDS in the region was "most often defined by poverty and chronic food insecurity".