During 2007 and 2008, a combination of new and ongoing forces drove global food prices to extremely high levels. Energy prices and subsidized biofuel production, income and population growth, globalization, and urbanization were among the major forces contributing to surging demand—while on the supply side, land and water constraints, underinvestment in rural infrastructure and agricultural innovation, lack of access to inputs such as seeds and fertilizers, and weather disruptions impaired productivity growth and the needed production response. According to International Monetary Fund data, rice and wheat prices soared in late 2007 and early 2008—up 60 percent and 89 percent respectively over 2006 levels. These rising food costs pose serious problems for the poor, including the urban poor, rural landless laborers, and many smallholder farmers. As poor households spend more money on food staples, higher prices translates to reduced energy consumption and less-diverse diets of lower quality.
Malnutrition and food insecurity play a pivotal role in the AIDS epidemics of eastern and southern Africa, affecting both risks of HIV transmission and subsequent AIDS-related impacts such as premature illness and death on household labor power and through the fracturing of intergenerational knowledge transfer. The response to such epidemics thus needs to focus on broad-based approaches to prevention, treatment and care, and mitigation to reduce the economic and social impact of the AIDS epidemics, as well as interventions to improve nutritional status and food security.
Two rapid regional assessments of the impact of high food prices on people living with HIV (PLHIV) and on the regional response to AIDS epidemics undertaken by the Regional Network on AIDS, Livelihoods and Food Security (RENEWAL) revealed that food and economic crises, whether driven by rising food prices or other factors, exacerbate and intensify the vicious cycles that play out between HIV, food insecurity, and malnutrition.
The studies found that food prices affected HIV prevention. Sudden increases in food insecurity often lead to migration as people search for work and food. Mobility is a marker of enhanced risk of HIV exposure, both for the person searching for work and food, and for other adults who remain at home. Recent studies in Botswana, Swaziland, Malawi, Zambia, and Tanzania have also shown associations between acute food insecurity and unprotected transactional sex among poor women.
Higher food prices also affected care and treatment. Adults living with HIV require 10 to 30 percent more energy than they did before they were infected, and children may need up to 100 percent more. Rising food costs constrain the ability to ensure an adequate nutritional intake. Also, for PLHIV, inadequate dietary quantity and quality, exacerbated by the spike in food prices, may lead to more frequent, more severe opportunistic infections and a more rapid progression to AIDS. For PLHIV, nutrition is important for adherence to treatment regimens. Some of the negative side effects of antiretroviral therapy are reduced if medicines are taken with food, and if limited available cash is diverted to food purchases, there may be less money to spend for transportation to clinics, which may be costly.
Higher food prices affected attempts to mitigate or reduce the social and economic impacts of AIDS. Evidence clearly shows that it is the poor and food-insecure who suffer greater and more enduring livelihood impacts from health and economic shocks. Chronic food insecurity constrains resilience and forecloses options to adapt to any stress. Other effects include children being taken out of school to work for cash or food. The increase in costs of supporting an orphan may result in fewer extended families being able to care for and feed additional orphans.
So what can be done? The food price crisis—superimposed as it is on a broader and deeper livelihoods crisis in southern and eastern Africa—strengthens the rationale for linking food and nutrition security with AIDS programming. It also makes it much harder to achieve and sustain such linkage.
To stimulate better understanding and response, a platform for regular public discussions on these issues at national and regional levels must be established. Such a move would help raise awareness and sustain interest and action on the HIV-hunger connection. Networks of PLHIV, nongovernmental organizations, UN agencies, and research bodies can take leading roles to ensure that governments and donors respond to food crises, and to ensure that vulnerable groups have a voice and are heard. Ultimately, national governments, donors, and international organizations need to go beyond lip service to properly fund and support programs that integrate HIV, food, and nutrition responses.
Scott Drimie, Stuart Gillespie, Paul Jere, and John Msuya are with the Regional Network on AIDS Livelihoods and Food Security, a project of the International Food Policy Research Institute.