EFFECTIVE FOOD AND NUTRITION POLICY RESPONSES TO HIV/AIDS: WHAT WE KNOW AND WHAT WE NEED TO KNOW

The impact of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) on people’s lives and on development is staggering. Millions have died and livelihoods have been devastated, particularly in Sub-Saharan Africa. Agriculture and natural resources are important components of such livelihoods. And the nutritional status of those infected and affected plays a large part in determining their current welfare and their ability to further develop their livelihoods towards activities that help to mitigate the impacts of AIDS and prevent the spread of HIV. This paper first reviews the potential pathways through which HIV/AIDS affects assets and institutions generally and then the specific impacts on agriculture, natural resource management, food security, and nutrition. The impacts on agriculture and resource management revolve around how to deal with labor and knowledge losses and institutional weakening. With regard to nutrition, HIV/AIDS significantly impacts individuals and households—through accelerating the vicious cycle of inadequate dietary intake and disease, and through diminishing the capacity to ensure the essential food, health, and care preconditions of good nutrition. The review addresses the question of how the public sector can and should respond to these challenges. The focus is primarily on mitigation, though the authors note that effective mitigation can also serve as a very cost-effective form of prevention. Communities must be actively involved not only because they have the most information about how their own livelihood constraints have changed due to HIV/AIDS but also as a way of overcoming stigma. The potential impact of the public response needs to be evaluated, both in terms of mitigation today as well as with regard to the reduction of susceptibility and vulnerability tomorrow. New interventions to address HIV/AIDS mitigation should only be developed if existing agriculture, food, and nutrition interventions areas cannot be effective by adapting them though the use of an HIV/AIDS “lens.” Public policy should not be blind to HIV/AIDS but neither should it be blinded by it. As labor becomes depleted, new cultivation technologies and varieties need to be developed that do not rely so much on labor, yet allow crops to remain drought resistant and nutritious. As knowledge becomes depleted, innovations such as farmer field schools have to emerge to facilitate the transfer of community-specific and organization-specific knowledge within generations and across them. Nutritional support has the potential to significantly postpone HIV/AIDS-related illness and prolong life. Regarding mother-to-child transmission of HIV, further confirmation of the protective effect of exclusive (as opposed to partial) breastfeeding is needed to strengthen existing policy. Appropriate community-based interventions aimed at improving the food, health, or care preconditions of nutritional well-being need to be designed through a participatory process of assessment, analysis, and action. Finally, the review outlines five research priorities. These comprise the development of mechanisms for information sharing and for the assessment of capacity; the evaluation of attempts at HIV/AIDS mitigation through food, agriculture, and nutrition interventions, and more basic research on the dynamics of shocks. Finally, a reexamination of the policymaking process is needed to understand the ways in which existing policies and programs may be modified to reduce their effects on either the spread of HIV or the downstream impacts of HIV/AIDS on households and communities