AIDS + Hunger: A Devastating Combination

AIDS and hunger coexist in many countries. In Malawi, for example, between 30% and 60% of the severely malnourished children cared for by Action Against Hunger during the past year carried the AIDS virus. This is a reality we've observed during our daily fight against hunger in more than 40 countries: Victims of hunger are also often victims of AIDS. Says Olivier Longué, Executive Director of Action Against Hunger - Spain: "Several years ago, we realized that groups of vulnerable people we were working with were the same groups that were affected by HIV/AIDS. Today, we've come to the conclusion that the fight against hunger and the fight against AIDS must be coordinated to be effective."

During 2003, five million people became infected with HIV, more than in any other year. Worldwide, 38 million people live with HIV/AIDS. Seventy-five percent of the deaths caused by AIDS in 2003 were in Sub-Saharan Africa, where more than half of the infected people live—some 25 million. However, the pandemic is growing most rapidly in Asia, where 2003 estimates indicated that 7.4 million people were living with HIV/AIDS, compared with 6.6 million in 2001.

The virus is most devastating in the world's poorest countries. Since it was discovered in the 1980s, HIV/AIDS has gone from being a problem of a specific urban demographic to walking hand-in-hand with hunger and poverty everywhere. Experts from all over the world who met in Bangkok in July 2004 agreed that HIV/AIDS is an exceptional crisis: It is both an immediate emergency and a long-term problem. Just like hunger.

More than a Health Issue

In July 2004, more than 19,000 scientists, politicians, and NGO representatives took part in the XV International Conference on HIV/AIDS in Bangkok. Upon his return from the conference, Longué stated: "HIV/AIDS is no longer exclusively a health issue; it has become a social issue of prime importance because it kills entire communities and threatens the future of many countries."

HIV/AIDS kills more people than those it infects. To begin with, the pandemic is reducing agriculture in many countries. It is estimated that by 2020, HIV/AIDS will have killed one-fifth of all agricultural workers in southern Africa. In many communities, development is now being undone. Due to labor reduction, farming families who used to produce a small surplus to sell are increasingly able to produce only what they need to subsist. Families are planting crops that require less labor, resulting in a poorer, less diverse diet. Agricultural income is falling in homes where the pandemic is simultaneously causing high medical and funeral expenditures. Many families are selling their livestock or going into debt in order to deal with the costs of caring for the sick. In Africa, expenditures associated with HIV/AIDS absorb, on average, one-third of domestic income.

The pandemic also has notable consequences for education. It is common for children, especially girls, of families affected by HIV/AIDS to be removed from school to care for sick family members and to help in the home. Further, HIV/AIDS has killed many elementary school teachers in countries such as Kenya, Zambia, and Zimbabwe.

Deconstructing Societies

Ultimately, HIV/AIDS is destabilizing numerous communities in which social structure is based on the family. As ACF food security expert Rebecca Brown notes: "Because of HIV/AIDS, the number of orphans (15 million) and single parent homes has skyrocketed, along with the number of households headed by a child or a senior.… HIV/AIDS is causing losses among the elites and among highly trained personnel. The disease also interrupts the transmission of a community's history and tradition, especially in communities where oral communication is the basis of collective memory. Moreover, public works such as irrigation canals and community infrastructure are being abandoned."

Desperate Answers: Emmigration and Prostitution

Faced with this situation, families must seek different ways to assure their survival. As Brown explains: "Sometimes there is an exodus from rural areas to cities to find work, while other times families are forced to take desperate measures such as prostituting the young women in the family, which increases the risk of infection." In such cases, families enter a vicious cycle: HIV/AIDS -> poverty -> survival strategies -> increased risk of infection -> HIV/AIDS, etc. Due to the extent of the disease, it is imperative that public health systems take decisive action. However, despite the fact that medication is getting less expensive, HIV/AIDS continues to be devastating in places with weak health coverage. Furthermore, in African countries, between 19% and 53% of public health workers die of HIV/AIDS.

In all these ways, AIDS causes hunger in the medium and long term. But the pandemic also causes hunger in emergencies. Explains Brown: "There is no doubt that AIDS increases the risk of famine in a region. AIDS affects all the economic and social factors of food security, and it adds to traditional vulnerability factors, such as unforeseen weather changes or low cereal production. This means that the action taken by communities, governments, and humanitarian organizations must be both rapid and sustained over time."

Solutions Do Exist

In spite of the pandemic's global spread, the spread of AIDS is falling in some countries. Brazil, Dominican Republic, Thailand, and Uganda have managed to reduce the rate of HIV infections.

Faced with the situation in most countries, however, Action Against Hunger is revising its support programs for vulnerable populations to integrate the fight against AIDS with the fight against hunger. We are adjusting each of our four interventions (health, nutrition, food security, and water and sanitation). "For example, water and sanitation programs have a clear aim: to guarantee basic living conditions, taking into account the people suffering from HIV/AIDS and improving their quality of life," says Curro González, ACF Water and Sanitation Agent. "Manual pumps that do not require much force can be used by sick people, and latrines are adapted for communities where there are many children and seniors. Educational programs also help clarify some false ideas about the transmission of AIDS in relation to water. Another factor is that in conflict zones, if women are able to travel less distance to gather water and can avoid entering insecure zones, they will have less risk of being raped and infected."

"Dietary aid programs should take into account the growing nutritional needs of HIV-infected people in order to strengthen their immune systems," says Brown. But even as programs are being adapted, Longué reminds us that "as of today, the best solution is prevention…. The medical field will have a difficult time finding a solution to this illness because of its social, cultural, and biological characteristics (long incubation period)." At Action Against Hunger we are taking into account all the social elements of the pandemic (including access to information, isolation, and gender roles) in designing our programs because we are convinced that we cannot defeat hunger without simultaneously confronting the disease.