HIV/AIDS affects the nutrition and livelihoods of individuals, households and communities, and the viability of institutions in a variety of ways. It commonly undermines the ability of individuals and households to feed and care for themselves, while eroding the capacity of communities and institutions to provide basic services and support for people in need.
Groups generally requiring special attention include:
people living with HIV/AIDS;
people caring for people living with HIV/AIDS;
orphans and households fostering orphans (in particular, orphan-headed households and single-parent households, especially those headed by women).
The impact of HIV/AIDS on nutrition and household food security
HIV/AIDS and nutrition are intimately linked. Poor nutrition can damage the immune system and contribute to the acceleration of full-blown AIDS. In turn, HIV/AIDS itself may lead to malnutrition. HIV weakens the immune system, thus compromising the bodys ability to fight infections. As a result, an HIV-positive person may become prone to repeated periods of prolonged illness, which can reduce their appetite and interfere with the bodys absorption of nutrients. Infections also increase the bodys need for essential nutrients. Many HIV-infected people are unable to meet these additional nutritional requirements and become weak and malnourished.
An adequate, well-balanced diet is therefore an essential component of basic care for people living with HIV/AIDS. Given the lack of medical care and drug treatment in most AIDS-affected developing countries, it is imperative that vigorous efforts to achieve and maintain good nutrition among HIV-infected people are undertaken as a matter of priority.
HIV/AIDS-related illness and death are major causes of and contributors to household food insecurity. This is understandable given that the disease typically strikes the most productive household members. When a breadwinner becomes sick, the household not only has to manage without their labour and income, but also with the loss of labour from those who have to care for the sick. AIDS is commonly characterized by repeated periods of illness, and results in recurrent loss of labour and income, as well as increasing health care costs.
A study conducted by the Zimbabwe Farmers Union (ZFU) showed that the death of a breadwinner due to AIDS cut the marketed output of maize in the small-scale farming and communal areas by approximately 60 percent. A study in Ethiopia demonstrated that labour losses reduced the time spent on agriculture from 34 hours per week for non AIDS-affected households to between 12 and 16 hours for those affected by AIDS.
In rural areas, agricultural production tends to be highly labour dependent and labour demands are often concentrated during specific periods of the year. Sickness or funeral attendance during these times may mean that all or part of a planting, growing or harvesting season is missed - as is all or part of a crop. The ability to participate in community activities is also greatly reduced.
Figure 1 - Summary of impact of HIV/AIDS epidemic on nutrition, food security and resources at individual, household, community and institutional levels.
When an adult household member dies, the surviving parent, grandparents, relatives and even children themselves have to help meet the households food, income and child care needs - a task which is often far too much for them to handle. Desperate to survive, some household members are driven to exchange sex for money, food, goods or services, or to leave home in search of work. This exposes them to greater risk of HIV infection.
Currently, most AIDS orphans are cared for through extended family networks. But as AIDS continues to ravage communities, leaving fewer and fewer unaffected households, increasing numbers of children are likely to end up living on the streets without adequate care or support.
When a person dies from an AIDS-related illness, hardships often intensify for the family members they leave behind, particularly women and children. For example, in some societies, women may lose access to land and other assets when their husband passes away, thereby losing the ability to feed their families.
The progressive depletion of household assets makes it more difficult for people to manage during natural disasters, like drought and flooding, and economic hardship. Under such conditions of severe stress, short-term survival is a priority over sustainable management of natural and other resources.
Proper care for people living with HIV/AIDS - including medication, regular treatment (particularly for major opportunistic infections), good nutrition and palliative care - is essential. However, the needs of people living with HIV/AIDS extend far beyond drugs and health care. Individuals who suspect or know they are infected with the virus need support and protection. At the same time, individuals living with HIV-infected people need social and economic support.
The impact of HIV/AIDS on communities and institutions
HIV/AIDS is destroying the institutional fabric serving rural communities. Formal and informal institutions suffer when staff and members fall sick and die from HIV/AIDSrelated illnesses. Repeated periods of illness lead to recurrent absences from work, which ultimately deprive organizations of experienced people. Loss of institutional capacity and the expenses involved in coping with staff loss and death can undermine public and private sector service delivery. It is therefore important to anticipate that, in areas with high HIV prevalence, the delivery and sustainability of projects may be seriously compromised.
The AIDS epidemic has killed about 7 million agricultural workers since 1985 in the 25 hardest-hit African countries - and could kill 16 million more before 2020.
HIV/AIDS also claims the lives of volunteers and members of community-based organizations. As households contend with increasing expenditures (e.g. health care, funerals, fostering orphans) while earning less income, it becomes more and more difficult to mobilize local resources for communal or group-based initiatives. Groups may eventually disintegrate as members die, or can no longer afford to pay their dues or contribute time.
Likewise, private-sector organizations are affected by the epidemic on various fronts. Not only does HIV/AIDS rob them of staff and institutional knowledge, but profitability is further reduced when the demand for goods and services falls with the purchasing capacity of HIV-affected households and businesses. Financial service providers may suffer increased losses when HIV/AIDS-affected clients resort to defaulting on loan repayments.
As a result of HIV/AIDS, sub-Saharan Africa will have 71 million fewer people by 2010, with higher rates of dependency. With fewer people and more dependants, HIV/AIDS will have a major adverse impact on the gross domestic product of various countries. It is estimated that by 2010, the South African economy will be 22 percent smaller than it would have been without HIV/AIDS, amounting to a total of about US$17 billion.
The result of this institutional breakdown may lead to a collective and individual inability to deal adequately with HIV/AIDS. In other words, it may not be possible to prevent its transmission, provide adequate care to people affected by the disease or mitigate its wide-ranging impacts. Therefore, projects have to address the institutional aspects of the epidemic in order to be effective in the context of HIV/AIDS.
Examples of interventions
The epidemics impact on individuals, communities and institutions is related primarily to their capacity to cope. The stage and pattern of a countrys HIV/AIDS epidemic is also important in assessing coping abilities. In the initial stages, for example, when HIV prevalence is low, there is little impact on households and communities. As HIV prevalence rises, however, the virus starts to spread beyond mobile and high-risk groups. The impact is most acutely felt when large numbers of people have been infected and AIDS deaths start to rise.
The combination of interventions and how they are implemented will differ depending on the stage of the epidemic. The response to an existing HIV/AIDS crisis will be fundamentally different from preparing for a crisis which may arise. This has important implications when considering HIV/AIDS in the project cycle.
Below are concrete examples of interventions that aim to protect and improve nutrition and food security among HIV/AIDS-affected households. The list is by no means exhaustive but merely aims to provide an overview of tried-and-tested methods that may be used to illustrate to stakeholders what can feasibly be done through the food and agricultural sector.
Awareness needs to be raised about the links between HIV/AIDS, food insecurity and malnutrition among people involved in policy and programme formulation, planning and project development in order to:
review and incorporate HIV/AIDS considerations into existing development policies, programmes and projects;
review and incorporate nutrition and food security objectives and considerations into HIV/AIDS policies, programmes and projects.
Nutritional care for people living with HIV/AIDS
Given the impact of good nutrition on life quality and expectancy in people living with HIV/AIDS, programmes that enhance physical access to nutritionally adequate food - in both quantity and quality - are required. These include home and community gardening programmes and other agricultural interventions that can produce the required variety and amount of food in a cost-effective way.
Since households are often drained of productive resources after full-blown AIDS develops, local food banks and external food aid may be required when families can no longer cater to their own needs.
Nutritional care also involves major nutrition education and communication efforts through existing community and home-based care organizations, as well as through the media - particularly rural radio. Such communication and education programmes and related training need to be developed and maintained.
Livelihoods and food security support for HIV/AIDS affected households
A mix of interventions (combined, when needed, with food aid) is required to assist households affected by HIV/AIDS. This mix may include supporting food production and diversification, introducing labour- and time-saving approaches, promoting income generation and protecting productive assets.
The mix may depend on the household type: Orphan- and elderly-headed households, for instance, often need more direct support and aid; female-headed households often need protected or increased access to means of production; while households fostering orphans may benefit from enhanced access to microfinance, etc.
Community-based livelihoods support and care systems
Since HIV/AIDS-affected households depend largely upon community-based organizations for care and support, the capacity of these organizations needs to be strengthened - and their establishment needs to be promoted in communities where they do not exist.
The physical capacity of local care organizations (such as mutual-help groups and orphanages in urban areas) providing nutritional care and food assistance also needs to be strengthened.
Given the high turnover of community volunteers, locally adapted training programmes on nutritional care and food assistance to people living with or otherwise affected by HIV/AIDS need to be established.
Access to education, life skills and vocational training
The goal is that orphans and other vulnerable children will attend school and receive a basic education in order to obtain skills that will help them achieve longterm food and livelihood security. Access to education may be enhanced through school feeding and other incentive programmes.
In reality, however, many orphans and vulnerable children are unable to attend school, even when incentive programmes exist, and few receive an education beyond primary levels. Their long-term needs include life skills and vocational education, especially related to nutrition, food and agriculture. It is therefore essential to provide such education and training through both formal and informal channels.
 Stover, J. and Bollinger,
L. The Economic Impact of AIDS. Washington, DC: The Futures Group, 1999,
 Loewenson, R. and Whiteside, A. HIV/AIDS: Implications for Poverty Reduction. New York: United Nations Development Programme for the UN General Assembly Special Session on HIV/AIDS, 25-27 June 2001, p. 10.
 FAO. HIV/AIDS, food security and rural livelihoods. Rome, 2001. (Fact sheet)
 Drimie, S. The Impact of HIV/AIDS on Rural Households and Land Issues in Southern and Eastern Africa. Rome, Italy: FAO, 2002, p.6.
 de Waal A. AIDS-Related National Crises: An Agenda for Governance, Early-Warning and Development Partnership. Justice Africa, 2001.