Twenty-ninth Session

Rome, 12-16 May 2003


Table of Contents


1. This update is a response to the request emanating from the Twenty-eighth Session of the Committee on World Food Security to “inform the CFS annually of the latest impact of HIV/AIDS on food security in countries severely affected by the disease”. It builds on recent literature as well as on the recommendations of the Committee made at its Twenty-Seventh Session for FAO to:

2. In the past two years, worldwide political commitment for the response to the HIV pandemic increased considerably. The UN General Assembly Special Session on AIDS (UNGASS) in 2001 and the creation of a Global Fund to fight AIDS, Tuberculosis (TB) and Malaria are two such indicators of commitment at global level. HIV/AIDS has also become a key concern in the overall UN development agenda. Stemming the spread of HIV/AIDS has been included in the Millennium Development Goals. The Rome-based food agencies (FAO, IFAD, WFP) have developed or are in the process of developing strategies to address the impact of the epidemic on food security for presentation to their governing bodies. HIV/AIDS has also been placed on the agenda of regional development banks and regional economic organisations. At national level, low and middle income countries have made some progress in HIV/AIDS planning and programme development2.

3. This update summarises some recent epidemiological trends, reviews the impact of AIDS on food and livelihood security, and highlights the role of poverty alleviation and improved food security in stemming the spread and mitigating the impact of the epidemic. Special attention is paid to the current situation in Southern Africa, where an acute food shortage coincides with some of the most advanced HIV epidemics.


4. The impact of AIDS is profound enough to challenge fundamentally the security and stability of a growing number of states around the globe. In fact, the UN Security Council has defined HIV/AIDS as an issue of human security.3 About 42 million people are estimated to be living with HIV/AIDS today, of whom 5 million acquired the human immunodeficiency virus (HIV) in 2002 alone. In the same year, AIDS claimed more than 3 million lives, most of them young adult breadwinners.4

5. Around 70% of people with HIV live in Africa, where AIDS is now the leading cause of death. While the food security implications of the epidemic are likely to be most pronounced in sub-Saharan Africa, trends in other parts in the world are equally alarming. Almost one million people in Asia and the Pacific acquired HIV in the past year, bringing to 7.2 million the number now living with the virus in this region - a 10 % increase from 2001. For an overview of regional trends see Table 1.

Table 1: Regional HIV/AIDS Statistics and Features, end of 2002


Epidemic started

Adults and children living with HIV/AIDS

Adults and children newly infected with HIV

Adult prevalence rate

% of HIV positive adult who are women

Sub-Saharan Africa

late ’70s to early ‘80s

29.4 million

3.5 million



North Africa
&Middle East

late ‘80s

550 000

83 000



South&South-East Asia

late ‘80s

6.0 million

700 000



East Asia & Pacific

late ‘80s

1.2 million

270 000



Latin America

late ‘70s early ’80s

1.5 million

150 000




late ‘70s to early ‘80s

440 000

60 000



Eastern Europe & Central Asia

early ‘90s

1.2 million

250 000



Source: adapted from UNAIDS (2002): AIDS Epidemic Update, December 2002

6. The deaths and misery that HIV/AIDS has brought in the past 20 years dwarfs that of all natural disasters combined.5 When compared to violent conflict, AIDS is estimated to have already killed more people than all the soldiers killed in the major wars of the twentieth century.6 While this comparison is meant to place the importance of HIV/AIDS in perspective relative to other shocks and stresses to peoples’ livelihoods, often wars and armed conflict generate and entrench the very conditions and human rights abuses in which the HIV epidemic flourishes.7


7. The linkages between HIV/AIDS and food security are bi-directional: HIV/AIDS is a determining factor of food insecurity as well as a consequence of food and nutrition insecurity. This relationship is shown in Figure 1.

Figure 1 - Bi-directional Relationship between HIV/AIDS and Food Security

8. Food insecurity and poverty fuel the HIV epidemic, as people are driven to adopt risky strategies in order to survive. The break-up of households due to labour migration in times of food insecurity as well as the exchange of sex for money or food during crises increase vulnerability, with women and children particularly exposed. In addition, poverty-induced malnutrition is likely to lead to an earlier onset of AIDS, due to an increased susceptibility to opportunistic infections. Thus, food security interventions, if carried out with an “HIV/AIDS lens” and if complemented with HIV-specific interventions, can contribute to reducing HIV infection.

9. HIV/AIDS impacts on food security include short and long-term effects. In the short and medium term, the epidemic impoverishes households through:

      1. Loss of labour in agriculture and other livelihood activities;
      2. Increased cost of health care and funerals;
      3. Diminished capacity to care for children and other vulnerable individuals;
      4. Erosion of the asset base.

10. AIDS also increases longer-term vulnerability through its systemic impact on social and economic systems and institutions in hard hit countries, as it leads to the adoption of irreversible coping strategies. AIDS forces children, particularly girls, to withdraw from school in order to work or care for ill parents. It reduces the inter-generational transfer of skills and knowledge of agriculture and livelihood while it also erodes the human resource base of institutions required to address the sectoral and cross-sectoral impacts of the epidemic. In other words, HIV/AIDS reduces the availability of labour and knowledge which in turn affect household level access to food.8

11. In conclusion, HIV/AIDS is interwoven with multiple other determinants of food security. Given the bi-directional linkages between HIV/AIDS and food security mentioned above, a food security response to the epidemic linking short- and long-term interventions is imperative.


12. To date, the most widely used indicator to describe the severity of the epidemic is HIV/AIDS prevalence. However, while providing an estimate of the “threat” to societies, HIV prevalence rates alone are not an adequate measure of impact. In particular, they do not distinguish between people who acquired the virus recently and those who are in an advanced stage of the disease.9 Furthermore, the majority of people in the developing world are not aware of their sero-status and may therefore not take action at individual or community level.

13. Recently, there have been increasingly demands to integrate HIV/AIDS concerns into multi-sectoral vulnerability assessments, food security analysis and early warning systems.10 This will help determine what aspects of AIDS impact must be tackled through expanded, well resourced, long-term, development-oriented food security and poverty alleviation policies and programmes versus aspects where short-term humanitarian interventions are needed.

14. To develop integrated response strategies that combine short- and long-term interventions in new ways (parallel rather than sequential), there is a need to refine the concept of “AIDS impact” as far as food security is concerned and to improve existing impact assessment frameworks. The latter will ensure a more effective food security-based response to the epidemic that takes the systemic and cumulative impact of the epidemic into account.

15. A comprehensive impact assessment framework would include a number of indicators sensitive to both HIV/AIDS and food security, in addition to prevalence rates. Examples are:

      1. Adult morbidity and mortality rates;
      2. % of single and double orphans in the population;
      3. % of households fostering orphans;
      4. Percentage of household income spent on health care;11
      5. Effective dependency ratio (adjusted for adult ill-health);12 and
      6. Average age of household head.

16. The following aspects should be taken into consideration when refining these indicators to inform food security policy and programming in AIDS-affected areas:

Figure 2: HIV/AIDS Impact and Response Matrix


AIDS Impact



HIV Prevalence


(1) Prevention

(4) Rehabilitation


(2) Impact Mitigation

(3) Impact Alleviation

Source: Adapted from Topouzis (2001): IFAD HIV/AIDS Strategy for East and Southern Africa.


17. In an assessment of the Southern Africa crisis in September 2002, the Special Envoy of the United Nations for Humanitarian Needs in Southern Africa highlighted the HIV/AIDS pandemic as a fundamental, underlying cause of vulnerability in the region that represented the single largest threat to its people and societies as contributing factors to acute vulnerability.13 Similarly, the most recent SADC food security Ministerial Brief states that HIV/AIDS directly contributes to, and is compounded by, food insecurity, and indicates that HIV/AIDS food insecurity linkages may be many and long-lasting.14 In particular, HIV/AIDS and its implications for food security are interwoven with aspects of governance, social sector performance, a functioning private sector, and macro-economic performance. 15

18. A joint mission of the Special Envoy of the United Nations for Humanitarian Needs in Southern Africa and the Special Envoy for HIV/AIDS in January 2003 concluded that a “key component in stopping the spread of HIV/AIDS is to improve people’s food security, which depends greatly on a multi-sectoral approach”.16 Their report argues that the bi-directional relationship between food security and HIV/AIDS must be recognised in all efforts to address food emergencies among HIV/AIDS affected populations.

19. The six countries most affected by the Southern Africa food crisis, namely Zimbabwe, Malawi, Zambia, Lesotho, Swaziland, and Mozambique about 15 million people were identified as in need of food assistance. In the same countries, UNAIDS estimates that in 2001 close to half a million people died as a result of AIDS-related diseases, leaving 2.5 million orphans. Three of these countries (Zimbabwe, Lesotho and Swaziland) show HIV prevalence rates close to or above one third of the adult population, which suggests that much of the impact on food security is yet to come. Some salient features of HIV/AIDS in the countries most affected by the current food crisis in Southern Africa can be found in Table 2.

Table 2: HIV/AIDS Indicators in Selected Southern African Countries


Total Population millions
UNFPA (2002)

People living with HIV (adult & children)

Adult HIV Prevalence Rate (%)

New AIDS Deaths 2001

New AIDS Orphans 2001

% under nourished
(FAO 2002)


0.9 (FAO)









































Source: UNAIDS, UNFPA, FAO, 2002

20. On account of its scale and near 15-20 year presence in Eastern, Southern and Central Africa, HIV/AIDS has evolved into a new type of crisis which is altering the parameters of food insecurity in severely affected countries. As such, HIV/AIDS needs to be differentiated from and be understood in the context of other emergency and development challenges. Further, its specific contextual and structural effects on food security need to be distinguished from other triggers of food insecurity, including drought and other natural disasters, war and civil conflict, etc. This is because HIV/AIDS:

21. There is no simple answer to whether AIDS has a more severe impact on food and nutrition security in sub-Saharan Africa than recurrent droughts and other factors. Without AIDS, there would still be food insecurity due to chronic poverty, the degradation of natural resources, drought, inappropriate policies, bad governance and civil strife. However, in those countries and communities worst affected by HIV/AIDS in southern Africa, the pandemic has exacerbated food shortages and reduced resilience to drought. As HIV infection spreads and more people fall ill and die, the impact on food security is likely to increase and outweigh the relative importance of other factors. Thereby, the impact of HIV/AIDS on a population’s ability to acquire and utilise food can be uneven within a country, due to the variation in the severity of HIV/AIDS, as well as its interaction with other factors that affect household food security and nutrition.

22. To address the double crisis consisting of a long-wave HIV/AIDS emergency and chronic and acute food insecurity new approaches are needed. These approaches need to be seen through an “HIV/AIDS lens” and combine emergency measures with long-term initiatives that: strengthen food security, nutrition and health, ease the burden of women and households, and address the issue of orphans. Such new approaches will have critical implications for donors, as it is now urgent to overcome the chronic imbalance in funding food and non-food emergency interventions as well as short-and long-term programmes. Some specific actions are suggested in the last section of this report.


23. Since the 27th Session of the CFS, a number of actions have been undertaken by FAO in collaboration with key partners, both in terms of normative work at FAO Headquarters and in direct response to the Southern Africa Crisis. Some of the highlights include:

In terms of normative work:

In terms of field operations:


24. Food insecurity and poverty fuel the HIV epidemic while poverty-induced malnutrition may contribute to earlier onset of AIDS, due to an increased susceptibility to opportunistic infections. A food security response to the epidemic, linking short- and long-term interventions is imperative, given the two-way linkages between HIV/AIDS and food insecurity. Such a response needs to address food production, food access and nutritional aspects. If designed with an "HIV/AIDS lens" and complemented with HIV-specific interventions, food security policies and programmes can contribute to preventing the spread of HIV infection and to mitigating the impact of the epidemic.

25. Given that HIV/AIDS is a long-wave crisis, governments and donors need to adopt a long-term, development-oriented approach in addressing its effects on food security, rather than merely a disaster relief approach. The Southern Africa humanitarian emergency has demonstrated that HIV/AIDS, in combination with acute food insecurity, has contributed to a new type of crisis requiring: a) novel responses to food insecurity; b) new and innovative ways of linking short- and long-term responses; and c) an increased commitment to addressing the structural vulnerabilities that underlie acute crisis situations. In particular, governments, FAO and donors need to ensure a balance in funding short-term, food-based responses and longer-term non-food based interventions.

26. Food security policies and programmes need to be adjusted to enhance household, community and national resilience to shocks, including HIV/AIDS. Traditional mechanisms designed to help communities cope with climatic shocks on food security may no longer function as a result of increased morbidity and mortality in the context of advanced HIV/AIDS epidemics. This means that many communities across Africa have reduced resilience to shocks they were once able to cope with. Measures to address the long-term, structural factors fuelling the double crisis of food insecurity and HIV/AIDS include:

27. Food security analysis and food security information systems need to take into account the linkages between HIV, poverty and food security in order to generate systematic and comprehensive region- and country-specific analyses in highly affected countries. This will require the application of refined HIV/AIDS impact assessment frameworks that go beyond using HIV prevalence rates in capturing the relevance of HIV/AIDS for food and livelihood security. Mechanisms that allow direct feed back of food security analysis results into food security and agricultural policy and programme formulation need to be strengthened to allow for regular policy and programming review that takes into account the changing dynamics of epidemic impact.

28. A strategic plan to mitigate the impact of HIV/AIDS on rural orphans, vulnerable children and adolescents, in view of the near 14 million such children in need of care, food and livelihood-building prospects is urgently needed. Such a plan could address children's and young people's needs through agriculture sector-based programmes, including on- and off farm income generation, apprenticeship programmes, etc. FAO is well placed to lead such a programme in the context of its work on conservation agriculture, farmer field schools, agriculture extension, post harvest storage, nutrition and basic rural education. The formation of Junior Farmer Field Schools, on the model of the successful Farmer Field Schools, is a promising, innovative way to address the needs and interests of orphans and vulnerable children as well as their guardians.


1 This brief was prepared by Günter Hemrich, Food Security and Agricultural Projects Analysis Service, FAO Rome. The comments on the first draft by Marcela Villarreal and Carol Djeddah, SDWP; William Clay, Florence Egal and Karel Callens, ESNP; Richard China, TCER; Angela Hinrichs, TCEO; and Amde Gebre Michael, Marijke Drysdale, and Ana Carla Lopez, ESAF, are gratefully acknowledged.

2 William McGreevey, Stefano Bertozzi, Juan-Pablo Gutierrez, Marjorie Opuni, Jose-Antonio Izazola (2002): Current and Future Resources for HIV/AIDS. In: State of the Art: AIDS and Economics.

3 International Crisis Group (2001): HIV/AIDS as a Security Issue. The term human security, first coined by the UN Development Programme, is used by a growing number of experts and leaders to stress that security is more than the presence or absence of armed conflict. Security, at its most basic level, is personal –the life and health of the individual, family and community; hunger, safety, and the security of the environment all play a role. The theory of human security stresses taking preventive action to reduce vulnerability and minimize risks to human rights, human safety and human lives.

4 UNAIDS/WHO (2002): AIDS Epidemic Update, December 2002.

5 Piot Peter and Per Pinstrup Andersen (2001): AIDS: The New Challenge to Food Security. Reprint from IFPRI’s 2001-2002 Annual Report entitled “AIDS and Food Security”.

6 International Crisis Group (2001): HIV/AIDS as a Security Issue.

7 UNAIDS/WHO (2002): AIDS Epidemic Update, December 2002.

8 FEWSNET/CARE (2001): HIV/AIDS and Food Insecurity: Breaking the Vicious Cycle, 23 April 2001.

9 UNAIDS/WHO (2002): AIDS Epidemic Update, December 2002.

10 Senior Management Group Background Paper (2003): HIV/AIDS and Famine in Southern Africa.

11 For a discussion of these four indicators, see Topouzis, Daphne (2001): Strategy Paper on HIV/AIDS for East and Southern Africa, International Fund for Agricultural Development.

12 de Waal, Alex and Alan Whiteside (2002): ‘New Variant Famine’: AIDS and Food Crisis in Southern Africa. (Draft).

13 T. Morris, Special Envoy of the Secretary-General for Humanitarian Needs in Southern Africa: Report of the First Mission to Lesotho, Malawi, Mozambique, Swaziland, Zimbabwe and Zambia, dated 24 September 2002.

14 SADC Food Security Ministerial Brief: 28 Feb 2003.

15 T. Morris, Special Envoy of the Secretary-General for Humanitarian Needs in Southern Africa: Report of the First Mission to Lesotho, Malawi, Mozambique, Swaziland, Zimbabwe and Zambia, dated 24 September 2002.

16 SMG Background Paper: HIV/AIDS and Famine in Southern Africa, 2003.