The link between HIV/Aids and hunger in rural communities has received a great deal of attention over the past few years — particularly in Southern Africa, where HIV/Aids has added a new dimension to the recent food crisis.
But research emerging from last week’s international conference on HIV/Aids and Food and Nutrition Security in Durban, South Africa, showed that very little is known about the actual impact of the pandemic on rural communities.
The three-day conference, organised by the Washington-based International Food Policy Research Institute (Ifpri), brings together policymakers, donors and researchers to develop strategies for improving and expanding the response to HIV/Aids and food security.
In his keynote address on Thursday, Dr Tony Barnett from the London School of Economics warned against the danger of demanding action when there was only “spotty and patchy evidence” about what was happening in farming systems.
Barnett raised questions that “fly in the face of conventional wisdom” on “what we think we know” about HIV/Aids and food and nutrition security.
According to Stuart Gillespie, conference director and senior research fellow at Ifpri, researchers attending the conference were taking “a critical look at existing evidence”, and finding that “while some of the research supports conventional wisdom about the massive impact of HIV/Aids on livelihoods, more research put on the table [this week] is forcing us to change the way we look at things.”
“We’re seeing that HIV/Aids is intertwined with multiple vulnerabilities, and we have to avoid Aids exceptionalism … it’s a complex issue that looks different in different places,” he said.
As an example, Barnett mentioned three studies he conducted in a small village in the Rakai district of Uganda, examining the effects of HIV/Aids on farming communities from 1989 to 2004.
Contrary to expectations, and despite an HIV prevalence of 8% in 1993, the farming system had not collapsed from the strain of Aids-related illnesses, and all the study respondents from 1993 were still alive.
The region’s “fairly robust and very resilient farming systems”, sustained by good soils and “high … rainfall”, had created a buffer against the impact of HIV/Aids.
This was not a “devastated community”, but the situation was not the same everywhere, and there was a need for more research and a greater diversity of responses.
Barnett called for large-scale donor and state-driven efforts that recognised the complex nuances in the impact of HIV/Aids on rural households. He admitted that this would be difficult for governments, but stressed that “one size will not fit all”.
Previous assumptions during the early stages of the pandemic — that HIV/Aids impacted wealthy, more educated people — were no longer valid, as poorer households were now more affected. But policies and programmes were not changing as quickly as the virus was progressing, and rural households remained neglected.
Labour technologies used in rural communities would also need to keep pace with the epidemic, he warned, as some were no longer appropriate.
“The problem is: how can we introduce innovations at a time when people are not living long enough to adopt to the innovations — is there enough time for communities to adapt to these changes; is there existing and appropriate technology which will work in these changed circumstances?” he asked.
While the benefit of antiretroviral (ARVs) medication was that it increased lifespans by between five and 10 years, this was still not being fully exploited.
“The problem is, we don’t know what to do — this is a novel situation, and the response must be rapid … [but we] don’t know what works,” Barnett said.
With the danger of drug resistant strains of the virus developing during this window, African countries had to ensure that ARVs were used regularly, and continued access to the treatment was available.
He expressed concern that large pharmaceutical companies, already feeling the pinch from dramatic ARV price cuts, would not respond rapidly to the need for a new generation of cheaper medicines for developing countries.
“We are in perilous waters,” he declared.
Making matters worse, rural households still had a problem accessing treatment, while widespread stigma remained prevalent in small communities. Under these circumstances, “how long will it be before we see a new epidemic of resistant HIV in rural areas?” Barnett wondered.
He cautioned that “bureaucratic inertia”, and using “yesterday’s solutions for today’s problems” would do more harm than good.
Current prevention methods had not provided all the answers; more research into the use of microbicides as a female-controlled prevention method was needed.
“The history of prevention shows us the mistakes we’ve made … it cannot be business as usual,” Barnett concluded.– Irin