<ul><li>Poverty, Agriculture and Health: </li></ul><ul><li>Lessons from the HIV response </li></ul><ul><li>Stuart Gilles...
The World of HIV © Copyright 2006 SASI Group (University of Sheffield) and Mark Newman (University of Michigan).
The World of Income © Copyright 2006 SASI Group (University of Sheffield) and Mark Newman (University of Michigan).
HIV prevalence in Africa
Three coexisting/interacting crises Livelihood/food insecurity HIV & AIDS Malnutrition
Vulnerability   of Livelihood Systems to AIDS Vulnerable Groups - Orphans, Elderly and Youth Headed Households,  Effect on...
  HIV   AIDS upstream   downstream   Food insecurity    Malnutrition   mid-stream Three stages of vulnerability
  HIV   AIDS prevention   mitigation   Food insecurity    Malnutrition   care & treatment HIV strategies
 
  HIV   Food insecurity  Malnutrition   Upstream vulnerability
HIV and Income Poverty
HIV and Income Inequality
  HIV   Food insecurity    Malnutrition   Upstream vulnerability Poverty? Wealth? Food insecurity Mobility Gender inequali...
  HIV   AIDS     Mid-stream vulnerability
The Vicious Cycle of Malnutrition and HIV Insufficient dietary intake Malabsorption , diarrhea Altered metabolism and  nut...
  HIV   AIDS     Mid-stream vulnerability ART access and adherence STIs (especially HSV-2) Malnutrition Food insecurity (t...
  AIDS   Food insecurity    Malnutrition   Downstream vulnerability
Impacts of HIV and AIDS on agriculture Subsistence, commercial, and agricultural extension Resource  (e.g. cash, labor) sh...
  AIDS     Food insecurity      Malnutrition   Downstream vulnerability Depends on quantity, quality and mix of assets at ...
More volatile food prices Source: Data from FAO 2009 and IMF 2009. Prices fell as financial crisis and recession developed
Food prices and food crises <ul><li>RENEWAL/UNAIDS/ NAP+ eastern and southern Africa </li></ul><ul><ul><li>Impacts on PLHI...
How to respond? Agriculture Social protection HIV programs Nutrition/health programs Livelihood/food insecurity HIV & AIDS...
  HIV   AIDS prevention   mitigation   Food insecurity    Malnutrition   care & treatment HIV strategies
Securing Livelihoods <ul><li>Local food production  (home gardens, ag inputs, small livestock)  </li></ul><ul><li>Training...
 
<ul><li>Skill building </li></ul><ul><li>Capital </li></ul><ul><li>Productive Assets </li></ul><ul><li>Protection from  as...
The Regional Network on AIDS, Livelihoods and Food Security  <ul><li>Facilitated by IFPRI, RENEWAL </li></ul><ul><li>bring...
Lessons and Challenges <ul><li>Beware AIDS exceptionalism </li></ul><ul><ul><li>Use an HIV  lens , not a filter </li></ul>...
 
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Poverty, Agriculture and Health: Lessons from the HIV Response

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  • Direct measures of poverty, such as the percentage below $1 per day shown here do not seem to show any clear pattern between countries
  • There is a striking association between income inequality (measured here by the GINI coefficient) and HIV – countries with higher income inequality appear to have higher HIV prevalence rates Similar patterns (slightly less clear) can be seen with other inequality measures such as the decile or quintile ratio There may be many counfounding factors here, such as differences in cultural practice (e.g. male circumcision and religion) Bubble plots such as this probably represent the limits of what can be understood from country level analysis – to find more robust relationships we need to go to regional or household level
  • Reductions in food intake Appetite loss, mouth sores Effects of food security decline Nutrient malabsorption Diarrhea Malabsorption of fats and vitamins Metabolic alterations Increased energy, protein requirements Oxidative stress.
  • Poverty, Agriculture and Health: Lessons from the HIV Response

    1. 1. <ul><li>Poverty, Agriculture and Health: </li></ul><ul><li>Lessons from the HIV response </li></ul><ul><li>Stuart Gillespie </li></ul><ul><li>International Food Policy Research Institute </li></ul><ul><li>Regional Network on AIDS, Livelihoods and Food Security </li></ul><ul><li>London International Development Centre, 23 June 2010 </li></ul>
    2. 2. The World of HIV © Copyright 2006 SASI Group (University of Sheffield) and Mark Newman (University of Michigan).
    3. 3. The World of Income © Copyright 2006 SASI Group (University of Sheffield) and Mark Newman (University of Michigan).
    4. 4. HIV prevalence in Africa
    5. 5. Three coexisting/interacting crises Livelihood/food insecurity HIV & AIDS Malnutrition
    6. 6. Vulnerability of Livelihood Systems to AIDS Vulnerable Groups - Orphans, Elderly and Youth Headed Households, Effect on Institutions Community-based, Civil society, Market, State, Global Outcomes Nutrition, Food Security, Education, Community Cohesion, Income Effect on Assets Human, Financial, Social, Natural, Physical, Political Responses Individual, Household, Community Vulnerability to infection HIV Stigma and Discrimination
    7. 7. HIV AIDS upstream downstream Food insecurity Malnutrition mid-stream Three stages of vulnerability
    8. 8. HIV AIDS prevention mitigation Food insecurity Malnutrition care & treatment HIV strategies
    9. 10. HIV Food insecurity Malnutrition Upstream vulnerability
    10. 11. HIV and Income Poverty
    11. 12. HIV and Income Inequality
    12. 13. HIV Food insecurity Malnutrition Upstream vulnerability Poverty? Wealth? Food insecurity Mobility Gender inequalities Social cohesion Hope?
    13. 14. HIV AIDS Mid-stream vulnerability
    14. 15. The Vicious Cycle of Malnutrition and HIV Insufficient dietary intake Malabsorption , diarrhea Altered metabolism and nutrient storage Increased HIV replication Hastened disease progression Increased morbidity Increased oxidative stress Immune suppression Nutritional deficiencies Source: Semba and Tang, 1999
    15. 16. HIV AIDS Mid-stream vulnerability ART access and adherence STIs (especially HSV-2) Malnutrition Food insecurity (time, resources for care)
    16. 17. AIDS Food insecurity Malnutrition Downstream vulnerability
    17. 18. Impacts of HIV and AIDS on agriculture Subsistence, commercial, and agricultural extension Resource (e.g. cash, labor) shortages and reduced productivity <ul><li>affects land use (crops, diversity, yields, livestock) </li></ul><ul><li>- move to low input/low output farming </li></ul><ul><li>- natural resource mining </li></ul><ul><li>- child labor </li></ul>Loss of farm-specific knowledge <ul><li>less intra-household learning (inexperienced farmers) </li></ul><ul><li>- greater risk aversion to new technology </li></ul><ul><li>less appropriate farming practices (environment) </li></ul><ul><li>(less schooling due to dropout & teacher mortality) </li></ul>Institutional capacity and organizational change <ul><li>loss of formal and informal institutional capacity </li></ul><ul><li>weaker rural organizations </li></ul><ul><li>- changes in cultural norms, property rights </li></ul>
    18. 19. AIDS Food insecurity Malnutrition Downstream vulnerability Depends on quantity, quality and mix of assets at household and community levels, institutional context and processes. AIDS impoverishes (directly and indirectly) Intra-household effects (women, children)
    19. 20. More volatile food prices Source: Data from FAO 2009 and IMF 2009. Prices fell as financial crisis and recession developed
    20. 21. Food prices and food crises <ul><li>RENEWAL/UNAIDS/ NAP+ eastern and southern Africa </li></ul><ul><ul><li>Impacts on PLHIV </li></ul></ul><ul><ul><li>Impacts on HIV response </li></ul></ul><ul><ul><li>Rapid qualitative appraisals, key informant interview, focus groups </li></ul></ul><ul><li>Negative interactions more common and more severe </li></ul><ul><li>Additional threshold effects e.g. children denied schooling, ARV treatment stopped…. </li></ul>
    21. 22. How to respond? Agriculture Social protection HIV programs Nutrition/health programs Livelihood/food insecurity HIV & AIDS Malnutrition
    22. 23. HIV AIDS prevention mitigation Food insecurity Malnutrition care & treatment HIV strategies
    23. 24. Securing Livelihoods <ul><li>Local food production (home gardens, ag inputs, small livestock) </li></ul><ul><li>Training ( e.g. conservation farming, vocational; farmer field schools) </li></ul><ul><li>Support existing livelihoods activities where possible </li></ul><ul><li>Address real asset constraints (cash, land, labor?) </li></ul><ul><li>Maximize efficiencies, pooling labour where appropriate </li></ul><ul><li>Attention to laws, rights, norms: e.g. inheritance </li></ul><ul><li>Challenges: Programs tend to be small-scale; hard to rigorously evaluate; uncertain sustainability </li></ul><ul><li>AIDS-sensitive pathways out of poverty (e.g. IMAGE) </li></ul><ul><li>Linkages and integration </li></ul><ul><ul><li>With food aid, ART programs, and/or HIV awareness (e.g. TASO in Uganda, AMPATH in Kenya) </li></ul></ul><ul><ul><li>Linking small-scale agriculture with social protection, school feeding, HIV treatment and nutritional support. </li></ul></ul>
    24. 26. <ul><li>Skill building </li></ul><ul><li>Capital </li></ul><ul><li>Productive Assets </li></ul><ul><li>Protection from asset/capital erosion </li></ul><ul><li>Employment </li></ul><ul><li>Survival </li></ul><ul><li>Productive Assets </li></ul><ul><li>Employment </li></ul><ul><li>PROTECTION AND PROMOTION </li></ul><ul><li>Agricultural inputs subsidy </li></ul><ul><li>Public works </li></ul><ul><li>Insurance programmes (Social, Crop & Livestock) </li></ul><ul><li>Village savings loans </li></ul><ul><li>Micro-credit/finance </li></ul><ul><li>PROMOTION </li></ul><ul><li>Public works </li></ul><ul><li>School Feeding </li></ul><ul><li>Cash and food for assets combined with skills building and cash for consumption/ Adult literacy training </li></ul><ul><li>PROVISION </li></ul><ul><li>Social cash transfers </li></ul><ul><li>Food and nutrition </li></ul>NEEDS INTERVENTIONS Malawi’s Draft Social Support Programme (Government of Malawi and UNICEF 2009) 5% 10% 25% <ul><li>Survival </li></ul><ul><li>Investment in human capital </li></ul>Ultra Poor with Labour Capacity Ultra Poor & Incapacitated Moderately Poor 40% MALAWI POVERTY LINE 15% Ultra Poor
    25. 27. The Regional Network on AIDS, Livelihoods and Food Security <ul><li>Facilitated by IFPRI, RENEWAL </li></ul><ul><li>brings together national networks of </li></ul><ul><li>Researchers </li></ul><ul><li>Policy makers </li></ul><ul><li>Public and private organizations </li></ul><ul><li>NGOs </li></ul><ul><li>to focus on the interactions between HIV, AIDS, food and nutrition security </li></ul><ul><li>www.ifpri.org/renewal </li></ul>
    26. 28. Lessons and Challenges <ul><li>Beware AIDS exceptionalism </li></ul><ul><ul><li>Use an HIV lens , not a filter </li></ul></ul><ul><li>Think livelihoods, not agriculture per se. </li></ul><ul><li>Rarely is it “either/or” </li></ul><ul><li>Face challenge of diversity, complexity, context-specificity </li></ul><ul><li>Use/adapt tools to move from understanding to responding </li></ul><ul><li>Evidence-based action (but don’t wait for last 5%!) </li></ul><ul><li>Learn by doing (action research)…. </li></ul><ul><li>… and by monitoring, evaluating and communicating </li></ul><ul><li>Balance quality, speed, capacity </li></ul><ul><li>Scale up: </li></ul><ul><ul><li>Focus on the process beyond the project, think about capacity and incentives. Aim for transformation, not exit strategies. </li></ul></ul><ul><li>Link research with action, both ways </li></ul>
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