PROBLEM STATEMENT

Global food security will remain a world wide concern for the next 50 years and beyond.

The links between food security, good nutrition and HIV&AIDS are well known, including the fact
that good nutrition supports positive living for people living with HIV who do not yet need
antiretroviral therapy (ART), and that good nutrition is essential for people who are on ART.
However, good nutrition is only possible when people have secure access to nutritious food. HIV and
AIDS can undermine food and income security, increase the risk of HIV transmission, decrease
resistance to opportunistic infections, undermine access and adherence to treatment, and
exacerbate social and economic impacts of the disease. Clearly, food and nutrition security are
extremely important in the push towards universal access to prevention, treatment, care and
support for people living with HIV (PLHIV). 2000-2010 Global Health Council)

The spread of HIV/AIDS is also having a negative effect on household food security. Not
only does the energy balance deteriorate, but so does nutritional status. This in turn
increases susceptibility to diseases, such as sexually transmitted diseases, tuberculosis
and pneumonia, and deaths from malaria. The reduction in household incomes and labour
means that fewer children attend school, and the increase in the number of orphans
presents a major problem for communities.1 FAO/UNAIDS. 1999. Sustainable
agriculture/rural development and vulnerability to the AIDS epidemic. UNAIDS Best
Practice Collection.

Women and the Youth are scantily represented in top decision making levels in the
district. HIV/AIDS continues to afflict this group of people seriously. These group of
people also represent the poorest in the district.nakuru dist devt plan 2008 -2012

HIV/AIDS pandemics have also contributed significantly to high levels of poverty in the
district.

CROSS CUTTING ISSUES

2.4.2.1 Poverty

Poverty was identified as a problem afflicting a large population in the district. Poverty
may be defined as the inability of an individual or members of the household to afford
minimum basic human needs composed of food and basic non-food items. The
government has injected enormous resources since independence in the fight against
poverty. The poverty levels have however, continued to rise in the district.

The causes of poverty include; unemployment, insecurity, landlessness, lack of basic

services such as health, education, social services and inadequate credit facilities. Women
and children, unemployed and the elderly people form segments of the most affected
members of the community. Recurrent land clashes have also played a big role in the
current state of poverty in creating tension, insecurity, forced migration and destruction
of life and property as well as wastage of time which would otherwise have been directed
towards productive activities. HIV/AIDS pandemics have also contributed significantly
to high levels of poverty in the district.

Female-headed households are particularly affected by poverty. Besides, women perform

all sorts of reproductive roles. This notwithstanding, women are constrained by poor
access to credit due to lack of collateral or social will. It is also acknowledged that most
of the women in the district are the ones fully involved in agricultural production whose
proceed mainly go to men as the family heads. When the women are poor, it has been
observed that they tend to have many children who e receiving inadequate necessities
including education.

In the urban areas the most affected are slum dwellers. For instance, in Nakuru town,
those living in single rooms without electricity or water pay more in relation to their
earnings as such facilities are not found in low class estates and slum areas. This scenario
is predominantly found in Kaptembwa, Ponda Mali and Rhoda estates in the Nakuru
Municipality as well as Makongeni in Kampi ya Moto division.

Another emerging class of poor people is the hundreds of squatting families who work in
flower farms and sisal plantations within Rongai constituency. These people lack the
basic factors of production and as such cannot redeem themselves from the grip of
poverty.

To address the employment and poverty problem, the government will provide an
enabling policy environment namely; provision and maintenance of essential
infrastructure, invest in human development and basic welfare; and where necessary
guarding against human exploitation and environmental degradation. To nurture business
confidence, the government will maintain stable political and economic climate; private
property rights and uphold the rule of law; and administration of justice.

In spite of the fact that food in the district is relatively less expensive compared to others,
the district has a high proportion of people living in the neighboring districts. The
population living in marginal areas of the district has a high proportion of people living
below the poverty line. nakuru dist devt plan 2008 -2012

HIV/AIDS

The impact of the pandemic has been felt at all levels of the district’s economic and
social circles. Already, Nakuru Town is home to 15 children homes and the majority of
children are HIV/AIDS orphans.

HIV/AIDS is acknowledged as the greatest challenge to the realization of health targets

in Kenya. To address this pandemic, the government made a commitment to
comprehensively implement the Kenya National AIDS Strategic Plan, 2005-2010. The
HIV prevalence rate in the district stands at 5.9%, which is a decline from 10% in 2003.
This, however, is not good news when translated into the number of people afflicted by
the scourge.

In addition, HIV/AIDS control units were set up in all ministries, with AIDS control
committees established at both the district and constituency levels.

The cost of ARVs was waived to zero and consequently the number of users has increase
threefold. VCT centres that are currently 19 in the district have been established in
various centres in the district thus increasing access to their services. Various
interventions on mitigations of the effect of the pandemic have also been rolled out
through a policy guideline on OVCs.

In spite of the progress made to addressing the HIV pandemic, enormous challenges
persist. For instance, the rate of new infections remains rather high, and there are major
differences in the risk of infection faced by different population groups. Particularly
vulnerable to infections are young girls, individuals in discordant relationships,
commercial sex workers and their clients, workers in commercial plantations and flower
farms, intravenous drug users.

Although, access to ART is increasing, the availability of affordable treatment stills fall
far short of the country’s needs.

With the rising cumulative deaths from AIDS, vulnerability to the impact of HIV/AIDS
particularly among OVCs, widows, and the elderly is becoming increasingly apparent
exacerbated by the generally high poverty levels.

Global food security challenges and policies

Global food security will remain a world wide concern for the next 50 years and beyond.

Recently crop yield has fallen in many areas because of declining investments and
infrastructure as well as increasing water scarcity. Climate changes and HIV/AIDS are
also crucial factors affecting food security in many regions.

Ref. International Food Policy Research Institute 2009. S.B. Blanche., H. S Utomo.

Def of food security usually include;

Food supply

Access

Adequacy
Utilization

Safety and sometimes

Cultural acceptability of food for all people at all times.

Food security is viewed as failure of livelihood to provide adequate supply at the

household level.

Food insecurity is synonym for poverty.

Objectives on HIV and food security

1. About food availability

2. Food sources
3. Culture and taboos that affect food security and access
4. Income sources

Nakuru Prov. General hosp ccc

Up to June 2010 the hosp ccc had registered a total of 13490 clients on HIV care. These
are clients on ARV therapy and and those not yet on ARV but being monitored and on
septrine. This number include both adults and children. According to ccc register adults
are registered from 14 years and above and the number is 12041 for those on HIV care
with 7679 female and 4363 male. The adult clients on ARV are 6648 ie 4343 female and
2305 male. (MOH July 2010).

Food by prescription

Out of the 12041 HIV clients under HIV care around 3000 are put on food by
prescription. This is high nutritious UJI and a paste donated by our Government through
USAID.The criteria for selecting those who should be put on food by prescription is
determined by taking weight, height and BMI. An adult with a BMI of below 18.5 and
pregnant women with BMI below 22.5 qualifies for food by prescription. They are
monitored for 3 months or until they regain weight. With food by prescription aclient can
gain weight of 5kg per month. Some clients become underweight again due to high
poverty level mostly in the slums and at household level.Around 20 clients are puton
food by prescription every month. (MOH 2010).

Integration, Food Security and HIV/AIDS

By Gwenelyn O'Donnell-Blake

The links between food security, good nutrition and HIV&AIDS are well known, including the fact
that good nutrition supports positive living for people living with HIV who do not yet need
antiretroviral therapy (ART), and that good nutrition is essential for people who are on ART.
However, good nutrition is only possible when people have secure access to nutritious food. HIV and
AIDS can undermine food and income security, increase the risk of HIV transmission, decrease
resistance to opportunistic infections, undermine access and adherence to treatment, and
exacerbate social and economic impacts of the disease. Clearly, food and nutrition security are
extremely important in the push towards universal access to prevention, treatment, care and
support for people living with HIV (PLHIV). 2000-2010 Global Health Council

HIV and food security

This paper presents the major challenges confronting individuals, communities and
nations. The estimates of the disease prevalence and patterns of the spread of the
infection are examined and common coping mechanisms of households and demise of
communities affected by HIV/AIDS are described. The implications of this deterioration
for agricultural production and the impact on national economies are highlighted. This
analysis is followed by a discussion of actions for and constraints to alleviating the
situation. Approaches to addressing this urgent problem are suggested and guidance on
the role of FAO is sought.

HIV/AIDS AND THE DETERIORATION OF FAMILIES AND

RURAL COMMUNITIES
5. HIV/AIDS can have devastating effects on household food security and nutrition.
2

Nutritional status is determined by various factors, often categorised into household food
security, health and care - all are affected by HIV/AIDS. The specific impact of
HIV/AIDS is related to the livelihood systems of affected households and will vary
according to their productive activities (agricultural and non-agricultural) and the
economic and socio-cultural context in which they live.

6. Direct impact on households: Classically, a downward spiral of the

family/household's welfare begins when the first adult in a household falls ill. There is
increased spending for health care, decreased productivity and higher demands for care.
Food production and income drop dramatically as more adults are affected. Once savings
are gone, the family seeks support from relatives, borrows money or sells its productive
assets. One study in Uganda showed that 65 percent of the AIDS-affected households
were obliged to sell property to pay for care. Frequently, children are forced to
discontinue schooling, as the family needs help and cannot pay school expenses. Time
dedicated to child care, hygiene, food processing and preparation is sacrificed. When the
AIDS patient dies, expenditures are incurred for the funeral and the productive capacity
of the household is reduced. According to a study in Tanzania, funeral expenses
represented about 60 percent of the direct costs associated with an AIDS victim.

7. In the next stage, the partner becomes sick and the downward spiral accelerates. The
household is eventually reduced to impoverished elderly people and children. These
individuals may have limited decision-making power and access to resources, as well as
less knowledge, experience and physical strength which are required to maintain a
household. Relatives may be unable to care for children whose parents have died. In
some areas, the percentage of orphans ranges from 7 - 11 percent. (in contrast to 2
percent in less affected areas).
8. Gender issues: Women are especially vulnerable in HIV/AIDS-affected households.
Usually, they care for the sick and dying in addition to maintaining heavy workloads
related to provisioning and feeding the household. Women are more likely to be illiterate,
of lower socio-economic status and have fewer legal rights, which combine to limit their
access to resources and social services. In some societies, socio-cultural practices, such as
a widow not being able to maintain access to or benefit equitably from the property of her
deceased husband, may further aggravate problems. Poverty, tradition and social pressure
tend to limit women's ability to express their wishes regarding choice of sexual partners
and "safer-sex" practices. Low-income, income inequality, and low status of women are
associated with high levels of HIV infections. Biologically, females are at greater risk of
being infected.

9. Nutrition impact: In households coping with HIV/AIDS, food consumption generally

decreases. The family may lack food and the time and the means to prepare some meals,
especially when the mother dies. Research in Tanzania showed that per capita food
consumption decreased 15 percent in the poorest households when an adult died. A study
carried out in Uganda showed that food insecurity and malnutrition were foremost among
the immediate problems faced by female-headed AIDS-affected households.

10. For the patient, malnutrition and HIV/AIDS can form a vicious cycle whereby
undernutrition increases the susceptibility to infections and consequently worsens the
severity of the HIV/AIDS disease, which in turn results in a further deterioration of
nutritional status. Even when a person does not yet show disease symptoms, infection
with the HIV virus may impair nutritional status. The person may lose their appetite, be
unable to absorb nutrients and become wasted.

11. Good nutrition is important for disease-resistance and may improve the quality of life
of AIDS patients. The onset of the AIDS itself, along with secondary diseases and death,
might be delayed in individuals with good nutritional status. Nutritional care and support
may help to prevent the development of nutritional deficiencies, loss of weight and lean
body mass, and maintain the patient's strength, comfort, level of functioning and self
image.

12. In most countries, AIDS medication and special nutritional supplements are neither
widely available nor affordable. While nutritional counselling has an important role in the
assisting HIV/AIDS patients, better access to drugs and medical care is also essential.
Improving the nutritional status of HIV/AIDS patients can also help improve the
effectiveness of treatment if it is available.

13. Breakdown in informal institutions and culture: Informal institutions, customary

practices and tradition are affected by HIV/AIDS. When a high proportion of households
is affected, the traditional safety mechanisms to care for orphans, the elderly, the infirm
and the destitute are overwhelmed. People have no time to devote to community
organisations. The effects on informal rural institutions are creating a crisis, particularly
among the extended family and kinship systems. This has implications not only for the
spread of HIV but for the viability of rural institutions.
14. The widespread loss of active adults affects the entire society's ability to maintain and
reproduce itself. Mechanisms for transferring knowledge, values and beliefs from one
generation to the next are disrupted, and social organization is undermined. Agricultural
skills may be lost since children are unable to observe their parents working. Due to
gender divisions, a surviving parent is not always able to teach the skills and knowledge
of the deceased partner. Within a rural household, there is a marked difference in impact
depending on whether the man or woman is affected first by the HIV virus. In effect,
widespread HIV/AIDS can tear the very fabric of a society.

15. Poverty and the disease: HIV/AIDS takes an especially heavy toll on the poor.
Affected rural families commonly shift to off-farm income earning activities such as
small-scale trading, processing and servicing, which requires access to urban or peri-
urban communities. People may migrate in search of employment, or may look for rapid
income, which can lead to high-risk behaviours such as drug abuse or involvement in
prostitution. The consequences of poverty thus increase the risk of infection, and the
disease in turn exacerbates poverty.

16. Whole communities thus become food insecure and impoverished. For instance, in
some highly affected communities, there has been an irreversible collapse of the social
asset base. It may be difficult to overcome this without assistance. Yet, the epidemic has
a significant effect on formal institutions and their abilities to carry out policies and
programmes to assist rural households. Institutions may suffer considerable losses in
human resources when staff and their families are infected with the HIV virus. Care for
sick family members, attendance at funerals and observation of mourning times reduces
the work output. Skilled staff are often the first to be affected by the epidemic. The
disruption in services further aggravates the difficulties in meeting the needs of an
HIV/AIDS affected population.

• Linking HIV/AIDS and food security initiatives can most effectively be

accomplished by the reciprocal incorporation of HIV/AIDS considerations
into food security initiatives and the incorporation of food security objectives
into HIV/AIDS programmes.

While specific strategies will vary according to the magnitude of the problem, the
resources available and the socio-cultural context found in each country, the following
should be considered as key elements of national approaches to combat the epidemic:

40. National strategies, based on high political commitment, concerted multi-sectoral

action and the effective involvement of all stakeholders, should be implemented with a
commitment of adequate resources.

41. The extent and severity of HIV infection needs to be assessed and the likely
consequences for food security recognised. Food Security Units should take the lead in
monitoring the implications of HIV/AIDS in affected areas and at national level and
warning about the impact.
42. The effect of the disease on rural social security systems, assets and other resources
needed to sustain rural livelihoods, demographic patterns, gender dynamics and other
social and economic processes need to be analysed. Laws and practices concerning
access to land and resources should be reviewed to ensure that the livelihoods of widows,
orphans, and other poor HIV/AIDS-affected households are protected.

43. Agriculture extension programmes need to promote technologies that meet the
changing needs of the rural households. Activities might include reorienting food
production, processing and preparation; promoting initiatives for alleviating labour and
capital constraints; fostering use of labour-saving tools and crops; introducing more
productive agro-technologies and shifting to higher value crops.

44. Agricultural sector staff need to be aware of HIV/AIDS and trained and encouraged
to identify and assist affected households, communities and institutions. All government
and agency staff should understand both the risk of HIV/AIDS and its means of
transmission. Most importantly, ministry staff must be willing and able to protect
themselves and their families against the disease.

45. Participatory household food security and community nutrition programmes present a
neutral and acceptable way to initiate discussion about HIV/AIDS where the disease
generates stigmatisation. This can simultaneously address household food security, health
and care while improving the nutritional situation of people living with HIV/AIDS.
Collaboration with local male and female leaders needs to be sought.

46. All field staff, in particular agricultural extension workers, need to be informed about
the importance of good nutritional status. Nutrition education and communication
strategies should include appropriate dietary recommendations for individuals suffering
from the disease, taking into account local food sources and production systems.

47. Popular messages to prevent the marginalisation of affected households and to help
communities deal with the epidemic must be disseminated. Specific attention should be
given to participatory communication. Innovative and successful local responses should
be shared among affected communities, local institutions and nationally.

48. Donor countries must assist in preventing the spread of this disease and mitigating its
negative impact on food security by providing advice and resources to countries heavily
affected by the HIV/AIDS epidemic. Such assistance might include food aid to provide
supplementary feeding to households and orphanages.

. RECOMMENDATIONS FOR CONSIDERATION BY CFS

52. The global HIV/AIDS epidemic presents an enormous humanitarian challenge for all
nations. The consequences threaten to inhibit social and economic progress and are a
particular threat to food security and nutrition in many countries and in particular in rural
communities. Governments are advised to implement strategies and mechanisms for
dealing with the epidemic. The international community has a responsibility to assist
governments and communities in these endeavours. To this end, the guidance of the CFS
is sought for directing FAO's continuing work regarding HIV/AIDS.

53. The Committee is invited to consider and endorse the following:

1. Governments confronted with the HIV/AIDS epidemic and its negative

implications for food security and nutrition utilise the guiding principles and
relevant elements of the framework outlined in this paper to develop their national
strategies, programmes and local activities.
2. FAO will:

• seek to strengthen collaboration with UNAIDS and other UN Agencies and

development partners to promote food security and nutritional well-being among
HIV/AIDS-affected populations;
• incorporate an HIV/AIDS dimension into on-going food security, nutrition and
agriculture initiatives through its normative work and field programme in
countries affected by the epidemic;
• support member countries in their efforts to prevent the worsening of the
HIV/AIDS epidemic and mitigate its negative effects on food security and
nutrition.

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1 Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome

2 Household food security exists when households are able to ensure that all people at all times have physical, social and economic
access to sufficient, safe and nutritious food to meet their food preferences and dietary needs for an active and healthy life.