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AIDS, the Other Face of HungerBy Alicia Garcia
Action Against Hunger
December 2003Twenty years after its discovery, the Acquired Immune Deficiency Syndrome - Human Immunodeficiency Virus (AIDS – HIV) is firmly in place in the public consciousness as a worldwide health concern of the first order, with all the fears and apprehensions this conveys. Yet still, little is known about the origins of this disease: what triggers it, what conditions enable it, and what the implications are for the living conditions of those who suffer from this illness.
A revealing fact: 95% of the 40 million global HIV cases of infection are in developing countries. The global maps of both AIDS and poverty in fact overlap dangerously. And this is no coincidence: our years of field experience provide a lot of clues to the links and relationship between AIDS and hunger.
AIDS is the main cause of death (greater than wars and famine) in Sub-Saharan Africa.
Already, 13.5 million Africans have lost their lives because of the epidemic and 25 million could die before 2020.
Considered one of the fiercest effects of globalization, AIDS does not affect everyone the same way. The poor and women are by far the most affected, while 13 million children have been orphaned and 1.3 million children remain sick.
Global Distribution of AIDS 
Total: 42 million What Isn’t Working in the Fight Against this Disease?Perhaps we need to understand why AIDS/HIV is different from the other diseases and epidemics that have afflicted the world and for which, sooner or later, medical advances have produced a remedy:
• In the first place, we are dealing with a mortal and incurable illness. Two decades of research have not shed any light on a possible vaccine except on medicines prolonging life.
• Treatment is very expensive and inaccessible for the majority of the affected population.
• AIDS/HIV has both a rural and urban dimension. Whereas other historical diseases were confined to a specific environment (countryside or city), AIDS/HIV swept away all geographical and socioeconomic borders within a few years.
• The long incubation period of the virus, often unknown by the patient, facilitates the spread of the disease during sexual intercourse.
• AIDS/HIV is not neutral: women are more vulnerable for biological and social reasons.
• Finally, we are dealing with a socially invisible disease: there is still considerable silence on the part of the affected people and communities. The denial of this issue is quite often the first obstacle to its solution.
• This turns AIDS into a battle that doctors can’t fight alone. The social dimension of this problem and the lack of information require strategies that cover “such diversified subjects as employment, agriculture, industry, trade, rural development, gender issues, family organization, the fight against discrimination, the promotion of Human Rights, etc.”, confirms Peter Piot, Director of the Joint United Nations Program on HIV/AIDS (UNAIDS). The health and educational dimensions of the disease, obviously, are first and foremost. A Problem of Development
Live and Let Live
“Stay away from my sister” “You are not my son anymore.” These are some of the most painful symptoms of AIDS – Help us overcome fear, ignorance, shame and injustice the world over.
This is the message used in the campaign launched the Joint United Nations Program on HIV/AIDS (UNAIDS) on the 1st of December. Because stigma and discrimination are some of the most negative aspects of this disease, and it’s precisely this part of the battle against AIDS that the citizens in the world have within their reach.
The associations that many people have with AIDS – images of prolonged sickness, of death, of sex or drugs – have converted the disease into one of the most deeply rooted taboos in society, sustained primarily by ignorance.
The stigma and discrimination of AIDS are not only painful for those who suffer from the disease, but also constitute a risk for the entire population that ultimately diminishes the collective security of all as long as there is a reluctance to recognize and accept the problem.
Faced with AIDS (as with many other difficulties), the poorest are much more vulnerable than their less poor counterparts. But the particular way in which AIDS reinforces hunger (and hunger reinforces AIDS) has ended up creating a new and dramatic vulnerability among the poor, a situation that is reflected prominently in Africa.
Poor people are more at risk of infection because they have little access to information, because their sexual age begins earlier, because they live in conditions of poor hygiene, because quite often there are cultural barriers that prevent the a woman’s freedom of choice, and because access to methods of contraception are much more limited than is common in the West. The poor can also count on fewer methods to mitigate the infection: treatment is enormously expensive and detection is untimely.
The alarming statistics of AIDS deaths also imply a drastic reduction in the labor force, an essential component for economies of agricultural subsistence. And this isn’t simply a loss of human resources: often the meager financial and material resources that are available to a poor families must be redirected away from basic food needs toward treatment of infected family members. Losing a parent (or both) forces many African children to abandon school in an effort to take on their parent’s farming tasks before ever having acquired the basic agricultural knowledge required for effective farming. The premature loss of broad segments of a population also supposes an irreversible loss of the knowledge that is transferred from one generation to the next. All of this accentuates the situation of poverty in countries with high levels of infection and slams shut the door that could have lead to development.
AIDS Reinforces Hunger, Hunger Intensifies AIDS
The Impact of AIDS on Malnutrition
People who suffer from hunger are more susceptible to infection and more vulnerable to its repercussions. Malnutrition accelerates the effects of diseases and sicknesses such as tuberculosis, pneumonia and diarrhea, that cause a deterioration of a person’s nutritional state. Moreover, HIV positive women who are malnourished run an even greater risk of transmitting the virus to their babies.
An HIV infected individual can require up to 50 percent more protein and up to 15 percent more calories than a healthy individual -- not to mention the metabolic disruption of proper vitamin and mineral absorption. This means that the onset of the disease (and let’s not forget about the long incubation period) or even death strikes earlier for people suffering from malnutrition compared to their well-nourished counterparts also living with HIV.
The chain of Events of the AIDS-Hunger Dynamic in Rural Sectors
Adult becomes sick > she/he reduces work > replacement labor is “imported”, perhaps from relatives > all adults work longer hours on the farms > healthcare expenses rise > household reduces food consumption > household switches to crops and farming systems with extensive use of labor, small animal husbandry> nutritional status of sick adult deteriorates > adult stops work> family members spend more time caring for sick adult and less time on childcare > divisible assets are sold > debts increase > children drop out of school to help with household labor > the adult dies > funeral expenses > household fragments as other adults migrate for work > household reduces cultivation of the land, more is left fallow > inadequate natural resource management leads to increased pests and disease > the effects of the loss of knowledge intensify > the use of common property resources increases > access to the land and the home property is reduced > solidarity networks become more strained, to the point of collapse, the partners become sick, the downward spiral accelerates.
Source: HIV/AIDS Food and Nutritional Security: Impacts and Actions. IFPRI/WFP, 2001
The Vicious Cycle of malnutrition and HIV
Insufficient dietary intake, Poor absorption, Diarrhea, Altered metabolism and nutrient storage > Nutritional deficiencies > Increased oxidative stress, Immune suppression > Increased HIV replication, Hastened disease progression, Increased morbidity.
AIDS & Poverty, Poverty & AIDS
The Impact on Food Security
With 30 million HIV positive people and 80% of the population relying on subsistence agriculture, AIDS/HIV is having its greatest impact on the food security of the African continent. Families that have lost members capable of productive labor are forced to cut back on the total acreage they plant or must cultivate agricultural products that are less labor intensive. These families have the additional tasks of devoting much of their time for caring the sick – time and attention that used to be dedicated to agricultural production – not to mention other demands on their limited income in for medical and funeral expenses. The loss of human and financial capital have a brutal impact, often difficult to measure, on the food security of these households. A lot of children become orphans before learning how to run the farm or how to provide for themselves.
The deterioration of living conditions in the rural world is having serious social consequences, such as massive migration to the cities, abandonment of schools, and child prostitution which, in the long term, can only worsen the situation. Let us not forget that AIDS has already made orphans of 13 million children in Africa alone.
In addition to the losses of human and financial capital in the countries most affected by AIDS/HIV, there is also an undermining social capital whose effects will be more visible in the medium to long term. Those countries hit by this pandemic encounter less and less incentive for coordinated action in areas of such importance as natural resource management, which very soon will add an environmental dimension to the problem.
Lastly, the “dishonor” associated with this sickness, tied strictly to the lack of information, is having a debilitating impact on the networks of solidarity, trust, and mutual support that have long functioned as coping mechanisms during crisis situations in poorer countries.
This is a distressing perspective, the responsibility for which we cannot assign to medicine alone. One thing we have learned from the African reality is that the fight against AIDS must go hand in hand with the fight against poverty. Global realities have also taught us that we must begin by getting rid of all the veils and taboos that have surrounded this disease for two decades. To openly confront this disease must be the first step if we are to conquer it.
Africa and Asia: The Present and Future of the Disease
• In the early ‘90s, it was estimated that in 2001 there would be 9 million HIV infected Africans. The reality is three times worse: 42 million people infected of which 29.4 million are African, and of the 3.1 million deaths, 2.4 million have been African.
• 7 million African farmers have died of HIV/AIDS.
• In 2005, the life expectancy in Botswana, Swaziland, and Zimbabwe will be between 24 to 33 years, far less than what we would expect of a situation without AIDS.
• In addition to the 13.7 million of African deaths, 25 million people could die before the year 2020.
• Two thirds of the cases of transmission during pregnancy happen in Africa.
• In 16 African countries, at least 1 out of every 5 people is infected with HIV. In seven of these countries, 1 out of 5 people of legal age live with HIV. In Botswana, for example, 35% of the adult population is infected. South Africa has the highest number of infected people: 5,000,000.
• However some countries like Uganda and Zambia have managed to reverse the curve of the epidemic in 2001 thanks to the mobilization of the entire population.
• HIV and AIDS are spreading at an impressive rate in Asia: it is estimated that there are 3 to 5 million infected people in India alone, and although the national statistics in China are not reliable, some experts have pointed out that there could be 10 million infected individuals in that country.
• In 2010 Asia will surpass Sub-Saharan Africa in absolute numbers and will be the epicenter of HIV/AIDS by 2020.
Women: HIV Discrimination
Women run a greater risk of contracting HIV than men, for biological, economic, and socio-cultural reasons. Of the 26 million infected adults in Africa, 15 million are women.
The risk of infection during unprotected intercourse is two to four times higher for women than for men. Women are also more vulnerable to other types of sexually transmitted diseases and are more reluctant to undergo treatment. Without treatment, sexually transmitted diseases (STDs) can multiply the risks of spreading HIV by 300% to 400%.
The cultural predominance of silence and passive attitudes towards sex stigmatizes women who are trying to get medical assistance for STD treatment. Girls have even less access to information about sex and suffer a greater level of sexual coercion. Vulnerable economic conditions also facilitate the exchange of sex for money or food. The chances of being infected are likewise increased by genital mutilation, “un-lubricated” intercourse, and other traditional treatments.
The premature death of adult males is often crucial in determining the economic dependency of women, who can suffer limitations on their access to or tenure of land, as well as access to important community groups or micro-financial institutions.
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