A Deadly Embrace: Famine and AIDS in Southern Africa

By Dr. John Kiwanuka Ssemakula, 12 August 2002

It seems that the four horsemen of the apocalypse Death, War, Pestilence (disease) and Famine have come to visit Southern Africa.

Copyright: 2002 - © WFP/Brenda Barton

This malnourished three-year-old child has been admitted to a hospital in Blantyre, Malawi six times. The current crisis is unfolding against a backdrop of one of the world's highest HIV/ AIDS rates. In many cases, southern Africa's young children are not just fighting against malnutrition but HIV/ AIDS.

Millions of people are experiencing starvation or the threat of famine in Southern Africa following poor harvests across the region. The causes are a combination of freak un-seasonal dry spells and drought, flooding as well as lowered levels of crop cultivation and planting. At the same time Southern Africa is in the grips of the worst AIDS epidemic in the world with the highest adult HIV prevalence rates, more than 35% in some areas. Famine and AIDS are now locked in a deadly embrace.

But it is not some biblical prophecy or the sins of the people that have brought the spectre of famine to stalk the region. Chronic poverty combined with inadequate policies have led to serious shortfalls in food production and higher prices of maize, the staple food of the region.  Politics and poor policies have also conspired to make a bad situation worse. In Zimbabwe commercial farmers have been prevented from working on their farms by supporters of the government, Malawi sold of its maize stocks on the advice of international donors and for a long time war and its after effects have stopped farmers from working in Angola.

It is estimated that 70% of Malawi’s populations is experiencing food shortages and there is a similar picture across the region. The safety net of past years in the form of imports of grain from South Africa to alleviate shortfalls has not worked this year, because South Africa has also had lower than normal yields of food. The potential for disaster is acute.

HIV/AIDS and Food security

The HIV/AIDS epidemic has long been recognized as posing a major threat to food and nutrition security in Sub Saharan Africa (SSA).

HIV/AIDS affects food security by reducing:

·          Food availability through decreased production, loss of labour, land, livestock other resources and assets.

·          Food access through declining income for food purchases.

·          The stability and quality of food supplies due to shifts to less labour intensive production of foods of lower nutritional content.

The effects of HIV/AIDS on Food security

In its annual report “The State Of Food And Agriculture 2001”, the Food And Agriculture Organization Of The United Nations (FAO) stated that it expected the HIV/AIDS epidemic to exacerbate food insecurity.  An estimated 7 million agricultural workers have died from AIDS since 1985 in SSA and another 16 million more could die within the next 20 years.  This dire prediction seems to be coming true.

According to recent FAO and UNAIDS studies, agricultural output of small farmers in some parts of Zimbabwe may have fallen by as much as 50 percent over the past five years, mainly as a result of AIDS. In the Kagera district  of Tanzania, the death of an adult in a household reduced spending on food by 32% and decreased food consumption by 15%.  It is estimated in Burkina Faso that almost 20% of rural families have reduced or abandoned farming altogether as a result of HIV/AIDS.

There is no suggestion that the AIDS epidemic is the cause of famine in Southern Africa, but it is almost certain it has played a part in the evolution of the current problem. Reduced food production and supply coupled with the shift to lower quality foods lead to chronic food insecurity, increased levels of protein energy malnutrition as well as other nutritional deficiencies, such as minerals and vitamins. 

This has serious consequences for people with HIV/AIDS who have a 50% higher protein and 15% higher energy requirements than compared to a normal person. One consequence of the food shortages is going to be an increased death rate in people with AIDS over the next few months. It is also to expected that there is will be increased rates of malnutrition in children and probably an increase in infant and child mortality across the region.  As nuclear, extended family and community networks are disrupted, the problem of children whose parents have died from AIDS will be compounded, resulting in a worsening of the ‘AIDS orphan ‘ problem.

What needs to be done?

The solution to mitigating this famine and preventing future famines is appropriate interventions and effective policies, ranging from immediate relief and food aid, to recovery and implementation of long term efforts to initiate development.  There needs to be a clear commitment and political will by governments in the region to tackle issues such as poor governance and weak systems that make their nations vulnerable to environmental and natural disasters. It is ironic that these are precisely the same qualities required in the fight against HIV/AIDS and these unfortunately have not been too much in evidence.

While both problems have been caused by a combination of natural disasters and man made problems, neither has come totally unexpectedly. Southern Africa has experienced similar problems with food shortages in the past and it was to be expected similar conditions would arise some time in the future. Similarly, in the case of the HIV/AIDS problem, the experience other countries in Sub Saharan Africa, most notably in East Africa coupled with epidemiological data within the region were clear pointer that AIDS would become a problem at some point sooner rather than later

The comparison between the two problems goes even further.  Food is the immediate treatment in cases of famine and indeed when treating nutritional related problems food is regarded as a drug and prescribed as such. In the case of HIV/AIDS the treatment is antiretroviral drugs as well as other medicines such as antibiotics for the treatment of opportunistic infections. In both cases the issue of availability, accessibility and affordability of the treatment is of great importance in dealing with the problem in the short to medium term. And also in the long term effective preventive measures will have to be put in place to prevent future problems. In the case of food security, it can be educating or encouraging more farmers to plant staple crops or to adopt more effective farming measures. The equivalent in the fight against HIV/AIDS is educating the public in order to induce changes in behaviour, accepting and adopting the use of protective measure such as condoms etc.

The table below illustrates how some of the measures and methods needed to deal with the AIDS problem could be applied to dealing with famine.

The measures outlined in the table are by no means exhaustive. But more importantly they are not new ideas! Most are fairly obvious and are a matter of common sense. The tragedy has not suddenly developed overnight, but over a months and years. There is still time to prevent a terrible humanitarian disaster and this time there is no excuse for all the parties involved for not taking the appropriate measures to deal with the famine or HIV/AIDS.

Because without these measures the deadly embrace of AIDS and famine will develop into a fatal dance that will continue to imperil the region for years to come.

References:

Food and Agricultural Organisation. (2001). Africa Regional review: The economic and social impact of HIV/AIDS. The State Of Food And Agriculture

Loewenson,R.,  Whiteside A.(2001). Implications for Poverty Reduction. UNDP Background Paper for UNGASS; p11-12. June

Kiwanuka Ssemakula. J. (2001). Cheaper drugs for HIV/AIDS in Africa: What happens next? Suggested strategies for distributing HIV drugs. medilinkz.org. April

UNAIDS. (2002) Report on the Global HIV/AIDS epidemic

International Food Policy Research Institute (2002). Fighting Famine In Southern Africa: Steps Out Of The Crisis. IFPRI Publications Online