| More Details |
The Regional Network for Equity in Health in Southern Africa (EQUINET) and
Oxfam GB along with government and civil society partners have, since early
2003, initiated a programme of research and analysis in support of policy and
advocacy focusing on HIV/AIDS and equity in health sector responses. The
programme, has initiated research in four southern African countries on equity in
health sector responses (Zimbabwe, Malawi, Tanzania and South Africa) and,
with support from DfID, undertaken regional analyses of specific health equity
concerns relating to HIV/AIDS, covering issues such as health personnel,
nutritional interventions, and gender equity in health sector responses (see
www.equinetafrica.org). This paper is one part of this overall project and deals
with the nutritional dimensions of health sector responses to HIV/AIDS.
HIV, nutrition and food security interact at a number of different levels biological,
individual and community. At the biological level it is well established that good
nutrition plays a critical role in the ability of the individuals immune system to
withstand and respond to infections. HIV is no exception. At the individual level
poor nutritional status (especially from a young age) leads to reduced physical
and intellectual capacity, ultimately leading to reduced earning potential. Poverty
is well recognised as an important factor in increasing vulnerability to HIV. Poor
women are especially vulnerable. Finally, communities with poor food security are
more likely to be engaged in high risk strategies such as increased migration, and
have decreased access to health care services. They are therefore at increased
risk of spreading or contracting HIV. Similarly, HIV erodes social capital and
traditional coping mechanisms within communities, thus increasing food
insecurity For example, one common coping strategy is to grow and consume
foods that are easier to cultivate and cheaper to purchase but these also tend to
be nutritionally poorer foods (such as starchy foods). Many households also skip
meals. Their vulnerability is increased by a reduction of their capacity to respond
both at a biological level and at an individual and community level.
This paper argues that the traditional focus on efficiency has resulted in a narrow
medical focus. The provision of free formula milk to some pregnant women who
are HIV positive is an example of narrowly conceived policy that is actually
increasing inequity. Women who have the resources to safely formula feed are
provided with a substantial subsidy in the form of free formula milk. Meanwhile
poorer women who cannot choose this mode of feeding are given nothing. A
greater awareness of the synergy between nutrition, food security and HIV/AIDS
could lead to more comprehensive policies, which encompass both greater
efficiency and equity. Such an approach would be one in which prevention,
treatment, rehabilitation and mitigation are combined in ways that will reduce
vulnerability and susceptibility to the virus. It would encompass a participatory
assessment of the factors that lead people to adopt risk behaviours and attempt
to address and influence these factors, rather than the risk behaviour per se, thus
addressing vulnerability to HIV. Consequently, if changes result from these
awareness exercises in terms of enhancing the resilience of livelihood systems,
then it can be argued that vulnerability to HIV is being reduced. The efficiency and
effectiveness of such interventions can be considerably increased if they are
targeted towards the most vulnerable, especially if this can be achieved in a
participatory manner that promotes social justice.
Presently there is a growing movement towards the allocation of financial
resources to provide a more focused approach towards HIV. However, unless
these resources contribute to the development of infrastructure, human capacity
and management processes, this response is likely to have only a short-term
impact on health problems, which are ultimately manifestations of economic and
social under-development and dysfunctional systems. The existing terms of trade
and instruments of globalisation in turn aggravate this. The campaign for wider
access to HIV medication needs to be fully supported, but it does, however, also
need to be linked to addressing the underlying causes of HIV vulnerability if equity
and effectiveness are going to be enhanced. Food and nutrition interventions can
play an important role in bridging this gap. |
Publications
