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HIV and the Ramifications for Food Security and Child Health in Affected Communities

The first cases of the acquired immunodeficiency syndrome (AIDS), caused by the human immunodeficiency virus (HIV), were recognized in 1981. Today, an estimated 39 million people worldwide are infected with the virus. Sixty-four percent of these individuals currently live in the poverty of sub-Saharan Africa, but the pandemic is now spreading fastest in the largest nations of Asia. A state of food security is said to exist when all people, at all times, have access to sufficient, safe and nutritious food to meet their dietary needs and food preferences for an active and healthy life. A concern for food insecurity arose in the HIV/AIDS pandemic, based on the well-known principles of the interaction of malnutrition and infection; more poorly nourished individuals are more severely affected by infectious pathogens while the ravages of infection tend to deplete the nutritional reserves. The social and clinical consequences of HIV/AIDS endanger access to food in areas already stressed by poverty and environmental deterioration. Interventions related to agricultural productivity, income generation and food assistance, must each be crafted and adapted within the local, community contexts, and recognized as necessary to mitigate the adverse effect of HIV/AIDS on food security. UNICEF has made caring, defined as the provision in the household and the community of time, attention, and support to meet the physical, mental, and social needs of the growing child and other household members, into one of the components of its efforts to promote child survival. Its domain includes care for women, breastfeeding and child feeding practices, psychosocial care, food preparation, hygiene practices, and household health practices. The positive deviance approach, that of identifying household caring behaviors that have the best growth, health and development outcomes in children, is now being applied in the context of HIV-positive children. Stigma is a pervasive factor, which tends to isolate households affected with HIV-positive members, and complicates the social context in which food security and care-related interventions can be delivered. Outstanding gaps in our knowledge of food security–HIV/AIDS relationships have been identified. The research questions include the true effectiveness of food assistance to mitigate the effects of HIV and the interaction of food security status with the efficacy and safety of antiretroviral therapy. However, investigation is somewhat of a luxury within the allocation of scarce financial resources, placing a premium on gathering and codifying useful pragmatic experience for mitigating interventions from the valuable experience currently being gathered on the ground by field workers and communities themselves.