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THE FIRST LINE
OF DEFENCE
Why Food and Nutrition Matter
in the Fight Against HIV/AIDS
THE FIRST LINE
OF DEFENCE
“I was in Malawi and met with a group of women
living with HIV. As I always do when
I meet people with HIV/ AIDS and other
community groups, I asked them what their highest
priority was.Their answer was clear
and unanimous:
food.
Not care, not drugs for
treatment, not relief from stigma,
but food.”
WFP/Luis Clemens
Peter Piot, UNAIDS Executive Director
ust ask Virginia Maramba how much food means
to her. Virginia is a widow from Muzarabani
District, Mashonaland Central Province in
Zimbabwe. Her husband, Andrew, died recently of
AIDS, leaving virtually nothing to provide for his
family. Now Virginia and her two children depend on
emergency food aid from the World Food Programme
(WFP).
J
“Honestly, I am not sure what I would have done if it
were not for the food aid from WFP. At least I am now
able to look after my family. We used to have just one
meal a day and most days it was just porridge. Now we
can afford to have two meals,” she said.
Before WFP began distributing food in her area, Virginia
says she occasionally did agricultural piecework. When
there was no work available she simply begged for food.
Virginia and her daughter
When none of her neighbours could
share their food, she would collect and
eat wild okra.
Her hunger was not due to a lack of
hard work. She planted a field of maize
and a vegetable garden. Both
produced very little due to erratic rains
and the lack of fertilizer. She harvested
only 20 kg of maize, which is not even
enough to feed her family for a month.
They will need food assistance until
the next harvest.
The World Food Programme is at the forefront
of the global HIV/AIDS response. Already
providing food assistance in 21 of the 25
nations with the highest HIV prevalence rates,
the agency is uniquely positioned to combat
this pandemic on the ground. Evidence of just
how disastrous the combination of hunger and
HIV/AIDS is to communities at risk is only now
becoming apparent. Some effects, like
explosions in the orphan population, won’t fully
manifest themselves for years. What is clear,
however, is that food assistance is essential, if
there is to be any headway in the struggle
against the virus.
“My only hope is that WFP will
continue giving us food,” Virginia said.
THE FORGOTTEN PLACES
THE FIRST NECESSITY
The rampant spread of HIV/AIDS is a global
crisis of epic proportions. An indiscriminate
killer, AIDS has claimed millions of lives from
every part of the world. Both rich and poor
have succumbed to this deadly virus. People of
all races and ages have been affected.
“Existing therapies require sound
But in the forgotten places, where Virginia and
millions of others like her live, where food
shortages and food insecurity are everyday
realities, the suffering brought on by HIV/AIDS
is particularly acute.
Ill equipped to handle a social crisis of this
magnitude, poor nations already struggling to
feed their people now face serious threats to
their infrastructures, work force and economies.
In these places, HIV/AIDS and food insecurity
go hand in hand, stifling hope, derailing
development and
weakening
people’s ability
to sustain
themselves.
nutrition. Adequate food is essential
for prolonging the lives of parents
and enabling them to have a few more
precious weeks, months or maybe
even years to work and spend time with
their families. Perhaps we cannot give
them hope for a cure, but we can
give them time.”
James T. Morris, WFP Executive Director.
For the poor across the globe, food is always the
first necessity. Even more so in the face of
HIV/AIDS. Good nutrition is the first line of
defence in warding off the detrimental effects of
the disease. And while it cannot match the
effectiveness of life-extending drug therapies,
nutritious food can help people infected with
HIV stay healthier, longer. This allows teachers to
continue to teach, farmers to continue to farm
and parents to continue to care for their
children. Without proper nutrition, however, the
disease progresses faster and with more force.
UNICEF/Jeremy Horner
WFP/Vanessa Vick
Take the case of Thandie Gina, a 47year-old mother of nine in Swaziland
who was tested HIV-positive earlier this
year. Her husband died of AIDS two
years ago, leaving her to care for her
four youngest children. Since last
August, Thandie has been receiving
WFP food aid through its implementing
partner, the Lutheran Development
Services. She says that the food aid has
greatly improved her health and helped
her family - particularly as drought
destroyed their own crops for three
consecutive seasons. “It was my eldest
daughter who advised me to go and
get tested for HIV/AIDS”, she says.
“I appreciate her advice as now I know
which nutritional diet is recommended
for the HIV-infected.”
UNICEF/Alejandro Balaguer
The suffering caused by HIV/AIDS extends well
beyond the person infected. It can wipe out a
household’s income, assets and savings. For
many of those infected by HIV/AIDS treatment
is not an option. For those barely able to eke
out an existence, anti-retroviral drugs are far
too great an expense. Even when drug
therapies are available, their effectiveness often
depends on the individual’s nutritional status. As
household assets dwindle and the need for
care increases, the family—particularly its
youngest members—is placed at higher risk.
Children are often removed from school in
order to fill the gap in income and help care for
the sick. The stigma associated with AIDS only
exacerbates a family’s difficulties. HIV status can
lead to eviction, divorce or loss of employment.
Many families have become over-burdened and
over-extended with the rising numbers of
orphans left in the wake of this disease. Long
before their parents actually die, children begin
to suffer the effects of chronic illness in their
family. They are often deprived of an education
and obliged to assume adult responsibilities at a
very young age, sometimes becoming head of
the household upon the death of their parents.
Often these children have little or no
agricultural knowledge to produce their own
food and minimal access to vital health services.
FINDING
THE
ENERGY
TO
BATTLE ON
Through food assistance as well as health and education initiatives, WFP gives
families affected by HIV/AIDS a better chance for survival. By providing basic
staples, WFP helps tackle the immediate difficulties of malnutrition and
encourages families to keep their children in school.
One example of WFP’s support for orphans and vulnerable
children is in Mozambique’s central region, which has the
highest adult HIV prevalence rates in the country. Chimoio, the
provincial capital, is right on the highway between the port
city of Beira and Zimbabwe – a main route for truck drivers.
Given the role that mobility plays in the spread of HIV, truck
drivers are a major factor in the spread of HIV and AIDS.
Each day, 15 children in Chimoio lose their parents to AIDS.
The organisation, Kubatsirana, is making an enormous difference.
Through a home-based care programme, families with chronically ill
members receive enough WFP food assistance to cover their basic
needs, enabling them to use the money and time saved on other
things such as education.
Kubatsirana also runs a vocational training programme so that
orphans receive skills training and participate in educational activities
to help them secure their future livelihoods.
Offering food is key to mitigating the most corrosive effects of
HIV/AIDS. When a person is infected with HIV, proper food and
nutrition help lessen opportunistic infections which attack the body
and cause weight loss, which in turn weakens resistance. Foods such
as corn-soya blend, which WFP often provides in HIV/AIDS affected
areas, are easy to prepare, eat and digest. This is particularly
important for households in which considerable time is spent caring
for a sufferer. In addition to a high density of energy and protein, these
foods are also fortified with vitamins and minerals which are particularly
important for people living with HIV/AIDS.
WFP/Tom Haskell
PRACTICAL PARTNERSHIPS
Working in close co-ordination with NGOs,
other UN agencies and national governments,
WFP makes sure that all its activities are
consistent with national HIV/AIDS strategies
and that resources are targeted where they are
needed most. WFP works with its partners
worldwide to provide counselling, education
on nutrition and skills training – as well as food.
In Uganda, one of WFP’s partnerships is in
home-based care. Through an Italian volunteer
organisation, Associazione Volontari per il
Servizio Internazionale (AVSI) and a project
called Reach Out, people living with HIV/AIDS
in the slums of Kampala receive food together
with other essential services.
The project targets widows who have lost their
husbands to AIDS. With little education and no
marketable skills, they are left destitute. But
their chances are greatly improved by food
assistance. Beneficiaries receive maize, pulses,
corn-soya blend and vegetable oil.
Although most clients at the Reach Out
project are women, Lwanga Wahab, 20,
is among a handful of young men to
have benefited. “When they came to
see me at home, I couldn’t even
walk a short distance. But now,
I have come all the way here
on foot.” Questioned about
the impact of food on his
life, Lwanga said: “When I
look at myself, I see that I
have changed; I cook
my beans - sometimes
posho, sometimes
porridge - which make a difference.”
Asked about this “difference”, he replied:
“Feeling that I am not in a bad situation.
I am free from hunger and it has done
something to build up my body.”
COLLABORATING
TO CONTROL TB
One of the more innovative uses of WFP food
aid is in support of tuberculosis (TB) treatment
and control programmes, such as those in
Lesotho and Uganda. TB is a serious public
health problem worldwide, affecting mainly
poor people in both rural and urban areas.
Besides affecting tens of millions of people
worldwide, it is also one of the most common
causes of death for people with HIV/AIDS. In
Cambodia, where HIV/AIDS is spreading rapidly,
the prevalence rates of TB are among the
highest in South-east Asia.
Controlling TB is vital to people living with the
virus: Someone who is HIV positive is
approximately 20 times more likely to develop
TB, while an AIDS patient is 100 times more
at risk.
Thanks to powerful collaboration
among the National Centre for
Tuberculosis Control, the Japan
International Co-operation
Agency, the World Health
Organization (WHO), local
NGOs and WFP, Cambodia
has a strong and successful
DOTS (Directly Observed
Treatment, Short-course)
Programme. Since 1994, WFP has helped the
National Tuberculosis Programme improve its
capacity for detection and cure. The role of WFP
food in its success has been vital.
WFP/Hun Chantha
TB patients are often physically weak. Food aid
is provided as a nutritional supplement to help
them gain weight and fight off the disease.
Additionally, since household income may be
reduced due to illness, the food also offsets the
costs of care and treatment.
Fortunately for Pisey, the health centre
director allowed her to stay at the
centre, with her husband, for a further
six months of treatment. At the centre
she receives 15 kg of rice, two cans of
fish and two litres of vegetable oil a
month from WFP. Thanks to this ration
and the DOTS treatment, her health
has been steadily improving and Pisey
is confident that she will get a better
job when her course of treatment ends.
Food is also a powerful incentive for
Cambodian patients to collect their medicine
and continue TB treatment. It encourages them
to remain hospitalised for the two months
necessary and motivates outpatients to
maintain their treatment until they are cured.
The monthly ration of rice, vegetable oil,
canned fish and sometimes corn-soya blend is
credited with reducing the mortality of TB
patients. If patients do not complete their
therapy, drug resistant strains of TB may
develop, with catastrophic consequences for
public health – not just in Cambodia, but all
over the globe.
PUSHING PREVENTION
WFP has developed strategies on how to use
food assistance, not only to mitigate the
immediate suffering caused by AIDS, but also to
encourage prevention.
This is exactly what happened to Kang
Pisey, 29, a worker in a clothes factory
in Phnom Penh. She and her husband,
who sells coconuts in the streets of the
Cambodian capital, were already
struggling to find enough money to
pay their rent and feed their two
children, when she was struck by TB
symptoms – severe coughing and high
fever. Fearing for her job, she was
reluctant to seek treatment, but when
her health worsened, she eventually
began a two-month course of DOTS
treatment. Her boss, the factory
manager, responded by firing her.
WFP/Shadley Lombard
Hunger, wherever it occurs, can drive people to
take risks. Ensuring a stable supply of food in
homes and the community is one form of HIV
prevention. Other prevention methods are
required for emergency situations where large
numbers of people are forced to live closely
together in camps for refugees or internally
displaced. The lethal mix of population
displacement, rape, occupying troops, women
in desperate circumstances and risky sexual
behaviour make such camps fertile ground for
HIV and AIDS.
Refugees, especially women, are highly
vulnerable to sexual violence and abuse at the
hands of combatants and civilians, including
those assigned to protect them. Humanitarian
workers bear responsibility for refugees’ basic
human rights to life, health, education and
information. This responsibility includes
reducing vulnerability to HIV infection by
helping refugees protect themselves.
UNICEF/Shehzad Noorani
WFP and its partners are exploring various ways
of reaching beneficiaries with prevention
messages, particularly in emergencies. In
Zambia, for instance, WFP and its partners have
trained groups in “Theatre for Community
Action” in which anti-HIV messages are shared
through drama, dance and music. The groups
perform for beneficiaries while they wait to
receive food distributions.
THE BATTLE
In conjunction with the United Nations High
Commissioner for Refugees (UNHCR), and the
United Nations Children’s Fund (UNICEF), WFP
hopes to reduce the epidemic’s impact on those
already infected and affected within the
refugee camps. Women attend training sessions
on reproductive health issues and HIV/AIDS
prevention while waiting to receive rations in
the refugee camps.
WFP and UNAIDS are increasing their cooperation in saving millions of lives – especially
in Africa, South-East Asia and the Caribbean.
With a special focus on pregnant women and
orphans, the two organisations have pledged
to make food security an integral part of the
overall struggle against HIV/AIDS.
HAS
JUST BEGUN
Until the eradication of this deadly virus, the
international community must find a way to
combat it. While the worst of the HIV/AIDS
pandemic is yet to come, with death rates still
rising, WFP is committed to putting food on the
tables of the world’s hungry, regardless of the
circumstances that have made them vulnerable.
For families on the front line, facing the daily
uncertainties brought on by the sickness,
stigma and insecurity of HIV and AIDS, WFP
food provides not only support today but also
some measure of hope for the future.
WFP/Debbi Morello
Printed: September 2003 - Cover Photo: WFP/Vanessa Vick - Inside Cover: WFP/Shadley Lombard
For more detailed information visit our website:
www.wfp.org
WFP PUBLIC AFFAIRS SERVICE
RESOURCES DEPARTMENT
Via Cesare Giulio Viola, 68/70 – 00148 Rome, Italy
Tel.: +39-066513-2628 – Fax: +39-066513-2840
E-Mail: wfp.hiv-aids@wfp.org