While HIV decimates African populations, hunger is exacerbated as more small farmers fall prey to the disease.
When HIV/AIDS first began its silent, deadly and unrelenting spread through the poor countries of the world, we at the World Food Programme (WFP), like many in the humanitarian community, tended to view the phenomenon as a medical crisis that had little to do with hunger and food aid. No longer. The WFP now finds itself on the frontlines of this crisis, grappling with a destructive phenomenon that has killed millions of people and rendered millions more virtually helpless and dependent on international food aid. Nowhere is this more apparent than in the southern region of Africa, where half of the continent's 30 million HIV/AIDS cases are found.
This year the region became a case study as the epicentre of a cataclysmic confluence of disasters - HIV/AIDS and potential famine. More ominously, the HIV/AIDS crisis is planting the seeds of future famines that could imperil many millions more lives.
To date, more than seven million farmers have died as a result of HIV/AIDS, most of them women who make up four-fifths of the agricultural workforce. Not only has this resulted in lower food production, but it has also severely weakened the principal pillar of traditional African family healthcare in countries where infection rates vary anywhere from 15 percent to as high as 35 percent of the population.
Across the region, the growing patches of untilled farmland that blight the landscape are an eloquent testament of the widespread hunger and dangers that may lie ahead. Frequently, if fields are tended at all, it is by weak grandparents whose fragile last years have been weighed down by the urgent need to feed growing numbers of orphaned grandchildren.
During a recent trip to southern Africa, I met a lone grandmother who was desperately trying to care for 18 children. And this from a meagre plot of land that, until the crisis, used to feed only one or two mouths. To witness the plight of those directly or indirectly affected by the AIDS crisis is to be confronted with a problem so vast it seems to defy solution.
Take for example the 14-year-old orphan I met who had suddenly found herself single-handedly caring for her six younger brothers and sisters. Buckling under the weight of enormous responsibilities, as well as the effects of hunger and stunting, she looked half her age yet had been deprived of the most innocent of rights -to a childhood.
And like 11 million other children orphaned by AIDS in Africa, this child faced additional threats to her survival. The reality is that even if she is lucky enough to have a plot of land, she will never be as productive as her parents.
Not only are children at a physical disadvantage, but also more importantly, because their parents are no longer alive, they have lost their connection to rural traditions that for centuries have been the key to the transfer of knowledge and survival.
How should we respond? It goes without saying that the billions of dollars allocated to HIV/AIDS treatment by donor countries (including the generous $15 billion just announced by United States President George Bush) is indeed encouraging. But the haunting truth is that under current conditions, especially in poor countries, the crisis is unlikely to be solved by medical means alone.
For one thing, antiretroviral drugs are unlikely to be effective if the user lacks basic nutrition, as is frequently the case in many poor countries. Furthermore, there simply isn't enough financial aid available right now to fund drug treatment for all the millions of people living with HIV/AIDS.
Recent estimates indicate that only five percent of those who are HIV-positive have access to drugs, and most of these are in the developed world. Even the lucky few in poor countries who receive free drugs often find their bodies worn down by lack of food and malnutrition, which in turn increases susceptibility to infection.
It is clear that in the absence of a medical solution, many of those in poor countries will be in urgent need of basic food aid to survive. So too will many of their children. It's estimated that by the year 2010, 25 million children will have lost one or both of their parents to AIDS: a potentially enormous caseload.
What we didn't appreciate at first, and what many in the developed world are beginning to realise, is that all of these people constitute a long-term hunger crisis of enormous proportions and a major challenge to the humanitarian community. We must also confront some extremely hard choices.
In the absence of sufficient free drugs to treat those suffering from AIDS or those currently infected who may develop full-blown symptoms of the disease, we will still have to find ways to keep them alive and productive. We cannot allow the shortage or absence of drugs to become a reason for doing nothing.
Unfortunately, until now, efforts to address the HIV/AIDS issue in many poor countries have not worked and a major refocusing of effort is needed. As a minimum first step, we must ensure that those living with HIV/AIDS receive basic nutrition that enables them to survive and care for their families as long as possible. We must create the conditions for an effective medical solution, and short of this, to at least prolong life. What has now become clear to us at the WFP is that food is the first line of defence against HIV/AIDS.
Peter Piot, the executive director of UNAIDS, who has asked many African HIV/AIDS carriers about their priorities, said: their answer was clear and unanimous. Not care, not drugs for treatment, not stigma, but food.
The WFP now distributes a food ration that takes into account the increased energy, protein, and micronutrient requirements of those with HIV/AIDS. Not only does it help to keep HIV/AIDS-infected parents alive longer, but it also gives them time to raise their children properly and to provide them with the necessary life skills to survive, if not prosper.
Improved nutrition can also help prevent transmission of the virus from mothers to babies. Furthermore, by simply feeding hungry people, they are less likely to resort to high-risk survival strategies, such as exchanging sex for food or cash.
If the new variant HIV/AIDS hunger crisis is to be overcome, we in the international community will have to start with basics, especially in an environment of extremely limited resources. Until the financial means are found to provide medical treatment for all, it's imperative to at least ensure that the needy receive enough food to survive. ( Source: The Sunday Independent, 6 July, 2003).