Alleviating the Double Burden

By Bruce-Lockhart, Kate | Women & Environments International Magazine, Fall/Winter 2011 | Go to article overview

Alleviating the Double Burden


Bruce-Lockhart, Kate, Women & Environments International Magazine


Women, Malnutrition and HIV/AIDS in Sub-Saharan Africa

In 2003, Stephen Lewis, then the UN Special Envoy for AIDS in Africa, traveled to the southern region of the continent to study the intersection of HIV/AIDS and food insecurity. His team was "stunned" by their findings: not only was HIV/AIDS closely linked with malnutrition, it was also deeply intertwined with the status of women. The quote on the right, a reflection on that trip, captures the devastating reality of the interplay between gender inequality, food insecurity, and HIV/AIDS. For Lewis, addressing the convergence of these factors became one of the most urgent priorities in the fight against the epidemic: "the toll on women and girls is beyond imagining; it presents Africa and the world with a practical and moral challenge which places gender at the center of the human condition..." (Lewis, 2006)

Throughout Sub-Saharan Africa, women are disproportionately affected by HIV/AIDS and malnutrition. To alleviate this double burden and address the pervasive gender inequality mat is so central to achieving the Millennium Development Goals, women must be at the crux of nutritional solutions to HTV/AIDS in SubSaharan Africa.

Malnutrition and HIV/AIDS: A Vicious Cycle

The synergistic relationship between HIV/ AIDS and malnutrition has deadly consequences for many people living with AIDS at both the individual and household levels, as it intensifies malnutrition and food insecurity. As Stephen Lewis articulated, at a basic level "AIDS leads to hunger; hunger exacerbates AIDS." (Lewis, 2006)

The intersection between HIV/ AIDS and malnutrition has an adverse effect on health, operating in a vicious cyclical relationship. Malnutrition exacerbates HIV/AIDS through hastening the onset of opportunistic infections and reducing the effectiveness of anti-retroviral drugs. HIV/AIDS has a similarly negative impact on nutritional status. It increases energy requirements by 10% for asymptomatic individuals, and by 23% for symptomatic. (Colecraft, 2008) In SubSaharan Africa, where access to food is often limited, there can be devastating consequences for the nutritional status of people living with HIV/ AIDS. The complications are numerous, including loss of appetite, gastrointestinal problems, diarrhea and malabsorption of nutrients. Not surprisingly, AIDS patients often display key indicators of malnutrition, such as micronutrient deficiencies and wasting.

Food Security

In a household affected by HrV/AIDS, food insecurity often becomes a reality. In Sub-Saharan Africa, where over 70% of the population are farmers, the losses of human capital in the form of labour are at the heart of the HTV/AIDS-food insecurity connection. (Gillespie and Haddad, 2002) This reduction in the household labour capabilities severely decreases agricultural output. The source of nourishment and income for the bulk of Sub-Saharan Africa's population, agricultural output, is further hurt by a loss in the transfer of intergenerational knowledge, as the productive adult population with experience in agricultural labour is the most severely affected by AIDS.

Losses in agricultural output lead to a decline in household income and food, resulting in the sale of productive assets such as livestock and farming inputs. The decline in income is further exacerbated by high medical and funeral costs associated with AIDS.

The potential consequences of these interrelated developments are worrisome for the future of food security in SubSaharan Africa because the agricultural labour force will likely be dramatically reduced. As a result, nutritional strategies must be at the heart of any attempts to mitigate the epidemic in Sub-Saharan Africa.

Women, HIV/AIDS and Malnutrition: Problems and Progress

Women in Sub-Saharan Africa are disproportionately impacted by malnutrition and HIV/AIDS - a double burden rooted in biology, socioeconomic realities, and the pervasive gender inequality. …

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