Date Published: October 23, 2007
Publisher: Public Library of Science
Author(s): Nigel Rollins
Abstract: Nigel Rollins discusses a new study showing that food insufficiency is a risk factor for increased sexual risk-taking in women in Botswana and Swaziland.
Partial Text: HIV and nutrition are linked in at least two important ways. First, the nutritional consequences of HIV have been obvious from the earliest reports of the epidemic in Africa. Patients suffering from the infection in Uganda were said to have “slim disease” . More than 25 years later, we are still grappling with the mechanisms by which HIV causes wasting and defining the macronutrient and micronutrient requirements of adults and children infected with the virus . The World Health Organization (WHO) recommends that energy requirements of HIV-infected individuals increase by about 10% from the time of infection and by 20%–30% when chronic opportunistic infections or HIV-specific conditions are present [3,4]. The WHO also recommends that HIV-infected patients should be assured of at least one recommended daily allowance of most vitamins. In the absence of an adequate diet, this often means that HIV care and treatment programmes must supply multiple micronutrient preparations [3,5].
In a new cross-sectional study published in PLoS Medicine, Sheri Weiser and colleagues collected data on both food security and HIV risk behaviour from population-based samples from five districts in Botswana and all four districts of Swaziland. In total, 2,051 adults were interviewed . The study participants were asked about the adequacy of their food intake over the preceding 12 months, and these data were related to condom usage, sex exchange, and other HIV risk behaviour such as having multiple partners. (For women, sex exchange was defined as exchanging sex for money, food, or other resources over the previous 12 months and for men this was defined as paying for or providing resources for sex over the previous 12 months.) Gender equity was explored through questions assessing aspects of sexual relationships.
For programme planners, these findings provide an additional rationale, even obligation, to consider hunger alleviation as a central component of HIV prevention programmes. In poverty-stricken communities, the incentive of reducing HIV risk behaviour should be an added reason for national governments and international agencies to invest in reducing hunger by improving infrastructure and development—as outlined in the Millennium Development Goals 1, 4, 5, and 6 (reducing extreme poverty and hunger, reducing child and maternal mortality, and preventing the spread of HIV/AIDS). Accordingly, the Global Fund to Fight AIDS, Tuberculosis and Malaria will need to consider how it deals with requests to provide food, as part of HIV prevention strategies, to populations known to be at high risk of food insecurity and, therefore, at risk of HIV infection.
The magnitude of the increased risk of HIV infection faced by poor and vulnerable women in areas of food insecurity needs to be better quantified, using methodologies that define clearly environmental influences such as drought, food production, and local cash flows as well as the personal interactions of women and men in such communities. Prevention interventions must address both the physical needs of hungry people as well as the autonomy that young women need to exercise their choices. Could conditional grants, for example, giving adolescent girls monthly allowances, be used to reduce gender pressures and HIV incidence in communities with high unemployment and teenage pregnancy rates? Would the economics of hunger reduction satisfy the donors focused on HIV?