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HIV/AIDS: What are the implications for humanitarian action?

A Literature Review

July 2003

Paul Harvey

Humanitarian Policy Group
Overseas Development Institute

The ODI has requested SARPN to distribute this draft report in Southern Africa as a way of facilitating comments on its contents.
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The crisis in southern Africa during 2002 highlighted the complex interactions between HIV/AIDS, food insecurity and humanitarian action. James Morris, the UN Special Envoy to Southern Africa, argues that:

'The HIV/AIDS situation in Southern Africa is challenging the paradigm of humanitarian assistance.' (World Food Programme 2002)

The impact of HIV/AIDS in sub-Saharan Africa is already devastating and will continue to be so for decades to come, as demonstrated by the fact that 2.4 million Africans are estimated to have died of HIV/AIDS in 2002 alone. The scale of the epidemic, and the impact of the HIV/AIDS epidemic on livelihoods, poses a series of challenges to the international aid system. Conventional definitions of emergency and development assistance and the architecture of aid delivery may need to be re-examined. There will clearly be a need for both humanitarian aid and development assistance in mitigating the impact of HIV/AIDS and therefore a need for clarity in understanding where emergency relief should be situated within the wider response to the HIV/AIDS epidemic.

There is a growing literature on the impact of HIV/AIDS on food security. An understanding of the complex and diverse ways in which the epidemic affects livelihoods is necessary to begin to map the ways in which the epidemic is increasing underlying vulnerability and potentially contributing to emergencies such as the recent crisis in southern Africa. This report reviews this literature in Section 2 and draws on existing work to demonstrate how the impact of HIV/AIDS can be conceptualised using the sustainable livelihoods framework.

Is the growing vulnerability to food insecurity caused by HIV/AIDS a development or a relief problem? Section 3 reviews the nascent literature on AIDS and emergencies and revisits the long and somewhat tortuous debates about linking relief and development in the context of the HIV/AIDS epidemic. It distinguishes four main arguments;

  1. The argument that HIV/AIDS in and of itself should be seen as an emergency issue worthy of a relief response due to the devastating impact it is having on mortality, morbidity and livelihoods.

  2. The argument that the HIV/AIDS epidemic is an additional shock to livelihoods that has greatly increased the food insecurity of people making them more vulnerable to other shocks. There is therefore a possibility that natural and complex disasters will start earlier, last longer and be triggered more easily. The humanitarian community will need to adjust its way of doing business to take this hugely increased vulnerability to shocks into account.

  3. The argument that the impact of HIV/AIDS on livelihoods means that some form of safety net or welfare system will be needed for those worst affected. At the same time development processes will need to mainstream HIV/AIDS issues in devising appropriate mitigation strategies. Relief will be needed as a long-term safety net in conjunction with other, more development orientated interventions.

  4. HIV/AIDS can be seen as threatening a descent into permanent or periodic crisis in which underlying vulnerability is so great that there is a permanent emergency or chronic crisis, similar to that previously only seen in long running conflicts. This is the argument put forward by De Waal that the HIV/AIDS epidemic is causing or will cause 'new variant famines'. The impacts of HIV/AIDS are so devastating that we are facing, 'a new kind of acute food crisis in which there is no expectation of a return to either sustainable livelihoods or a demographic equilibrium'.

None of these positions are necessarily mutually exclusive. Long-term safety nets may be needed for those worst affected by HIV/AIDS, emergencies resulting from other shocks will need to take the underlying vulnerability of AIDS into account and, as the impact of AIDS mounts, the possibility of chronic crisis will grow.

Whatever label is attached to emergencies in the context of an HIV/AIDS epidemic (new variant famine, chronic crisis, emergency or development problem) it is clear that aid agencies must take HIV/AIDS into account, both in terms of policy and practical programming approaches. This is the subject of Section 4, which aims to summarise the lessons learnt by the humanitarian community in dealing with the links between HIV/AIDS and acute food insecurity from the crisis in southern Africa and suggest possible avenues for future good practice. This is based on a review of the growing grey literature resulting from the southern Africa crisis and initial interviews and correspondence with aid agencies. Further field-work will be conducted in southern Africa to build on this preliminary work.

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