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Save the Children

Food security, livelihoods and HIV/AIDS: a guide to the linkages, measurement and programming implications

Michael O'Donnell
Contact: m.o'

August 2004

Posted with the permission of Michael O'Donnell, food security and livelihoods advisor, Save the Children, UK.
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Executive summary

This paper is intended both for managers and technical staff working either in food security and livelihoods or in HIV/AIDS and reproductive health who require an introduction to the linkages between the two areas, and as a guide to the many issues that need to be considered when carrying out assessments (or reviewing others’ assessments) and when planning interventions. The focus is specifically on economic impacts of AIDS, and does not address important emotional, psychological and social impacts.

HIV/AIDS/ Livelihoods Linkages

HIV/AIDS affects food security and livelihoods in very different ways for different households. The impacts will vary according to the assets of the household, its demographic composition and the circumstances in question, i.e. whether they are affected by the chronic illness of a member, the recent death of a member, or whether they are supporting orphans.

The mechanisms by which households are affected is best understood using a sustainable livelihoods framework, and considering impacts on each of the different types of assets available to the household.

During chronic illness the main effects are: loss of labour due to illness; loss of labour due to increased caring; increased requirements for spending on healthcare. Death leads to an immediate loss of labour, but can lead to other changes in household composition that can positively or negatively affect labour availability. There can be changes in livelihood patterns as remaining members try to optimise their available assets. This can lead to successful coping, or following a period of unsustainable response (e.g. by selling productive assets) could ultimately result in the dissolution of the household.

The economic effects of taking in an orphan depend on the existing composition of the household and then on the age, gender and skills of the incoming orphan, which determines the net contribution of the orphan to the household.

Measuring Impacts

To understand the impacts of AIDS, we need to know what happens to a household once it becomes affected, and the extent to which that is related to HIV/AIDS or to other factors. Ideally there should be two sets of comparisons, therefore:

  1. A comparison of the situation of the household between when they were unaffected and affected, i.e. the change following illness/ death/ addition of orphans.
  2. A comparison of affected households with unaffected but otherwise similar households, to try to control for non AIDS-related factors.
Studies must specify the definition of “AIDS-affected” and distinguish between chronic illness, death and the support of orphans, and must then use proxy indicators that are relevant to that group and that can be feasibly collected in the field.

A variety of methodologies and tools are available for looking at the impacts of AIDS, including qualitative studies, quantitative household surveys, the Household Economy Approach and Individual Household HEA. The relative strengths and weaknesses of each approach are indicated. The decision on which approach(es) to take should also be guided by:

  • the specific purpose of the assessment and the type of information that is sought
  • the level of detail and precision that is required, and
  • the use to which that information will be put (e.g. is it simply to shed light on a problem, or will it be used for designing interventions?)
Translating Linkages into Programming Responses

A proposal to undertake programmes to mitigate the impacts of HIV/AIDS on livelihoods should first consider how it fits into a broader programme of prevention care and treatment of HIV/AIDS, and second whether there are equally pressing food security problems not directly related to HIV/AIDS which also need to be addressed.

Empirical evidence to date shows that not all AIDS-affected households are food insecure, and that many unaffected households are food insecure, and therefore the blanket labelling of AIDS-affected households as a vulnerable group in need of food security assistance is inappropriate. Targeting of food aid or other emergency interventions is still best done using socio-economic/ wealth criteria rather than demographic or health criteria.

Other issues to consider when planning food aid interventions in particular are:

  • Ability to identify the target group
  • Potential role of stigma
  • Ensuring participation of women and children in programmes
  • Appropriate siting of distribution points and manageable packaging of rations
  • Designing appropriate rations, in terms of nutritional context, palatability and digestibility
Proposals for food- or cash-for-work programmes should particularly assess the implications for household labour availability and the profitability of the work in contexts of high HIV prevalence.

School feeding is likely to be harder to justify as a response to HIV/AIDS, particularly if it is not combined with other interventions. In particular, a school meal is unlikely to counter-balance the increased demands on children (particularly girls) to assist at home with caring and with productive activities, while feeding specifically targeted at orphans or otherwise-affected children could have a stigmatising effect.

A wide variety of potential interventions could be considered in relation to enhancing livelihoods, and these are categorised according to whether they primary address human, financial, social, physical or natural capital. Strong emphasis on monitoring and evaluation and on documenting experience is necessary to fill in current gaps in knowledge of what “works” and what doesn’t in different contexts. A well thought out combination of interventions – particularly if they build upon possible synergies between one another and with interventions in other sectors relating to prevention, care and treatment – will be most effective.

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