Kenya: Poverty Fuelling Spread of Aids

from All Africa

The Nation (Nairobi)

Zipporah Musau
Nairobi

Men, money, and mobility may have been among the main drivers of the HIV/Aids epidemic in its early days, but now poverty, widespread in Africa, has increasingly become one of the major risk factors.

Although we have known for the past 20 years the cause of HIV infection and how it is spread, we are only now beginning to understand what fuels the epidemic.

Food insecurity and malnutrition accelerate the spread of HIV, both by increasing exposure to the virus and by increasing the risk of infection following exposure, according to Dr Stuart Gillespie, a senior research fellow at the International Food Policy Research Institute (IFPRI).

"Hunger and HIV/Aids are entwined in a vicious cycle. Malnutrition and lack of food heighten susceptibility to HIV exposure and infection, while Aids in turn exacerbates hunger," says Dr Gillespie.

When people are short of food, they may be forced to separate from their families to earn a livelihood. Migrant workers are at the heightened risk of HIV exposure and infection, and may spread the virus when they return home. Poor women may trade sex to feed their families. They may also be less able to access information about the disease or less able to act on their knowledge of risk to minimise HIV exposure.

Lack of proper nutrition may lead to increased HIV transmission efficiency by lowering immunity and compromising the strength of stomach and genital lining. Malnutrition among pregnant and breast-feeding women may increase the chances of infecting their babies.

In addition, reduced food intake and food quality hasten the progression to full-blown Aids among people already infected with HIV. Studies show that weight loss of five per cent over a period of four months, for example, leads to opportunistic infections and increased risk of death. Infections are longer-lasting and more severe in someone who is malnourished. They may also be more frequent.

Food an important weapon

According to Dr Gillespie, links between HIV/Aids and hunger are particularly acute in rural communities, where households are often dependent on agriculture for both income and food. Improving rural livelihoods and agricultural production can help reduce both the spread of HIV and the effects of Aids. He says that programmes that reduce the need for poor people to migrate to look for work, for example by restoring degraded land, can also reduce their risk of being exposed to the virus.

As evidence of the interactions between Aids and hunger has accumulated, both agriculture and nutrition specialists have begun to take Aids into account. In turn, Aids experts have become increasingly aware of the critical importance of nutrition, particularly if anti-retroviral drugs (ARVs) are to be effective.

A recent study shows that if patients are malnourished when they start ARV therapy they are six times more likely to die than well-nourished patients.

They are also more likely to suffer side-effects, which may cause them to stop taking the ARVs altogether. And if many people stop, drug resistance will spread fast.

Malnutrition also increases the chances of disease transmission between adults. For example, Vitamin A deficiency is particularly associated with an increased risk of STDs, including genital ulcers and cervical herpes simplex virus shedding, which increase the risk of HIV transmission.

Focusing on the single premise that high rates of HIV prevalence in Africa are mainly due to high levels of unprotected, non-monogamous sex has restricted policy interventions. Hence, prevention of HIV is pursued predominantly through initiatives to "change behaviour", such as the ABC approach (Abstain, Be faithful, and use a Condom). Several studies stress the need to look beyond proximal factors of high-risk behaviour in HIV transmission. There is need to investigate why people engage in high-risk behaviour to successfully address the crisis.

Moreover, the use of the term "pandemic" conceals the fact that multiple epidemics may differ in causation, velocity, duration, and impact.