The HIV and urban food security nexus in Africa

Emergency food supplies and food security in Wuhan and Nanjing, China, during the COVID-19 pandemic: Evidence from a field survey

MOTIVATION

Detailed empirical work on the impact of the COVID-19 pandemic on food security is scant. Local management of food security has received little attention.

PURPOSE

This article describes emergency food policies in Wuhan and Nanjing, China during lockdown in 2020 and their implications for household food security in the two cities.

METHODS AND APPROACH

Policy documents and background data describe the emergency measures. Online surveys of residents of two Chinese cities were used to gauge household food security.

FINDINGS

Despite the determined efforts of provincial and city governments to ensure that food reached people who were locked down in Wuhan, or subject to restrictions on movement in Nanjing, households experienced some decline in food security. Most households found they could not access their preferred foods. But a minority of households did not get enough to eat.Government had contingency plans for the pandemic that ensured that most people had sufficient, if not preferred, food. But not all households were fully covered.

POLICY IMPLICATIONS

A more resilient system of food distribution is needed, including a relatively closed and independent home delivery system. Grassroots organizations such as residential community committees, property management organizations, and spontaneous volunteer groups need to be brought into the management of emergency food provision.

The Household Food Security Implications of Disrupted Access to Basic Services in Five Cities in the Global South

COVID-19 has caused significant disruptions regarding the extent to which households can access basic services and resources in cities around the world. Previous studies have indicated a predictive relationship between the consistency of resource access and food access among urban households. These investigations, however, have predominantly been isolated to Southern Africa and have not accounted for other dimensions of food security. To test whether these results are observable outside Southern Africa, and with a more multidimensional measure of food security, this investigation proposes a method for building an index of urban household food access, utilization and stability. The scores for the constructed index are then compared across household survey samples collected from five cities in the Global South. The investigation then assesses the predictive relationship between the consistency of household resource access and this more multidimensional index of food insecurity. While the general trend of inconsistent resource access predicting food insecurity is confirmed, there are geographic differences in the strength and quality of this relationship. These findings suggest that the resource access disruptions inflicted by COVID-19 will likely have a heterogeneous impact on urban food security dependent upon the affected resource and the city in which a given household resides.

High magnitude of food insecurity and malnutrition among people living with HIV/AIDS in Ethiopia: A call for integration of food and nutrition security with HIV treatment and care Programme

BACKGROUND

Food insecurity and malnutrition has been reported to have a strong connection with human immunodeficiency viruses (HIV); this is more pervasive in Sub-Saharan Africa including Ethiopia. In this study, we examined the predictors of food insecurity and factors associated with malnutrition among people living with HIV (PLHIV) in Benishangul Gumuz Regional State, Ethiopia.

METHODS

We conducted a cross-sectional study at outpatient antiretroviral therapy (ART) clinics. Data were collected using participant interview, anthropometry, and participants' chart review. Interviews were carried out with 390 PLHIVs who were on antiretroviral treatment follow-up. Four robust multivariate linear regression models were used to identify predictors of food insecurity and factors associated with malnutrition.

RESULTS

The prevalence of food insecurity and malnutrition among PLHIV were found to be 76% and 60%, respectively. The predictors of food insecurity were: urban residence; household dependency; average monthly income below 53.19 USD; poor asset possession; CD4 count below 350 cell/μL; and recurrent episodes of opportunistic infections (OIs). Correspondingly, malnutrition among PLHIV was found strongly associated with: female gender; urban residence; income below 53.19 USD; poor asset possession; duration of less than one year on ART; and recurrent episodes of OIs.

CONCLUSION

The study findings suggest that the higher prevalence of food insecurity and malnutrition among PLHIV underscore: the need for economic and livelihood intervention; addressing contextual factors including the gender dimensions; adoption of nutrition-specific and sensitive interventions; and integration of food and nutrition security with HIV treatment and care programmes.

Mapping disruption and resilience mechanisms in food systems

This opinion article results from a collective analysis by the Editorial Board of Food Security. It is motivated by the ongoing covid-19 global epidemic, but expands to a broader view on the crises that disrupt food systems and threaten food security, locally to globally. Beyond the public health crisis it is causing, the current global pandemic is impacting food systems, locally and globally. Crises such as the present one can, and do, affect the stability of food production. One of the worst fears is the impacts that crises could have on the potential to produce food, that is, on the primary production of food itself, for example, if material and non-material infrastructure on which agriculture depends were to be damaged, weakened, or fall in disarray. Looking beyond the present, and not minimising its importance, the covid-19 crisis may turn out to be the trigger for overdue fundamental transformations of agriculture and the global food system. This is because the global food system does not work well today: the number of hungry people in the world has increased substantially, with the World Food Programme warning of the possibility of a "hunger pandemic". Food also must be nutritious, yet unhealthy diets are a leading cause of death. Deepening crises impoverish the poorest, disrupt food systems, and expand "food deserts". A focus on healthy diets for all is all the more relevant when everyone's immune system must react to infection during a global pandemic. There is also accumulating and compelling evidence that the global food system is pushing the Earth system beyond the boundaries of sustainability. In the past twenty years, the growing demand for food has increasingly been met through the destruction of Earth's natural environment, and much less through progress in agricultural productivity generated by scientific research, as was the case during the two previous decades. There is an urgent need to reduce the environmental footprint of the global food system: if its performances are not improved rapidly, the food system could itself be one main cause for food crises in the near future. The article concludes with a series of recommendations intended for policy makers and science leaders to improve the resilience of the food system, global to local, and in the short, medium and long term.

Food Swamps and Poor Dietary Diversity: Longwave Development Implications in Southern African Cities

While the literature on food deserts focuses on limited availability of food in urban settings, ‘food swamps’ may better characterize the extensive prevalence and accessibility of cheap, highly processed foods. For urban populations, access to nutritionally inadequate poor-quality food has dire developmental consequences. The long-wave impacts of malnutrition at gestational and early childhood stages are negative and can be non-reversible. Moreover, those who survive into adulthood may face a lifetime of sub-optimal physical and mental development that undermines the second and third UN Sustainable Development Goals—to end hunger and to ensure healthy lives. This paper assesses the long-term health vulnerability of children with limited access to adequate and nutritious food in rapidly urbanizing cities. The analysis focuses on the African Urban Food Security Network (AFSUN) data drawn from 6453 household surveys in 11 cities and nine countries in Southern Africa. The results indicate that children in these households are consuming a limited diversity of food, have limited access to resources and have greater odds of experiencing both short-term and long-term food and nutrition insecurity. These findings demonstrate an underlying vulnerability to long-term health impacts stemming from nutritionally inadequate diets, with potentially significant costs to human capital.

The Stepping Stones and Creating Futures intervention to prevent intimate partner violence and HIV-risk behaviours in Durban, South Africa: study protocol for a cluster randomized control trial, and baseline characteristics

BACKGROUND

Preventing intimate partner violence (IPV) remains a global public health challenge. Studies suggest urban informal settlements have particularly high levels of IPV and HIV-prevalence and these settlements are rapidly growing. The current evidence base of effective approaches to preventing IPV recognizes the potential of combining economic strengthening and gender transformative interventions. However, few of these interventions have been done in urban informal settlements, and almost none have included men as direct recipients of these interventions.

METHODS

Stepping Stones and Creating Futures intervention is a participatory gender transformative and livelihoods strengthening intervention. It is being evaluated through a cluster randomized control trial amongst young women and men (18-30) living in urban informal settlements in eThekwini Municipality, South Africa. The evaluation includes a qualitative process evaluation and cost-effectiveness analysis. A comparison of baseline characteristics of participants is also included.

DISCUSSION

This is one of the first large trials to prevent IPV and HIV-vulnerability amongst young women and men in urban informal settlements. Given the mixed methods evaluation, the results of this trial have the ability to develop a stronger understanding of what works to prevent violence against women and the processes of change in interventions.

TRIAL REGISTRATION

NCT03022370 . Registered 13 January 2017, retrospectively registered.

Livelihood experiences and adherence to HIV antiretroviral therapy among participants in a food assistance pilot in Bolivia: a qualitative study

INTRODUCTION

Health and development organizations increasingly promote livelihood interventions to improve health and economic outcomes for people living with HIV (PLHIV) receiving treatment with antiretroviral therapy (ART). In-depth understanding about how PLHIV make labor decisions in the context of treatment for HIV - and treatment decisions in the context of their livelihoods - is essential to guiding intervention design and developing hypotheses for future research on livelihoods and ART. However, few studies have explored the perspectives of PLHIV regarding integration of livelihoods and ART in urban, resource-limited settings.

METHODS

Qualitative interviews explored the livelihood experiences of food insecure ART patients in four Bolivian cities (n = 211). Topics included work-related barriers to ART adherence, HIV-related barriers to work, and economic coping mechanisms. Themes were identified using content coding procedures, with two coders to maximize reliability.

RESULTS

Participants reported complex economic lives often characterized by multiple economic activities, including both formal and informal labor. They struggled to manage ART treatment and livelihoods simultaneously, and faced a range of interpersonal and structural barriers. In particular, lack of HIV status disclosure, stigma, and discrimination were highly salient issues for study participants and likely to be unique to people with HIV, leading to conflict around requesting time off for clinic visits, resentment from co-workers about time off, and difficulties adhering to medication schedules. In addition, health system issues such as limited clinic hours or drug shortages exacerbated the struggle to balance economic activities with HIV treatment adherence.

CONCLUSIONS

Improved policy-level efforts to enforce existing anti-discrimination laws, reduce HIV-related stigma, and expand health services accessibility could mitigate many of the barriers discussed by our participants, improve adherence, and reduce the need for livelihoods interventions.

Role of antiretroviral therapy in improving food security among patients initiating HIV treatment and care

OBJECTIVE

Although the physical health benefits of HIV antiretroviral therapy (ART) are well documented, the socioeconomic benefits are still being established. Few studies have examined the effects of ART on food insecurity, although studies suggest there may be a benefit via improved health and ability to work.

DESIGN

Twelve-month prospective cohort study of 602 treatment-naive patients initiating clinical care in Uganda.

METHODS

Longitudinal multivariate logistic regression was used to investigate the effect of ART on food insecurity compared to HIV care without ART. A staged regression approach was used to explore pathways through which ART may affect food insecurity.

RESULTS

Food insecurity decreased significantly for both the ART and non-ART groups over time, with the ART group experiencing greater reductions by the end of the study. ART remained a significant predictor of reduction in food insecurity over time after controlling for baseline differences in the regression model (odds ratio 0.642; P < 0.01). Improvements in work and mental health status were identified as potential pathways through which ART may improve food security.

CONCLUSION

Taken together with the well known benefits of food security on ART adherence, treatment retention and clinical outcomes in resource-poor settings, our results suggest that a positive feedback loop of improved functioning and productivity could result from the interaction between food security and ART. Policymakers could leverage this positive cycle by strengthening mental health support and promoting sustainable food security interventions as part of HIV treatment programs.