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HIV/AIDS Devastation in Malawi and Zimbabwe
Refugees International
September 25, 2002

By Maureen Lynch and Ada Williams

http://www.refugeesinternational.org/cgi-bin/ri/bulletin?bc=00453

HIV/AIDS has a devastating impact on African communities and permeates every aspect of life – health, family relationships, food security and productivity. The statistics are staggering. Prevalence rates range from 16 percent in Malawi, where more than three million people face starvation, to 25 percent in Zimbabwe, where six million people need food to help them survive until the next main harvest. The HIV/AIDS problem is not going away. One farmer described his village’s situation, "We can’t complete two days without a funeral." The current food shortage has only intensified the plight of those with HIV/AIDS, and no community has been left unaffected. In his testimony before the U.S. House of Representatives International Relations Committee on June 13, 2002 James T. Morris, Executive Director of the World Food Program, noted that "this [food] crisis is the first in history in which HIV/AIDS plays a major role."

HIV/AIDS directly impacts food security and nutrition for the individual, the household, and the community. The International Food Policy Research Institute reports that people living with HIV have higher than normal nutritional requirements: up to 50 percent more protein and up to 15 percent more calories. The infection, when compounded by inadequate diet, leads more rapidly to malnutrition. The poor suffer the gravest consequences because they are more likely to be malnourished before they become infected. Malnutrition shortens the asymptomatic period of HIV infection, hastens the onset of AIDS and ultimately death, and may also increase the risk of HIV transmission from mothers to babies. Conversely, the onset of full-blown AIDS, and even death, may be delayed in well-nourished individuals who are living with HIV. Diets rich in protein, energy, and micronutrients can help prevent opportunistic infections. Referring to people who lack food and are suffering from HIV/AIDS, one aid worker told RI "people living with HIV/AIDS should be the top priority for food assistance."

Food insecurity can lead to use of extreme measures. In Zimbabwe’s rural areas, women and girls turn to transactional sex for food or cash from those who have money, such as gold panners. One village woman said that it is the lack of food that forces women to be promiscuous, thus leading to the further spread of HIV/AIDS. "With food, people will not be promiscuous."

The stress that HIV/AIDS places on social structures in African communities has been, and will continue to be, devastating. When there are no food shortages in communities, it is customary for villagers to help each other; but during times of crisis it is harder to help if they themselves are starving. In a Zimbabwean village, farmers explained that they used to draw water and weed the fields of those suffering from AIDS. One farmer told RI, "We used to assist those suffering with AIDS and orphans, but now we can’t because we have no food, and have to work harder to find it, so there’s no time or energy to help anymore."

Traditionally in Malawi, funerals are very important. One must provide large amounts of food to show respect. Unfortunately, this food crisis, along with alarming death rates, has meant that people are being ostracized for not providing enough food for funerals.

Another severe consequence of HIV/AIDS has been the number of children left without parents. There are 400,000 AIDS orphans in Malawi right now; and in Zimbabwe, an estimated 500,000 children have lost at least one parent to the epidemic. The result of parents dying of AIDS is that there are more child-headed households and many elderly are taking care of young children. One aid worker explained that she worries about the grandparents, who at this age should be taken care of themselves.

Although the extended family system in Africa is very strong, it is impossible to take care of everyone during times of crisis. Usually orphans are absorbed into the communities through social networks and extended family relations. Unfortunately, the numbers are too high for people to keep caring for orphans in their homes. Orphans often have a tough time within the community living with extended families. They sometimes are not accepted by their extended family, may face abuse, and are blamed for eating all of the food in the home. There are damaging side effects of this: young girls turn to prostitution for food and cash, and young boys turn to crime. Communities, who want to help but are living on the edge of starvation, have run out of ways to feed orphans. Farmers say, "We cannot get food to feed them." In a village in Malawi, one community was trying to provide assistance to orphans through a community-based nursery school. A villager told RI, "Sometimes orphans do not have clothing like other school kids and feel isolated." AIDS orphans in many villages do not attend school and therefore are often unable to take advantage of school feeding programs. "AIDS orphans need special care. We should reach out to them, but food may not be enough. They should be targeted for special assistance," an aid worker told RI.

Aid agencies responding to the food crisis and the HIV/AIDS epidemic say, "There is no danger of overlap. Everything is needed because the problem is so big." In response to the need for food and health, one health center had HIV/AIDS programs catering to those suffering with malnutrition. Oxfam is currently running an HIV/AIDS sensitization program for truck drivers who deliver food assistance. NGOs operate orphan support and home based care programs. In addition to information provided in a weekly radio broadcast about the disease, one NGO had been training volunteers in villages of Malawi to work with youth. Unfortunately, those programs lost funding in light of the new food emergency.

In both Malawi and Zimbabwe, there is a struggle to understand how to best care for orphans. The debate is whether community care that strengthens and supports extended families caring for orphans would help or whether operating orphanages would be best. The governments of Malawi and Zimbabwe have not clarified the focus of assistance for orphans, though it is generally believed that supporting communities to care for orphans is the best solution.

HIV/AIDS has to been seen as part of a wide-ranging problem that also includes chronic poverty and the food emergency. Giving communities food for the emergency and empowering sustainable food production are steps in the right direction.

Refugees International therefore recommends that:

• The Governments of Malawi and Zimbabwe and the international community should give priority food assistance to those infected by HIV/AIDS.
• The Governments of Malawi and Zimbabwe should adopt a clear policy for AIDS orphans, particularly in relation to supporting community based care.
• The Governments of Malawi and Zimbabwe and international donors should expand funding to support communities that care for AIDS orphans.
• The Governments of Malawi and Zimbabwe and international donors should fund income generation programs for orphans.
  

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