Scott Drimie

Strengthening Families to Support Children Affected by HIV and AIDS

Abstract This paper provides an overview of the arguments for the central role of families, defined very broadly, and we emphasise the importance of efforts to strengthen families to support children affected by HIV and AIDS. We draw on work conducted in the Joint Learning Initiative on Children and AIDSs Learning Group 1: Strengthening Families, as well as published data and empirical literature to provide the rationale for family strengthening. We close with the following recommendations for strengthening families to ameliorate the effects of HIV and AIDS on children. Firstly, a developmental approach to poverty is an essential feature of responses to protect children affected by HIV and AIDS, necessary to safeguard their human capital. For this reason, access to essential services, such as health and education, as well as basic income security, must be at the heart of national strategic approaches. Secondly, we need to ensure that support garnered for children is directed to families. Unless we adopt a family oriented approach, we will not be in a position to interrupt the cycle of infection, provide treatment to all who need it and enable affected individuals to be cared for by those who love and feel responsible for them. Thirdly, income transfers, in a variety of forms, are desperately needed and positively indicated by available research. Basic economic security will relieve the worst distress experienced by families and enable them to continue to invest in the health care and education of their children. Lastly, interventions are needed to support distressed families and prevent knock-on negative outcomes through programmes such as home visiting, and protection and enhancement of childrens potential through early child development efforts.

A systematic review on the meaning of the concept ‘AIDS Orphan’: confusion over definitions and implications for care

Abstract Global publications on the international AIDS epidemic report on the existence of an ever-increasing number of orphans and vulnerable children. It has been suggested that by the end of this decade there will be in excess of 25 million AIDS orphans globally, an issue which will require understanding and organisation of long-term medical, psychological and social support. This study provides a systematic review to examine the use, overuse and misuse of the term orphan and explores the benefits and limitations of this approach. It then summarises the knowledge on orphans to date. Using a search strategy of published studies and recent conference abstracts, 383 papers were identified where the concept of AIDS and Orphan was raised. The papers were systematically coded and reviewed to understand when and how a child is labelled an orphan, and to summarise the effect of orphanhood on outcome measures, most notably psychologically and physically. All controlled studies published prior to 2006 were reviewed. A consistent picture of negative effects of parental death (however defined) on a wide range of physical, socioeconomic and psychological outcomes were recorded. Seventeen studies met criteria for in-depth review (empirical, fully published, control group). The majority of studies are cross-sectional (two are longitudinal) and employ a very wide array of measures – both standardised and study specific. This detailed analysis shows a mixed picture on outcome. Although most studies report some negative effects, there are often no differences and some evidence of protective effects from quality of subsequent care and economic assistance. The lack of consistent measures and the blurring of definitions are stumbling blocks in this area.

Multiple stressors in Southern Africa: the link between HIV/AIDS, food insecurity, poverty and children's vulnerability now and in the future.

Abstract Several countries in Southern Africa now see large numbers of their population barely subsisting at poverty levels in years without shocks, and highly vulnerable to the vagaries of the weather, the economy and government policy. The combination of HIV/AIDS, food insecurity and a weakened capacity for governments to deliver basic social services has led to the region experiencing an acute phase of a long-term emergency. “Vulnerability” is a term commonly used by scientists and practitioners to describe these deteriorating conditions. There is particular concern about the “vulnerability” of children in this context and implications for childrens future security. Through a review of literature and recent case studies, and using a widely accepted conceptualisation of vulnerability as a lens, we reflect on what the regional livelihoods crisis could mean for childrens future wellbeing. We argue that an increase in factors determining the vulnerability of households – both through greater intensity and frequency of shocks and stresses (“external” vulnerability) and undermined resilience or ability to cope (“internal” vulnerability) – are threatening not only current welfare of children, but also their longer-term security. The two specific pathways we explore are (1) erosive coping strategies employed by families and individuals; and (2) their inability to plan for the future. We conclude that understanding and responding to this crisis requires looking at the complexity of these multiple stressors, to try to comprehend their interconnections and causal links. Policy and programme responses have, to date, largely failed to take into account the complex and multi-dimensional nature of this crisis. There is a misfit between the problem and the institutional response, as responses from national and international players have remained relatively static. Decisive, well-informed and holistic interventions are needed to break the potential negative cycle that threatens the future security of Southern Africas children.

Community-based agricultural interventions in the context of food and nutrition security in South Africa

Abstract Despite South Africa being a food-secure country in terms of aggregate food availability, it is listed by the World Health Organization as one of 36 high-burden countries, home to large numbers of stunted children. Recent findings, in the context of both over- and under-nutrition, have indicated that adult and child malnutrition rates have deteriorated in South Africa. The complementarities and synergies between food availability, access and utilisation need to be aligned in interventions used to address and strengthen food and nutrition security. This is particularly pertinent in the context of the widespread AIDS epidemic which interacts with food insecurity in complex ways. It is against this backdrop that home-grown or small-scale food production is explored as a feasible contributor to food and nutrition security for the rural poor with particular emphasis on contextual and technical factors. By illustrating a few successful models of home gardening, the evidence for addressing micronutrient deficiencies in these types of interventions is presented. The challenges to establish sustainable home gardening practices and the efforts needed to address gender-distinctive issues are discussed. The case is made for community-based agricultural interventions as a critical component of the various interventions used to address food and nutrition security at the household level.

The Integrated Food Security Strategy of South Africa: An institutional analysis

Abstract In 2002 the Integrated Food Security Strategy (IFSS) was approved by Cabinet as the strategy that would integrate the many previously isolated policies tackling the challenge of food insecurity in South Africa. Recent focus on food security due to rising food prices at a national and global level has placed the food security agenda back in the spotlight. In this paper it is argued that there is a disjuncture between the institutional response mechanism defined in South Africas strategy and the complexity of food insecurity nationally. It outlines why, as a response seated uncomfortably under the leadership of the National Department of Agriculture, the IFSS remains frustrated by a range of structural and organisational challenges. The IFSS provides a useful case study to demonstrate the importance of institutional arrangements to achieve food security that by its nature, requires integrated responses from diverse stakeholders.

Playing the role of a ??boundary organisation??: getting smarter with networking

BackgroundThis paper discusses the practices of organisations that cross the boundary between research and politics, to promote evidence-based policies and programmes.MethodsIt uses the experience of a network of organisations in Africa to describe the methodology, challenges and successes of efforts to promote utilisation of research on the inter-connections between HIV/AIDS, food security and nutrition in South Africa. It emphasises that crossing the boundary between science and politics can be done systematically and is inevitable for any attempt that seeks influence policy making.ResultsThe paper reveals the complexity of the research-policy making interface and identifies key lessons for the practice of networking and engaging policy and decision-makers.ConclusionThe concept of boundary organisation is a helpful means to understand the methodological underpinnings of efforts to get research into policy and practice and to understand the ‘messy’ process of doing so.

Broadening Psychology’s Contribution to Addressing Issues of HIV/AIDS, Poverty and Nutrition Structural Issues as Constraints and Opportunities

HIV/AIDS, more than any other public health problem, challenges dominant models of the role of psychology in health promotion and prevention. This paper focuses on poverty and resulting food insecurity as a structural risk factor for HIV infection. The paper considers the role of health psychology in global health concerns and argues that, while individual-based interventions are important, health psychology needs to shift to playing a proper role in broader level initiatives. Health psychology, in thinking about global health concerns such as HIV, needs to view an understanding of health, education and nutrition delivery programmes in low resourced contexts as at the core of the discipline.

Agricultural production in Greater Sekhukhune: the future for food security in a poverty node of South Africa?

Abstract This paper argues that within the range of complementary activities necessary to secure the food security of marginalised groups in South Africa in places such as Greater Sekhukhune, the aspect of agricultural production is often neglected. A comprehensive approach to food security should focus on exploiting opportunities around increasing local food availability through production, as well as stimulating food accessibility by, for example, supporting small enterprises through micro-credit, and supporting food utilisation through education. In this way a range of options is created that vulnerable people can adopt to promote their livelihoods beyond survivalist strategies. This paper explores the issue of agricultural production within Greater Sekhukhune to provide insights into the challenges facing a comprehensive food security strategy that would guarantee food supply through a range of interventions. The study in the Greater Sekhukhune District in Limpopo Province was conducted through two sets of household surveys (2004 and 2006) and the responses to the agricultural production part of these surveys are discussed. Marked changes from 2004 to 2006 were observed. For “agrarian reform” to be a success, the necessary institutional framework needs to be in place to enable a broad range of services from government and non-governmental actors. The facilitation of such “joined up government”, although in existence in theory, requires concerted political will to become a reality.

The HIV and urban food security nexus in Africa

The relationship between HIV and food security has been characterized by a tendency to view both as primarily rural phenomena. The urban literature, in turn, has been dominated by a biomedical focus on the nutritional implications of HIV infection on people living with HIV (PLHIV). Recently, attention has turned to related issues such as the value of nutrition supplementation, the nutritional implications of anti-retroviral therapy and the impact on both of rising food prices. This paper argues that the focus on rural food insecurity, the individual PLHIV and the nutritional aspects of food security, while valuable and necessary, are limiting our ability to understand the social and economic relationships that are central to the HIV-food security nexus in urban contexts. Rapid urbanization makes food security in the urban context a complex issue with a number of different and overlapping dimensions. Understanding the reciprocal relationship between HIV and urban food security requires a new social framework which incorporates, but is not constrained by, a focus on the nutritional impacts of the epidemic.

Food Security Indicators after Humanitarian Interventions Including Food Aid in Zimbabwe

Background Rural households in contemporary Zimbabwe experience various levels of food insecurity and vulnerability. Worsening macroeconomic conditions, a fragile political environment, poor rainfall, low incomes, deteriorating environmental conditions, and the impact of HIV and AIDS characterize their livelihoods. Non-governmental organizations have responded to the situation through a number of food interventions to alleviate food insecurity and poverty. Objective To provide an analysis of food security indicators used to assess households benefiting from food interventions in 2006 in Zimbabwe. Methods A total of 60 households were chosen for each of three districts (Uzumba-Maramba-Pfungwe [UMP], Chivi, and Tsholotsho), targeting beneficiaries of the Agricultural Protracted Relief Programme. Household food security indicators calculated on the basis of data collected by questionnaire included the Household Dietary Diversity Score (HDDS), months of food shortages, and the Household Food Insecurity Access Scale (HFIAS). Districts were compared by analysis of variance and Tukey post hoc analysis. Results The mean HDDS differed between the districts; households in Chivi consumed foods from a greater variety of groups than households in Tsholotsho and UMP (4.7 vs. 2.7 and 3.0, respectively; p < .001). Food shortages during the previous year were experienced by 76.4% of the households, with UMP having the lowest occurrence of food shortages (56.7%) and Tsholotsho the highest (95%). Households in Tsholotsho experienced hunger throughout the year; for households in UMP and Chivi, October to January were the critical months when households experienced the most hunger. Spearman correlation analysis showed an inverse correlation between HFIAS and HDDS (r = −0.425, p < .01). Households that experienced food shortages the previous year had a lower mean HDDS (3.2 vs.3.9, p = .013) and a higher mean HFIAS (17.1 vs. 12.0, p < .001) than households that did not experience food shortages. Conclusions The study demonstrated the value of using a variety and combination of indicators in the design of food security interventions. The HDDS showed that beyond availability, food security also involves access to a variety of nutritious foods. The indicator pertaining to months of food shortages allows a deeper understanding of the nature of food insecurity; hunger in Tsholotsho is experienced throughout the year, implying that the causes are chronic rather than seasonal, whereas Chivi and UMP experience seasonal hunger. The HFIAS usefully revealed the condition of food security in each site in terms of the availability, stability, and intake of food.