Sunday, January 11, 2004

When HIV/AIDS first began its unrelenting spread through the poor countries of the world, we in the World Food Programme (WFP), like many in the humanitariancommunity, tended to view the phenomenon as a medical crisis that had little to do with hunger and food aid.

No longer. WFP now finds itself on the front lines of this crisis, grappling with a destructive phenomenon that has killed millions of people and rendered millions more dependent on international food aid. Nowhere is this more apparent than in the southern region of Africa, where half of the continent’s 30 million HIV/AIDS cases are found.

This year the region became a case study as the epicenter of a cataclysmic confluence of disasters—HIV/AIDS and potential famine. More ominously, the HIV/AIDS crisis is planting the seeds of future famines that could imperil millions of additional people.

To date, more than 7 million farmers have died as a result of HIV/AIDs, most of them women who make up four-fifths of the agricultural work force. Frequently, if fields are tended at all, it is by weak grandparents who have been weighed down by the urgent need to feed growing numbers of orphaned grandchildren. During a recent trip to Southern Africa, I met a lone grandmother who was desperately trying to care for 18 children.

To witness the plight of those directly or indirectly affected by the AIDS crisis is to be confronted with a problem so vast it seems to defy solution. Take for example the14-year-old orphan I met, who suddenly found herself singlehandedly caring for her six younger brothers and sisters. Buckling under the weight of enormous responsibilities, as well as the effects of hunger and stunting, she looked half her age. Yet she had been deprived of the right to a childhood.

How should we respond? It goes without saying that the billions of dollars allocated to HIV/AIDS treatment by donor countries (including the generous $15 billion just announced by President Bush) are indeed encouraging. But under current conditions, especially in poor countries, the crisis is unlikely to be solved by medical means alone.

For one thing, anti-retroviral drugs are unlikely to be effective if the user lacks basic nutrition, as is frequently the case in many poor countries. Furthermore, there simply isn’t enough financial aid available right now to fund drug treatment for all of the millions ofpeoplelivingwith HIV/AIDS.

Recent estimates indicate that only 5 percent of those who are HIV-positive have access to drugs, and most of these are in the developed world. Even the lucky few in poor countries who receive free drugs often find their bodies worn down by lack of food and malnutrition, which in turn increases susceptibility to infection.

It is clear that in the absence of a medical solution, many of those in poor countries will be in urgent need of basic food aid to survive. So too will many of their children. It is estimated that by the year 2010, 25 million children will have lost one or both of their parents to AIDS — a potentially enormous caseload.

In the absence of sufficient free drugs to treat those suffering from AIDS or those currently infected who may develop full-blown symptoms of the disease, we will still have to find ways to keep them alive and productive. We cannot allow the shortage or absence of drugs to become a reason for doing nothing.

Unfortunately, until now, efforts to address the HIV/AIDS issue in many poor countries have not worked and a major refocusing of effort is needed. As a minimum first step, we must ensure that those living with HIV/AIDS receive basic nutrition that enables them to survive and care for their families as long as possible.

What has now become clear to us at WFP is that food is the first line of defense against HIV/AIDs. WFP now distributes a food ration that takes into account the increased energy, protein and micronutrient requirements of those with HIV/AIDs. Not only does it help to keep HIV/AIDS-infected parents alive longer, but it gives them time to raise their children properly and to provide them with the necessary life skills to survive, if not prosper.

Improved nutrition can also help prevent transmission of the virus from mothers to babies. Furthermore, by simply feeding hungry people, we reduce the likelihood that they will resort to high-risk survival strategies — such as exchanging sex for food or cash.

If the “new variant” HIV/AIDs-hunger crisis is to be overcome, we in the international community will have to start with basics, especially in an environment of extremely limited resources. Until the financial means are found to provide medical treatment for all, it is imperative to at least ensure that the needy receive enough food to survive.

James T. Morris is the executive director of the United Nations World Food Programme.

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