There is an inextricable link between HIV and food insecurity, with each heightening and reinforcing the other. A new pilot trial published in AIDS addresses this relationship with an agricultural intervention that increased food security and also improved HIV outcomes.
“Food insecurity and HIV--we can think of them as intertwined in a vicious cycle, each enhancing the vulnerability to, and exacerbating the severity of the other condition,” says Dr. Sheri D. Weiser, the trial’s co-primary investigator and associate professor at UCSF. Indigent individuals may experience an increased vulnerability to the acquisition of HIV, as they may be more likely to engage in risky sexual to obtain food and other basic needs. Once infected, food insecure HIV positive individuals may experience higher rates of mental health problems such as depression, anxiety, stress, and substance abuse; they may also be less likely to take their prescribed medications, as some medications may have side effects if they are not taken with food. Eventually, these individuals may be too ill to work or find food, which exacerbates their food insecurity and, in turn, perpetuates the cycle.
According to Weiser, “The trial really emerged from interest and belief in the concept that addressing root determinants of food insecurity by using a livelihood intervention could be a very important strategy to improve health outcomes.”
In order to do so, the researchers implemented a multifaceted farming intervention, entitled Shamba Maisha, which means “Farm Life” in Swahili. It was sponsored in part by the National Institution for Health and the University of California Global Health Institute and included collaborations between researchers in the United States and Kenya, health economists, and non-governmental organizations including KickStart International, the developers of the water pump technology.
The trial was conducted over a one year period in the Nyanza region in Kenya, an area that has an HIV prevalence of 15.1%, more than twice the national average. Participants, all HIV positive, were randomly assigned to either a control or intervention group. Those in the intervention group were given agricultural and financial management training, and microfinance loans to purchase manual water pumps, as well as other farming supplies.
In Kenya, farmers are often dependent its two main rainy seasons. Since the water pump decreases reliance on rain and consistently supplies water, it may provide a more sustainable option and improve food security over the longer term, especially with the increasing frequency of drought and other climate changes.
The trial’s co-primary investigator and UCSF professor, Dr. Craig R. Cohen, says the water pump also plays a critical role in one of the goals to shift people from sustenance agriculturalists to horticulturalists. He explains that the shift has both economic and nutritional advantages, “The price can vary four to seven times for the amount grown in the dry and wet season. It’s supply and demand so you actually have vegetables for your own family to consume and the excess is where you can really earn quite a bit of extra income. It’s really for the individuals to expand their market and expand their income and their dietary diversity. They have security because they have access to water for irrigation.”
In comparison to the control group, the study found that the participants included in intervention arm significantly improved their food security and the quality of food consumed. They also had a significant increase in CD4+ cell counts, while their rate of viral suppression increased by nearly fifty percent.
The researchers emphasized it was not a panacea, but they found that the study had the potential to be transformative for families with land and access to surface water for irrigation. Cohen was able to visit the pilot study site every three months and saw changes in the land over time. Families may have purchased additional cattle or invested in improvements, like the addition of a fence, and the fast-growing crops initially grown changed to ones that required more skill and could generate a higher income. “These seem like small steps, but for these families, they are huge, huge steps,” Cohen tells me.
Weiser adds that there were also changes evident in the community--like decreased levels of stigma surrounding HIV and respect for the participants, with the neighbors of the participants seeking their advice on farming. She also noted a transformation in the participants. With dietary improvements, they were able to take their medications on full stomachs, and the additional income provided money that could be used for things like transportation to the clinic. The financial gains could also be empowering for some of the female participants--they were able to use some money for their children’s school fees without having to wait for their husbands--who, in turn, felt their stress was decreased.
One of the most remarkable changes Weiser observed was the change in the participants’ perspective and morale. “People are feeling better about themselves, saying things like ‘I used to be hopeless and I had no vision for the future and now things are different, I’ve started working, gaining confidence, feeling more capable.’ That was something that was so striking and what came up over and over again was a change in the level of hope”
The researchers are currently working on a larger, randomized cluster trial and collaborating to identify ways to expand in other regions.