Seasonal Hunger, the 2001-03 Famine and the Dynamics of HIV in Malawi
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Paper presented at the Seasonality Revisited International Conference, Institute of Development Studies, UK, 8–10 July, 2009
Secure access to food, adequate in quantity and quality, is becoming increasingly problematic for many. The number of food insecure is rising worldwide, reaching more than 1 billion according to the latest estimate (FAO 2009). Falling incomes, in part due to the global financial crisis, and continuing high food prices are proving devastating for those whose livelihoods are the most precarious. Climate change and variability are contributing to food insecurity in Africa and other regions and will do so increasingly in future. The most vulnerable are those dependent on highly seasonal, rainfed agriculture (IPCC 2007).
The impact of rising levels of hunger on human health and particularly major diseases such as HIV/AIDS, tuberculosis and malaria is of wide concern. However, our ability to predict with confidence is limited. With respect to HIV/AIDS, much of what is known about the effect of hunger and other facets of poverty comes from cross-sectional or longitudinal studies of limited duration and with few survey rounds that shed little light on dynamic effects, whether trends or cycles, and give little insight into the impact of major shocks (Gillespie et al. 2007). The fact that hunger is both a cause and a consequence of HIV/AIDS further limits the ability of these methods to disentangle the effect of change in any one.
The evidence reported here brings new light to bear on this question. It assesses the 2001-03 famine in Malawi as a country-scale natural experiment on the effect of hunger on the dynamics of HIV. The famine has been described as a particularly severe seasonal hunger event (Devereux et al 2008) and thus it also brings into sharper relief the links between seasonal hunger and HIV risks.