End inequalities; End AIDS; End pandemics was this year’s World AIDS day theme which was marked on December 1st 2021. But while the campaign focuses on HIV prevention and treatment, we acknowledge that inequalities also apply to the other needs of people who are living with HIV that support their health and wellbeing, like food and nutrition security.
Food And Nutrition Inequalities; Is Food Available?
Access to Better Safe Adequate Nutrition
Inequitable access to better safe adequate nutritious foods is one of the factors hindering improved health for people living with HIV/AIDS. This could partly be due to people’s preferences and choices, but mostly due to inequities across food environments that restrict access to healthy diets or promote low-quality diets.
The food system comprises supply chains, food environments, consumer behavior, and external drivers, all interdependent and collectively influence diets and outcomes of nutrition and health. With urbanization, globalization, and trade liberalization, these systems are changing rapidly and, consequently, dramatically impacting the nutritional status of populations. As evidenced with COVID-19, Pandemics also magnify inequalities and increase their effects. Evidence from one of the informal settlements in Kenya showed that HIV patients became at high risk of food insecurity and malnutrition because they could not fend for themselves and their household members due to the effects of COVID-19.
Imbalances in Food Systems
The imbalances in food systems exist and are propagated by multiple factors, including food availability- having sufficient quantities of food through local production or import, including food aid. Food production has focused mainly on staple grains like (maize, rice and wheat), yet most national food-based dietary guidelines recommend the consumption of more fruits, vegetable nuts, and whole grains.
This prioritization of the staples then creates an imbalance in healthier non-staples. Natural resources, ecosystems and climate change also affect food production, affecting the quality and quantity of food available to consumers. At the same time, the type of food produced is also influenced by consumer choices and demands, which can increase pressure on the ecosystem and contribute to climate change. Evidence has shown that animal source foods for instance, increase the production of greenhouse gases.
Similarly, producing fruits and vegetables, staple grains, and intensive use of cropland and freshwater creates environmental stress. Use of nitrogen and phosphorous fertilizers can also affect the quality of food. Unfortunately, the effects of production and consumption practices are mostly felt in low-income countries where resources to adapt fast enough to environmental changes are limited, as are their options for accessing healthy food.
Regulated Food Environment
A well-regulated food environment that looks beyond demand and supply to include environmental impact, ecosystems management, and effect on climate change is a better approach to ensure more equitable availability and accessibility of diverse food for all, and less inequality in nutrition outcomes.
But geographic conditions and lack of appropriate infrastructure can also limit food availability and distribution, especially perishable foods. Many of these foods (fruits and vegetables) are grown in rural areas far from the town and cities where they supply food, and are often characterized by poor road networks. Food access is also influenced by factors such as distance to the food and available means of transport, health, purchasing power and the food prices, access to land (size and quality), access to agricultural inputs, technology and services, access to facilities and equipment for food preparation and storage and preservation, as well as knowledge and skills.
Indeed, inequities in food accessibility and basic infrastructure for the rural, the poor, the geographically isolated and those marginalized in whichever way result in limited access to sufficient quantities of healthy food and thus increase the vulnerability of these populations, including those living with HIV to malnutrition. We need all stakeholders to do their absolute best to have better food systems.