Putting Food on the Table: An Exploration of Livelihood Strategies and Their Role in Maintaining Nutritional Status Among Patients on Antiretroviral Therapy
Research by the Council’s Horizons program aimed to explore and understand the role that livelihood strategies play and, in particular, the ability to achieve food security or adequate access to food in maintaining nutritional status among patients on antiretroviral therapy.
A picture is emerging of multi- or bi-directional links between HIV and AIDS, food and nutritional security, and livelihoods in general. As antiretroviral therapy (ART) becomes more accessible in Africa, it is expected that some stresses placed on individuals, families, households, and communities may be alleviated. However, we lack understanding of the dynamic relationship between treatment, food security, and nutrition.
The aim of this study was to explore and understand the role that livelihood strategies play—in particular, the ability to achieve food security or adequate access to food—in maintaining nutritional status among patients on ART. This study has direct policy implications as it explores the urgent question of how to put food on the table and provide nutritional support beyond the distribution of food and nutrition supplements.
The study was nested within two existing Horizons operations research projects exploring issues around ART and adherence: one in Zambia and one in Kenya. The study in Zambia was conducted in two urban compounds in Lusaka and two urban compounds in Ndola (an intervention and comparison site in each town) and had a community focus. The study in Kenya was conducted in Mombasa and had a more clinical focus.
This study consisted of a cross-sectional formative assessment. Quantitative, qualitative, and participatory methods were used. A preliminary qualitative investigation (focus group discussions) was followed by a quantitative survey (in Zambia only), which in turn led to further qualitative probing through in-depth interviews of livelihood networks. The quantitative questionnaire for Zambia was informed by the formative qualitative work and by existing instruments and indicators for measuring food security. In Mombasa, existing data were reviewed and the relevant sections extracted based on the preliminary qualitative investigations.
Banner photo: Manoocher Deghati/IRIN
Key findings include:
- The majority of people on ART in Zambia are food insecure, and most people on ART in both Zambia and Kenya frequently miss meals.
- Most food is purchased.
- Most food supplementation is shared among family members and others.
- Among those who receive food supplementation, it represents a lifeline enabling them to eat and develop social capital.
- Livelihood networks are important resources in times of difficulty and consist of a range of people including family members, friends, and shopkeepers.
- Neighbors are important members of an individual’s livelihood network, as often what is most significant to daily survival is proximity and immediacy.
- Study participants report a diverse use of gardens/small farms for support.
- With ART, respondents’ health has rebounded but their livelihoods lag behind.
- Respondents with high adherence and high BMI tended to be more self-reliant and more likely to have multiple income sources.
Given that food supplementation is not a long-term solution, findings from this study highlight the importance of livelihood strategies in helping people on ART adhere to medication regimens and achieve good nutrition. The study has identified four areas in which inputs and support could be provided in order to bolster livelihood strategies. These areas are: skills, livelihood networks, assets, and food and cash transfer projects. These four areas are not mutually exclusive and as such are overlapping and interlinked.
Banner photo: Manoocher Deghati/IRIN
'Health regains but livelihoods lag': Findings from a study with people on ART in Zambia and Kenya (abstract)
Samuels,Fiona; Rutenberg,Naomi
AIDS Care 23(6): 748-754
Publication date: 2011
Food on the table: The role of livelihood strategies in maintaining nutritional status among ART patients in Kenya and Zambia (PDF)
Samuels,Fiona; Rutenberg,Naomi; Simbaya,Joseph; Okal,Jerry; Kisengese,Nicodemus; Luchters,Stanley; Kaai,Susan; Geibel,Scott
Horizons Research Summary
Publication date: 2008
Project Stats
Location: Kenya (Mombasa) , Zambia (Lusaka; Ngombe and Bauleni compounds)
Program(s):
HIV and AIDS
Topic(s):
HIV care, support, and treatment
Duration: 5/2006 - 7/2007
Population Council researchers:
Scott Geibel
Naomi Rutenberg
Non-Council collaborators:
Fiona Samuels (International HIV/AIDS Alliance)
International Centre for Reproductive Health
Joseph Simbaya (Overseas Development Institute)
Rick Homan (Family Health International)
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