As part of CARE Canada’s Southern African Nutrition Initiative (SANI) funded by the Government of Canada, the Interagency Coalition on AIDS and Development (ICAD) is leading a capacity-building initiative to improve the health outcomes of women living with HIV and children living with and/or affected by HIV in targeted regions of Malawi and Zambia. The ultimate aim is to contribute to the reduction of maternal and child mortality in targeted regions.
This capacity-building initiative will be accomplished through twinning partnerships between organizations or groups in Canada and in selected districts in Malawi and Zambia. Small grants have been awarded to selected organizations to implement 18-month community projects that focus on gender, sexual and reproductive health and rights (SRHR), HIV and nutrition/food security.
Twinning is a formal, substantive collaboration between two or more organizations. Twinning encourages civil society organizations to collaborate and form partnerships with like-minded organizations in other countries or regions and provides a platform for the two-way exchange of knowledge, expertise and strengthening of capacity on specific project related approaches, strategies, interventions, and lessons learned from local contexts.
THE FOUR TWINNING PROJECTS
Capacity Enhancement of Women of Reproductive Age on HIV, SRHR, Nutrition and Gender in Dowa and Ntchisi (Malawi) and Niagara (Canada)
National Association for People Living with HIV/AIDS in Malawi (NAPHAM) (Malawi) and Positive Living Niagara (Canada)
The organizations will seek to enhance the capacity of women of reproductive age living with HIV on nutrition, HIV, SRHR and gender in order to improve their health and nutritional status and children under 5 living with or affected by HIV through two key areas of intervention:
1) Increasing knowledge among women and men about HIV, nutrition and gender equality
2) Increasing women’s economic empowerment
NAPHAM and PLN will work collaboratively on material development and adaptation, using pre-existing materials. They will each deliver separate but related interventions in their communities and will exchange lessons learned, including through a NAPHAM visit to Niagara.
NAPHAM will implement activities through their existing support groups for people living with HIV in Ntchisi and Dowa.
Towards Reducing the Impact of HIV for Women of Reproductive Age Living with HIV and Children under Five Living with or Affected by HIV in Ntchisi and Dowa Districts (Malawi) and Mpika District (Zambia)
The organizations will seek to improve the health and nutritional status of women of reproductive age living with HIV and children under 5 living with or affected by HIV through two key areas of intervention:
1) Increasing knowledge and uptake of prevention of mother to child transmission (PMTCT) services
2) Increasing nutritional knowledge and access to nutritional supports
Each organization will work with support groups in 3 different districts to implement project activities. Support groups typically have about 30 to 40 members, 90 percent of which are women. The three partners will work collaboratively on material development and sharing experiences, and will implement activities separately in the 3 districts.
The men and women who will be trained in each activity are to be identified through pre-existing support groups. Different men and women will be identified and trained for each activity in order to avoid over burdening a small group of women, and to build stronger, equitable community systems by engaging more women in leadership roles and access to skills development. The men and women engaged and trained in different activities will work collaboratively within the support groups to offer skill and knowledge development and ongoing support to the women in the support groups.
Improving nutrition of women living with HIV in Mpika and Shiwa ng’andu, Zambia
Child Participation Inclusive Education in Mpika (CPIEM) (Zambia), Chickanjebela Women’s Club (Zambia), and CAP Network (Canada)
The organizations will seek to enhance the capacity of women of reproductive age living with HIV on nutrition, HIV, SRHR and gender in order to improve their health and nutritional status and children under 5 living with or affected by HIV through two key areas of intervention for each Zambian organization:
1) Increasing knowledge and skills for proper nutrition among women reproductive age living with or affected by HIV
2) Improved knowledge and skills on HIV, gender and SRHR among women and girls of child bearing age
Chikanjebela Women’s Club
1) Increasing knowledge and skills of Club members and People Living with HIV related to HIV, nutrition, gender and SRHR
2) Increasing the capacity of Chikanjebela Women’s Club to implement nutrition, care-giving and training projects
Chikanjebela and CPIEM will each implement separate projects, in their communities, based on specific community needs and organizational capacity, with some overlap in activities and development of materials. Chikanjebela will engage in two visits to CPIEM as well as one visit to Program for Vulnerable Children and Women (PVCW), another Zambian organization implementing a SANI twinning project.
CAP Network will provide capacity building and implementation support to the two organizations, through Canadian headquarters as well as a locally-hired Project Officer, and will conduct two visits to the Zambian organizations—one at project start-up and a second monitoring visit during implementation.
Improving Nutrition Status for Children Living with or Affected by HIV in Mponela and Dzoole, Malawi and Toronto, Canada
The organizations will seek to improve the nutrition and life skills knowledge and capacities of children age 0-18 living with or affected by HIV and their households through three key areas of intervention:
1) Increasing nutrition and life skills knowledge and capacity of children living with HIV
2) Enhancing the knowledge of households of children living with or affected by HIV on nutrition and HIV-related care
3) Providing nutrition and economic supports to households of children living with HIV
Teresa Group will support PAWOC in adapting its materials for use in the Malawian context. Two PAWOC staff members will travel to Toronto in Month 3 to learn from Teresa Group about how they implement their activities and the materials they use, as well as to learn about the political environment as it related to HIV in Toronto. Thereafter, a representative from Teresa Group will also visit PAWOC to learn about PAWOC’s activities.
PAWOC’s activities will work with 180 households (60 in Dzoole A, 60 in Dzoole B and 60 in Mponela) delivering a series of interventions that will target the children living with HIV, their parents and the household unit.
The goal of the SANI HIV/SRHR capacity building initiative is:
To reduce the impact of HIV, gender inequality and poor nutrition as confronted by women of reproductive age living with HIV and children under 5 living with and/or affected by HIV in selected districts in Malawi and Zambia.
The objectives of the initiative are:
- To improve the health and nutrition outcomes of women of reproductive age living with HIV and children under 5 living with and/or affected by HIV;
- To strengthen community/civil society capacity in Canada, Malawi and Zambia to address gender, SRHR, HIV and food and nutrition security;
- To increase the knowledge of community/civil society in Canada, Malawi and Zambia to better understand and address linkages between gender, HIV and food and nutrition security through the exchange of good practices;
- To identify and disseminate results and lessons learned about community twinning projects the community/civil society response to gender, SRHR, HIV and nutrition/food security in Canada, Malawi and Zambia.
An Overview: Food Security, Nutrition, HIV, Gender and SRHR
In 2014, there are an estimated 805 million people globally who are defined as chronically undernourished (FAO, IFAD, WFP, 2014). Recent research underscores the critical intersection between HIV infection, nutrition, and food security (UNAIDS/WHO, 2011). Issues of gender inequality further compound this relationship.
In sub-Saharan Africa, high HIV burden is shouldered by low income regions already experiencing limited quantity and quality diets. In 2014, the sub-Saharan region of Africa had the highest prevalence of undernourishment. Approximately one in four people in the region remain undernourished (FAO, IFAD, WFP, 2014).
Lack of food security has direct implications for HIV prevention and treatment efforts. Food availability constrains individual choice about work and education. This in turn can lead to increased migration and mobility, disruption in access to health services, and situations of heightened vulnerability to HIV infection such as transactional or commercial sex (for food, goods or money) or staying in abusive relationships due to economic dependency.
Nutrition and food insecurity have negative implications for treatment adherence, individual health outcomes and immediate and long-term downstream health system costs (e.g., through failures of first-line treatments and the need to move to a more costly second-line regimen) (UNAIDS/WHO, 2011). Poor nutrition exacerbates HIV and can hasten AIDS-related illnesses in people living with HIV. HIV infection affects the appetite and the ability to take in and absorb food yet the metabolic changes affiliated with HIV and treatment compliance increase a person’s nutritional needs. Adults living with HIV have 10-30 percent higher energy requirements than an HIV-negative, healthy adult; children living with HIV have 50-100 percent higher needs than those who are HIV-negative (WFP, WHO, UNAIDS, 2008). Evidence shows that people living with HIV who are undernourished when they initiate into antiretroviral therapy are 2-6 times more likely to die in the first six months of treatment than those who have a normal body mass index (UNAIDS/WHO, 2011).
Similarly, HIV infection erodes food security and nutrition by reducing work capacity and jeopardizing household and community livelihoods (WFP, WHO, UNAIDS, 2005). In agrarian societies, productivity falls as labour is lost to sickness, death and care-taking responsibilities; increasing hectares of land lie fallow; livestock are sold in distress sales to pay for medical treatments or funerals; and agro-biodiversity, skills development and related intergenerational knowledge transfer are broken as parents die before they are able to pass on knowledge to their children (ICAD, 2005).
Gender inequality remains a key driver of the HIV epidemic and a leading factor contributing to food insecurity. Food insecurity occurs as a result of power imbalances and poverty as much as inadequate food supplies (Bezner Kerr et al., 2013; ICAD, 2005). Existing gender inequalities put women and girls at heightened risk for transmission. Women often have less social and economic power within relationships making protecting themselves extremely difficult. HIV and traditional gender roles have a disproportionate impact on the lives of women and girls. Women and girls traditionally bear an unequal responsibility for the work of caregiving for those who are sick and orphaned children due to AIDS effectively removing their labour from formal employment markets and the education sector (ICAD, 2004). Unequal intra-household decision making power (including income and food distribution), divisions of labour, resource and services access, and control (e.g., property/inheritance rights, access to water and land, credit, information and education) have deep implications for women’s and girl’s health, food, nutrition and livelihood security (ICAD, 2005; FAO, 2011).
The linkages between HIV and sexual and reproductive health rights (SRHR) are many. Most HIV infections are sexually transmitted or are associated with pregnancy, childbirth and breastfeeding. Sexually transmitted infections increase the risk of acquiring or transmitting HIV, and lack of sexual and reproductive wellbeing and HIV share root causes. Among women of childbearing age, HIV is the leading cause of death. When done correctly, linking of HIV and SRHR allows for the best use of limited health resources and can improve health service delivery (Stop AIDS Alliance, 2012).
The Southern African Nutrition Initiative (SANI) is a 24 million CAD initiative to address under-nutrition in women of reproductive age and children under five in Malawi, Mozambique and Zambia. Funded by the Government of Canada, SANI is led by CARE International and implemented in partnership with Cuso International, the Interagency Coalition for AIDS and Development, and McGill University’s Institute for Global Food Security in Canada, and with the Government and communities of Malawi, Mozambique and Zambia.