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 will be 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.
This initiative will use a twinning model to build the capacity of community-based organizations to address intersections between HIV and nutrition and improve information, education and services for women living with HIV and children living with and/or affected by HIV, working with a SRHR framework. Twinning is a formal, substantive collaboration between two 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 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.
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.
Cuso International looking for skilled volunteers for SANI
SANI placement with ICAD’s capacity building initiative:
The role of the Program Management Advisor (PMA) is to provide ongoing organizational and programmatic technical support to the four twinning partners based in Malawi, related to the delivery of their SANI twinning projects. The PMA is expected to support the organizations in their project management and delivery and to support the coordination of the SANI Twinning Initiative in Malawi, including coordination between projects and with CARE Malawi.
Location Lilongwe, Malawi
Start Date Oct – Dec 2018 (flexible)
Length of Placement 10 Months
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).