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HIV, Drought a Bad Mix

July 29, 2003

Heather Heilman
Phone: (504) 865-5714

hheilman@tulane.edu

A drought in southern Africa is not exactly an unusual occurrence. They happen regularly, once a decade or so, sometimes to devastating effect as in the Ethiopian famine of 1984. But until recently, drought was something Africans were equipped to recover from.

inside0701_jmason"Although people may lose their cattle and suffer malnutrition, they historically bounce back from drought, both in terms of the way traditional societies respond and the way governments respond," said John Mason, professor of international health and development.

But whether the region will soon recover from the drought of 2002 remains to be seen. The reason is that this area also has the highest prevalence of HIV and AIDS on the planet.

"Because of the epidemic, the impact of the drought is greater and people are unable to recover from it in the traditional way," Mason said.

The AIDS epidemic complicates the food shortage in a number of ways, and the food shortage complicates the epidemic. There are fewer healthy, able-bodied people available to work at food production and fewer working to earn money to buy food.

And malnutrition is particularly hard on those who are sick and may speed the transition from HIV to AIDS. Mason visited Africa this spring on behalf of UNICEF to help evaluate the nutritional situation of children in six countries hardest hit by the drought--Lesotho, Malawi, Mozambique, Swaziland, Zambia and Zimbabwe.

He was accompanied by his wife, Karen Mason, an epidemiologist at Louisiana State University, and Tulane public health student Adam Bailes. Mason found a few pieces of good news to report. Food assistance during the famine was more effective and well-monitored than ever before. Rural areas, where malnutrition is usually most severe, fared a bit better than expected. But urban areas, where there is the least malnutrition but where prevalence of HIV is highest, are the places where the situation is deteriorating most rapidly. And the need for assistance continues even though the drought is over, according to Mason.

"What's happening is that households are losing their productive members, so they're getting poorer, which impedes their ability to feed themselves, which reduces their resistance to disease, including AIDS."

In addition to food assistance, a way of getting economic assistance to families that have lost all their productive members is needed. At this point there is no social welfare system in place. In addition, the area needs widespread use of the anti-retroviral that blocks mother-to-child transmission of HIV. Currently about 30 percent of pregnant women in the region have HIV and about 10 percent of babies may have AIDS.

The entire menu of anti-retrovirals is in short supply and prohibitively expensive in southern Africa, and a way to make them more accessible could make a tremendous difference. But perhaps the best use of economic assistance would come through investing in schools.

"There are such large numbers of destitute children whose parents have died, and the schools are where they go, first of all, to get food. It's where they can fit back into society, and also learn how to avoid getting HIV themselves," Mason said. "There's a window of opportunity when these kids are around 7 to 12 years old, where they're open to behavior change before they become sexually active. The fact is that there's such severe selection pressure that societies that change their behavior will survive and those that don't, won't. "It's an out-of-control catastrophe," he said.

Heather Heilman can be reached at hheilman@tulane.edu.

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