Although ART is increasingly accessible and eases some stresses, it
creates other challenges including the importance of food security to
enhance ART-effectiveness. This paper explores the role livelihood
strategies play in achieving food security and maintaining nutritional
status among ART patients in Kenya and Zambia. Ongoing quantitative
studies exploring adherence to ART in Mombasa, Kenya (n=118) and in
Lusaka, Zambia (n=375) were used to identify the relationship between
BMI and adherence; an additional set of in-depth interviews with people
on ART (n=32) and members of their livelihood networks (n=64) were
undertaken. Existing frameworks and scales for measuring food security
and a positive deviance approach was used to analyse data. Findings show
the majority of people on ART in Zambia are food insecure; similarly
most respondents in both countries report missing meals. Snacking is
important for dietary intake, especially in Kenya. Most food is
purchased in both countries. Having assets is key for achieving
livelihood security in both Kenya and Zambia. Food supplementation is
critical to survival and for developing social capital since most is
shared amongst family members and others. Whilst family and friends are
key to an individual's livelihood network, often more significant for
daily survival is proximity to people and the ability to act
immediately, characteristics most often found amongst neighbours and
tenants. In both countries findings show that with ART health has
rebounded but livelihoods lag. Similarly, in both countries respondents
with high adherence and high BMI are more self-reliant, have multiple
income sources and assets; those with low adherence and low BMI have
more tenuous livelihoods and were less likely to have farms/gardens.
Food supplementation is, therefore, not a long-term solution. Building
on existing livelihood strategies represents an alternative for
programme managers and policy-makers as do other strategies including
supporting skills and asset accumulation.
Fiona Samuels and Naomi Rutenberg