"Health regains but livelihoods lag": Findings from a study with people on ART in Zambia and Kenya

Overseas Development Institute, ODI, London, UK.
AIDS Care (Impact Factor: 1.6). 06/2011; 23(6):748-54. DOI: 10.1080/09540121.2010.532535
Source: PubMed


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.

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    • "Increased research is being done into how this new reality of treatment availability shapes infected people's lives in this region: improvements in clinical and laboratory outcomes are translated into improved physical and mental health functioning and socio-economic wellbeing (quality of life, household well-being, labour productivity) for patients and for those around them (Beard et al. 2009); studies are done on how people on ART self-manage their illness and how ART adherence impacts on their life activities, on social relationships and on rebuilding livelihoods (Martin et al. 2013, Parker et al. 2009, Samuels and Rutenberg 2011). ART is said to strengthen social relationships and self-identity as it 'improves people's capacity to work, important for social and economic viability and validation, allowing people to play their societal role as breadwinner, parent or adult' (Wekesa and Coast 2013: 5–6). "
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