Exploring the Intersecting Challenges of Climate Change, Food Insecurity and HIV/AIDS in Sub Saharan Africa

Background/Purpose: The number of people living with HIV/AIDS (PLHIV) is estimated at 25.6 million, and 330,000 died of AIDS-related illness in the year 2022 alone in sub-Saharan Africa (WHO, 2023). PLHIV in the region face numerous challenges related to their health, the economic burden of managing the illness, and dealing with stigma and discrimination. These challenges often lead to reduced spending on essentials such as food and social exclusion, which severs access to food support networks or employment opportunities necessary to acquire food, compromising the nutritional intake of individuals living with HIV/AIDS. Food insecurity occurs when people lack consistent access to food and often impacts their nutritional health, immunity, and adherence to antiretroviral therapy (ART) protocols while increasing their vulnerability, especially in times of disaster (Sharma et al., 2022). Spatio-temporal evaluations of food insecurity self-sufficiency ratio (SSR) in African regions show that climate factors (temperature and precipitation) already impact food production (Zhang et al., 2023). As such, building resiliency and adaptation for the prevention and treatment of HIV calls on understanding climate change-related food insecurity. This study aims to review factors associated with climate change, food insecurity, and HIV/AIDS in Sub-Saharan Africa (SSA).

Methods: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, this review focused on studies from 2014 to 2023 (since the historic Paris Agreement review completion by the Intergovernmental Panel on Climate Change). Several databases were explored, including Google Scholar, PubMed, selected EBSCO, Medline, AMED, ASSIA, IBSS, and ISI Web of Knowledge. Assessment of Multiple Systematic Reviews (AMSTAR) measurement tool was used to score articles. The keywords used for the first search were “HIV,” “AIDS,” “Africa,” “climate change,” “environment,” “food,” and “food insecurity.” The inclusion criteria were qualitative, quantitative, meta-analysis qualitative, narrative case survey, focus interview, and mixed methods studies; articles were excluded if they were non-English studies, dissertations, thesis, book chapters, and books. The final review resulted in n=18 articles.

Results: Five major themes across various articles showed that 1) food insecurity related to climate change increases HIV transmission by mechanisms such as increased gender disparities, sexual violence, sexual risk behaviors and transactional food-for-sex, and substance use; 2) as agricultural livelihoods become precarious, the rate of urbanization and migration grow, exposing people to various disease contexts and less access to food availability and sources; 3) as food availability becomes challenging, fewer people are likely to adhere to ART which requires nutritional balance to maintain the intake of medicines; 4) disaster preparedness and emergency responses, and 5) there is a general call for governance and policies on alleviating poverty, addressing nutrition status, food security, and climate change.

Conclusion and Implications: These themes demonstrate that ongoing climate changes and challenges associated with food insecurity can have severe consequences for those with increased vulnerabilities, such as the PLHIV. Addressing food insecurity requires a critical reflection with multifaceted collaborative practices, policies, and research that integrate HIV/AIDS prevention and treatment strategies while addressing social determinants of health such as food, and strengthening policies to mitigate climate change.