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...scale, breadth, and interconnectedness of the pandemic's causes and impacts. Against this backdrop, there is an urgent need for broader understanding of the integral role that food and nutrition security can and should play in such responses. The first part of this article will define concepts and map potential interactions between HIV/AIDS and food and nutrition security. The second will focus on what is known about how food and nutrition insecurity may increase the risk of exposure to HIV infection and how HIV/AIDS in turn impacts food and nutrition security. The third section provides a conceptual tool--an HIV/AIDS lens--to help agricultural and other development policies become more "HIV-responsive." The concluding section highlights a few important research gaps.
Defining Concepts and Mapping Interactions
The interactions at a societal level can be represented by figure 1, which shows the waves of determinants of HIV infection, from macro-to micro-levels, and the subsequent waves of impacts, from micro to macro (see Gillespie and Kadiyala for additional maps of interactions at the household and individual levels). Looking at the top left-hand quadrant, and with time flowing left to right, we can see the various factors that condition susceptibility or risk of exposure to HIV at different levels and are discussed in the subsequent sections. HIV infection in an individual is the epicenter of figure 1. Following HIV infection, in the top right-hand quadrant, we can see the various sources and levels of vulnerability to AIDS-related impacts. These impacts are not onetime events, they are processes--often hidden, slow-burning, but potentially very destructive. There is potential for a vicious cycle to kick in when impact waves become casual waves.
[FIGURE 1 OMITTED]
How Food and Nutrition Insecurity Accelerate the Spread of HIV
Few studies have rigorously investigated the direct impact of food insecurity on adoption of high-risk behaviors. Inequalities of several sorts are central to the HIV risk that people face.
Gender
Women are biologically, socioeconomically, and socioculturally more at risk of HIV infection than men. Globally, just under half of all people living with HIV are female. Women and girls make up almost 57 % of all people infected with HIV in sub-Saharan Africa, where a striking 76% of young people (aged 15-24 years) living with HIV are female (UNAIDS). Biologically, male to female transmission of HIV is between two and four times more efficient than female to male (Mastro and de Vincenzi). Socioculturally, women's relative powerlessness also shapes risk. In South Africa, Jewkes and Abrahams found 2,070 rape incidents per 100,000 women in the 17-48-year age group, per year. Economically, women's dependence on men, their unequal access to resources, opportunities, and assets, including land, often place them at high risk (Hallman).
Mobility
Cross-sectional studies in South Africa (Zuma et al.), Senegal and Guinea-Bissau (Lagarde et al.), Tanzania and Zimbabwe (Boerma et al.; Bloom et al.) and four cities in Kenya, Zambia, Benin, and Cameroon (Auvert et al.) found mobility (often a consequence of poverty) to be associated with high-risk behaviors and HIV prevalence. In a cross-country analysis of national-level data from Latin American and Caribbean countries, Stillwaggon found urbanization and labor migration...
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