The complexity and the context-specificity of interactions between HIV/AIDS and food and nutrition security presents challenges for research in this area, as do some of the methodological implications of dealing with such a fundamentally cross-cutting issue. Effective incorporation of the dynamics of HIV and AIDS in food and nutrition theory and practice continues to be constrained by the following main gaps in research and in action.
First, existing research on the inter-relationship between HIV and AIDS and food and nutrition security, and actions derived from it, is limited in several ways. Though there is increasing understanding that the interactions are potentially two-way, far more attention remains focused on the impacts of AIDS on food security than on the other direction i.e. how food and nutrition-security outcomes, policy and practice may contribute to the spread of HIV. Second, much research remains limited to cross-sectional studies, with the dynamics of impact and response and their micro-macro links, remaining under-researched. Third, data tend to be somewhat over-concentrated on smallholder farming households in eastern Africa, and more geographical and contextual breadth is needed. And fourth, more interdisciplinary studies are needed involving collaborations between researchers from different disciplines and perspectives in order to truly understand why the interactions between HIV/AIDS and food and nutrition security play themselves out differently in different contexts.
There is very little empirical basis to guide responses to what is known about the interactions. Little is known about designing cost-effective solutions, scaling them up, situating them in the larger strategies for obtaining complex development objectives, or monitoring the full multi-dimensional nature of such interventions. "Best practices" are announced that have never been properly evaluated or compared.
When considering responses, there also remains an over-emphasis on individuals as passive victims, overcome by AIDS - rather than as innovators. Too few studies seek to capture and learn from the many innovations that are underway. Policy response is also compartmentalized - even at the level of clinical nutritionists rarely interacting with food security specialists on issues of household and community food and nutrition security. Another problem is that monitoring and evaluation, frequently weak throughout development, is particularly weak or non-existent when it comes to tracking the HIV-relevant impacts of non-health policy.
Then there is a common view that AIDS is so different that it demands completely new programs, new technologies, new responses. This is not only inaccurate, it is also dangerous because it adds to the prevailing sense of hopelessness. While AIDS is different to other health shocks, any move toward 'AIDS exceptionalism' will not facilitate understanding of important interactions, and may thus close off some important opportunities for effectively responding. We should thus not be blind to AIDS, but nor should we be blinded by it. An HIV lens (not a filter) should be used.
A broad consensus emerged from the Durban conference on the need to keep the focus on three overlapping and interacting sets of problems: HIV/AIDS, food insecurity, and malnutrition. Interactions between these problems may require certain modifications to interventions, to maximize their effectiveness in the context of HIV/AIDS. In other cases, HIV has added yet another rationale and another degree of urgency to making these programs work at scale.
In hollowing out household livelihoods, assets, and knowledge, HIV/AIDS reduces local capacity to respond. Fear and stigma associated with HIV/AIDS also paralyzes response at many levels. Government services and employees are seriously affected by the epidemic e.g. agriculture extension, health and education services. In addition, capacity is constrained by the predominant vertical sectoral approach to response - even in countries where HIV is deeply rooted and where the policy environment has been the most conducive, there is limited evidence of a true multi-sectoral response, beyond declarations made on paper. Ministries of agriculture and major donors have for the most part still not mainstreamed the implications of AIDS into their policy processes and programs. Without such mainstreaming and broad collaboration the scale, breadth and depth of response will continue to be dwarfed by that of the epidemic itself.