Food insecurity and ART adherence in Swaziland: the case for coordinated faith-based and multi-sectoral action

ABSTRACT

Faith-based organisations (FBOs) have long been involved in HIV and AIDS impact mitigation and humanitarian relief, but most are not equipped to intervene in the structural drivers of food insecurity and attendant health inequities. Acknowledging limitations is as paramount a task for organisational effectiveness as maximising strengths. This article reports findings from a study of HIV-positive care supporters who volunteer with a church-run home-based care organisation in Swaziland. The article seeks to assess the impact of chronic food insecurity on antiretroviral adherence practices and how these individuals manage daily food shortages. Findings highlight the limited capacities of FBOs in highly vulnerable settings and the imperative for international and governmental coordination.

Les organisations confessionnelles sont depuis longtemps impliquées dans l'atténuation de l'impact du VIH/sida et dans l'aide humanitaire associée, mais la plupart d'entre elles ne sont pas équipées pour intervenir sur les facteurs structurels de l'insécurité alimentaire et les inégalités de santé qui en découlent. Du point de vue de l'efficience organisationnelle, la reconnaissance de ces limites est aussi primordiale que la maximisation des forces. Cet article présente les résultats d'une étude au Swaziland sur les aidants concernant les soins du VIH qui agissent bénévolement dans une structure de soins à domicile, dirigée par une église. L'article tente d'évaluer l'impact de l'insécurité alimentaire chronique sur l'observance des traitements antirétroviraux et examine comment les personnes concernées gèrent les pénuries alimentaires quotidiennes. Les résultats mettent l'accent sur les capacités limitées des organisations confessionnelles dans des environnements à forte vulnérabilité et sur l'urgente nécessité de la mise en place d'une coordination internationale et gouvernementale.

Desde hace mucho tiempo, las organizaciones basadas en la fe (obf) han dedicado sus esfuerzos a mitigar los efectos provocados por el vih/sida y a prestar ayuda humanitaria. Sin embargo, en su mayoría las mismas no están preparadas para actuar sobre los factores estructurales de la inseguridad alimentaria ni sobre las desigualdades de salud asociadas a estos. En términos de la eficacia de dichas organizaciones, el reconocimiento de ese tipo de limitaciones constituye una tarea tan importante como la de potenciar sus fortalezas. El presente artículo da cuenta de los resultados surgidos de un estudio sobre una organización de fe que, a través del trabajo voluntario de acompañantes seropositivos, presta cuidados de salud en distintos hogares de Suazilandia. En este sentido, el artículo se propuso valorar el impacto que la inseguridad alimentaria crónica tiene en el acatamiento del régimen de tratamientos antirretrovirales por parte de personas seropositivas, así como evaluar la forma en que estas personas resuelven diariamente la escasez de alimentos. Los hallazgos al respecto subrayan la escasa capacidad que asiste a las obf en situaciones de alta vulnerabilidad, además de la imperiosa necesidad de que exista coordinación a nivel internacional y gubernamental.

KEYWORDS:

• Social sector – HIV/AIDS and sexual health
• Environment (built and natural) – Food security
• Civil society – Partnership
• Aid – Development policies
• Sub-Saharan Africa

Acknowledgements

The authors are grateful to the women and men of Shiselweni Home-Based Care for their participation in the study.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes on contributors

Arnau van Wyngaard has been a pastor of the Swaziland Reformed Church (Shiselweni congregation) since 1985 and CEO of Shiselweni Home-Based Care since 2006. He holds a PhD from the University of South Africa in the Science of Mission, as well as a certificate in the Advanced Health Management Programme from the Yale University School of Public Health. He is a research associate at the Department of Science of Religion and Missiology, University of Pretoria in South Africa. and has published extensively on the theology of HIV and AIDS, with specific reference to the AIDS epidemic in Swaziland.

Robin Root is Professor of Anthropology, Department of Sociology & Anthropology, Baruch College, City University of New York, and a medical anthropologist who has explored social aspects of HIV and AIDS in Swaziland since 2005. She holds an MPH in Population and International Health from Harvard University and a PhD in Anthropology from the University of California, Los Angeles.

Alan Whiteside was brought up in Swaziland and has been engaged in economic analysis and HIV research for over 30 years. He holds a D Econ from the University of Natal, Durban. He is the founder and former director of Health Economics and HIV/AIDS Research, University of KwaZulu-Natal, and CIGI Chair in Global Health Policy, Balsillie School of International Affairs, Canada. He was appointed Officer of the Order of the British Empire (OBE) in 2015 for services to science and strategic interventions to curb HIV/AIDS.

Notes

1. Caregivers are not required to disclose their HIV status, but where they had voluntarily disclosed this, they were invited to participate in the study.

2. From time-to-time, the entire group of caregivers is issued with food parcels. However, during the four-month period of the research, SHBC did not issue food parcels to the caregiver group as a whole.

3. These were the four core questions, while further questions (5 and 6) were asked to obtain related information on food sourcing.

4. Question 5 and Question 6 specifically used the term “church” as one of the options from where food is sourced and might have been interpreted as an entity apart from other FBOs, thus resulting in some respondents acknowledging that they had received food from SHBC while simultaneously indicating that they had not received food from “church”.