National Emergency Response Council on HIV/AIDS

CLIMATE CHANGE: LESS FOOD AND MORE DISEASE

19 July 2021

Surprizing torrential rain in winter got most EmaSwati talking

This week has been characterized by cold weather patterns, which is to be expected because we are deep into the winter season in Eswatini. A burning conversation though is the unusual rain which is continuously pouring and ‘adding salt to injury’ as temperatures keep dropping.

For many of us EmaSwati, it is very unusual to have torrential rain in winter and this can easily be attributed to the change in weather patterns, the world over, known as climate change. This has intrigued my mind along the subject of how climate change has actually altered our daily lifestyles which we ordinarily plan according to the four seasons of the year. Consequently, this has adverse effects on the HIV Response, in that it changes the way people receive HIV services and their adherance to treatment.

So, what is climate change. Climate change is a long-term change in the average weather patterns that have come to define local, regional and global climates. These changes have a broad range of observed effects that are synonymous with the term. Changes observed in earth’s climate since the early 20th century are primarily driven by human activities, particularly fossil fuel burning, which increases heat-trapping greenhouse gas levels in the atmosphere, raising the average surface temperature. These human-produced temperature increases are commonly referred to as global warming.

Two of the greatest threats to human health in the 21st century are climate change and HIV/AIDS, which are both linked through a number of social, economic, and biological factors. These include food insecurity, the spread of certain infectious diseases, human migration and destruction of transportation and healthcare infrastructure.

Of these, food insecurity appears to be a particularly important mechanism that feeds into some of the other pathways such as increased migration and prevalence of other infections. Food insecurity is known to increase HIV transmission by fuelling substance use and decrease health outcomes among those already infected with HIV due to weakened immune system. However,  the relationship between food insecurity and HIV is also complex.

Effects of Climate change on HIV transmission

Food insecurity drives transactional sex for money or food and heightens the risk of condom-less sex and gender-based violence by aggravating women’s disempowerment, thereby increasing HIV transmission. Food insecurity also creates conditions conducive to substance use and poor mental health by driving rural-to-urban migration and disrupting social networks. Starvation and risky infant-feeding practices among struggling mothers also elevates the risk of mother-to-child transmission.  Simultaneously, food insecurity worsens health outcomes among people living with HIV (PLHIV) by degrading immune function and compromising adherence to, and effectiveness of Antiretroviral Treatment (ART). Food insecurity is an especially important mechanism as it feeds into some of the other ways such as increased migration and prevalence of other infections.

Effects of climate change on HIV Treatment

Among PLHIV, food insecurity negatively impacts individuals along the entire cascade of care. Specifically, food insecurity has consistently been shown to compromise ART adherence and also prompts PLHIV to miss scheduled clinic visits. A number of mechanisms underlie these associations, including resource trade-offs between money to buy food, medicines, and transport to clinics; worsened side effects when taking ART without food; and poor mental health driven by food insecurity. As a result of these associations, food insecurity has been consistently associated with incomplete viral suppression and increased HIV-related illness and death.

Furthermore, consequences of food insecurity such as weight loss, low Body Mass Index (BMI) have all been shown to predict opportunistic infections. Finally, lack of food may hinder optimal absorption of certain antiretroviral medications, which may, in turn, contribute to treatment failure. Despite these concerns, climate change policies do not often include any measures to intensify HIV treatment and prevention programmes.

In times of drought, families will adopt extraordinary measures to ensure they can secure food. Women are most vulnerable during these time periods. Girls, particularly in rural locations, will be married off earlier than usual, which is consistent with earlier sexual debut and higher school drop-outs. Increases in transactional and commercial sex behaviours are a norm, and both are independently associated with HIV.

Destruction of health and transportation infrastructure due to floods and extreme weather events affects access to HIV prevention and treatment services. This increases transmission of HIV due to decreased access to condoms and other prevention services and worsens health outcomes among those already infected through interruptions in ART access and treatment.

Strategies for dealing with Climate Change for PLHIV

There are several strategies Eswatini can learn and put to good use in order to weaken the effects of climate change on HIV health outcomes.

  • First, mitigation strategies that reduce greenhouse gas emissions are key to slowing the acceleration of climate change, in particular by investing in clean energy sources such as wind, solar, and hydroelectric power.
  • In the developing world, incentivizing collaborations between the public and private sectors to help cut carbon emissions should also be a core component of future mitigation efforts. Such technological advancement has already been proposed to reduce greenhouse gas emissions and promote economic development.
  • Adaptation strategies that aim to the reduce the negative health impacts of climate change on vulnerable communities is also of paramount importance. Adaptation strategies should include education and investment in sustainable technologies such as solar water pumps for year-round irrigation and agroforestry techniques for increased biodiversity and reduced erosion.
  • There should also be focus on addressing climate-related HIV coinfections such as malaria, by educating communities about the interaction with HIV and by distributing bed nets and draining sources of stagnant water.
  •  At national level, improving communication and collaboration between government ministries responsible for agriculture, health, and transportation should also be central to adaptation efforts to maximize resource utilization and increase overall program effectiveness.
  • Policies that protect communities against food insecurity through long-term crop rotations and improved water conservation and storage measures, particularly in regions heavily impacted by HIV/AIDS, should therefore be prioritized in global policy agendas in the years ahead.