A Holistic Approach to the Overlapping Epidemics of HIV, Hunger, Gender Inequity and Poverty

The growing crisis of malnutrition, directly linked to HIV, will increase as people live longer on antiretroviral therapy (ART) and require a sustained source of food to take with daily HIV medicine. Malnourished individuals starting ART have a sixfold risk of mortality, compared to those who are not malnourished. People lacking food risk developing ART resistance if they stop therapy due to lack of food. The AIDS epidemic in Rwanda has unique features related to the 1994 genocide, when nearly a million people were killed, and 250,000 women were raped and many exposed to HIV. Since 2004, WE-ACTx has worked in partnership with the government and many NGOs to develop a comprehensive approach to HIV care, integrating critical non-medical services, including access to trauma counseling and support groups, patient transport support, and a focus on nutrition, nutrition education, and income-generation activities. Provision of ART is critical to save lives of individuals with HIV/AIDS in Rwanda. But food is also a critical part of the menu. Delivery of a holistic range of services to clients coping with overlapping problems of disease, hunger and poverty can be achieved via a partnership grassroots model that leverages the resources and expertise of different stakeholders and is aimed at educating and empowering individuals and households to take charge of their lives and health. This requires a focus on the urgent problems of hunger, poverty and gender inequity that underlie the HIV epidemic. Our grassroots partnership model represents a creative, cost-effective approach to delivering these programs.