Today, millions of people in Zambia face the threat of hunger, not because food isn’t available but because they are too poor to afford it. Perhaps, more troubling is how this inadequate access to nutrition is emerging as a widespread problem for people living with HIV or AIDS. After all, when residents cannot afford to keep food on their tables, they are less likely to take the required drugs they need to survive, even when those medications are free of cost.
But at UNC’s School of Social Work, researchers are leading a pilot exploratory study that could help Zambia’s poor increase their financial assets and improve their overall health, especially among food-insecure adults living with HIV. Researchers were awarded $40,000 in grants to pursue the study, including from the School’s Armfield-Reeves Innovation Fund and from the Center for AIDS Research at both UNC and the University of Alabama at Birmingham.
The project, in collaboration with Zambia’s Ministry of Community Development, Mother and Child Health, aims to address the various risk factors that hinder or prevent an individual from taking needed antiretroviral drugs—medications known to suppress the HIV virus and stop the progression of the disease. These risk factors are important to understand because too often, studies “target the biological and biomedical part of HIV, but it is also a social problem,” explained Assistant Professor and Principal Investigator Gina Chowa.
“So this study will increase the knowledge in terms of the social and economic structural barriers to preventing and managing HIV/AIDS,” she said.
Currently, 14 percent of Zambia’s 18- to 49-year-olds have been diagnosed with HIV. Yet, many of these individuals struggle to maintain their treatment because of the severe side effects that occur from taking powerful medication on an empty stomach, said Research Associate and study Co-Investigator Rain Masa.
“Obviously, these patients are trained about the importance of food and nutrition for maintaining their health status,” Masa said. “But if they don’t have the resources to buy the food they need, then that message becomes almost futile.”
Although residents living with HIV often receive some food assistance if needed, that support typically lasts six months to a year, Masa added. “And when you are required to take your medication for the rest of your lives, that (assistance) really is not enough,” he said.
Chowa and Masa hope to address this problem with the launch of the “Integrated HIV and Livelihood Program,” a year-long project that promotes social and economic well-being by employing participants with the tools they need to generate sustainable wealth and health. These tools include small business training and a grant (about $200 in U.S dollars) to help participants launch a retail startup.
Participants also receive training on how to better manage their money and are given the opportunity to open a savings account with a local bank.
“The idea of adding the savings component to the treatment is to address sustainability,” Chowa said. “You can’t just look at income generation because if they just increase their income, it’s about consumption… and then they’re not planning for the future, and they run the risk of falling back into the cycle of poverty and food insecurity. So we added the savings component so they can actually build assets and sustain their food security in the home so they are able to adhere to the drugs.”
The UNC researchers are partnering with two medical centers in Zambia and expect to enroll a total of 100 participants, ages 18 to 24, in the longitudinal study. Long-term, Chowa hopes the exploratory research will offer the results needed to conduct a larger study.