Drying Climates and Gendered Suffering: Links Between Drought, Food Insecurity, and Women’s HIV in Less-Developed Countries

Abstract

HIV/AIDS represents the leading cause of death among women of reproductive age globally, and gender inequalities in the burden of HIV/AIDS are most pronounced in poorer countries. Drawing on ideas from feminist political ecology, we explore linkages between suffering from drought, food insecurity, and women's vulnerability to HIV. Using data from 91 less-developed countries, we construct a structural equation model to analyze the direct and indirect influence of these factors, alongside other socioeconomic indicators, on the percentage of the adult population living with HIV that are women. We find that droughts are significant in shaping gender inequalities in the HIV burden indirectly through increased food insecurity. We draw on prior research to argue that due to gendered inequalities, food insecurity increases women's vulnerability to HIV by intensifying biological susceptibilities to the disease, reducing access to social and health resources, and motivating women to engage in risky sexual behaviors, such as transactional sex. Overall, our findings demonstrate that droughts serve as an important underlying factor in promoting HIV transmission among vulnerable women in poor countries, and that food insecurity is a key mechanism in driving this relationship.

Food insecurity and the risk of HIV acquisition: Findings from population-based surveys in six sub-Saharan African countries (2016-2017)

“…These findings also support that food security has a significant gender dimension, where women are both more at risk of severe hunger, and suffer more consequences due to limited coping strategies, which includes different forms of sexual activity in exchange for material support. 14 Finally, the inter-country heterogeneity of certain risk behaviors suggests that there might be multiple different pathways between food insecurity and HIV acquisition, and these are likely to be highly contextual.…”

“…[11][12][13] The impact has been assumed to be gendered in that women are particularly vulnerable to income shocks and to disruption to access to health resources. 14 Food insecurity has also been associated with lower efficacy of antiretroviral treatment (ART) due to drug malabsorption or decreased adherence, with virologic failure. 15 As countries pursue the new UNAIDS 95-95-95 goals, weather extremes disrupting food production and supplies could jeopardize epidemic control, both in terms of increased risk behaviors, as well as disruption of treatment due to displacement or poverty, impacting access to testing and ART services.…”

“Burnt by the scorching sun”: climate-induced livelihood transformations, reproductive health, and fertility trajectories in drought-affected communities of Zambia

“…Another pooled analysis of 19 population-based surveys in sub-Saharan Africa similarly showed that adolescent girls and unemployed women experienced higher rates of intimate partner sexual and physical violence in drought-affected communities [ 43 ]. A recent analysis of national vital statistics from 91 LMICs found that food insecurity mediated the association between drought and women’s HIV prevalence [ 44 ]. An advantage of the qualitative approach used in the current study is its capacity to situate intermediary variables, like early marriage or transactional sex, on the mechanistic pathway from food insecurity to sexual health outcomes in drought-affected areas.…”

Exploring linkages between climate change and sexual health: a scoping review protocol

“…Climate change impacts broader environmental systems to increase strain on global food and water supplies. 2 13 14 Drought can increase food insecurity [15][16][17] and migration, [18][19][20] and disrupt both provision of-and access to-health services. 13 Food insecurity is associated with HIV acquisition risks through behavioural (eg, transactional sex) and mental health (eg, alcohol use, depression) pathways.…”