Once HIV and AIDS enter a home, a family already struggling to meet basic needs can be pulled into a downward spiral of poverty and illness. When a breadwinner falls ill, resources may begin to evaporate. While needs increase — for lifesaving medication or transport to health clinics —income often goes down. Money reserved for school fees goes toward health care. Healthy family members, usually women, may stop working or reduce their hours to care for sick relatives, further shrinking household income. Meals can become smaller and less nutritious. Over time, savings may be depleted and household assets sold. With little warning, HIV and AIDS can push economically secure households into poverty and poor households into destitution.

Since its launch in 2009, the Livelihoods and Food Security Technical Assistance (LIFT) project has been working to end this downward spiral. LIFT strengthens the capacity of United States Government agencies — and their public, private and civil society partners — to design and implement livelihood and food security interventions that improve the economic resiliency and health of vulnerable households. LIFT programs can ensure that individuals and families, particularly those affected by HIV and AIDS, are able to pursue healthier, more economically secure lives.

LIFT has provided technical support services to missions of the U.S. Agency for International Development (USAID) and their local partners in five countries: the Democratic Republic of the Congo, Ethiopia, Namibia, Nigeria and Swaziland. The project has developed and implemented customized guidelines, trainings and other tools to help vulnerable households — and those who serve them — in a number of key, interrelated areas:

Health and nutrition

For people living with HIV and AIDS, malnutrition can be both a cause and effect of poor health, so an adequate, well-balanced diet is an essential component of care. Proper nutrition strengthens the immune system, reduces vulnerability to opportunistic infections and can help delay progression from HIV to AIDS. It can also improve the effectiveness of antiretroviral therapy.

LIFT helps communities integrate activities that strengthen the economic and food security of HIV-affected households into existing HIV care and support programs. LIFT technical assistance includes support to establish or strengthen existing referrals between clinic and community services. By linking individuals in clinical care to viable economic growth opportunities, LIFT helps people living with HIV and AIDS overcome their vulnerability to food insecurity and improve their overall health.

Economic development

LIFT works with USAID missions and implementing partners to address the economic vulnerability caused by increased medical costs and reduced household earnings. Partners can choose from a wide range of strategies and interventions designed to meet each household's evolving needs. For example, the poorest households may receive cash transfers or participate in cash-for-work programs. Households struggling to make ends meet may join informal savings groups that help them protect their assets and maintain their access to adequate nutritious food. Households with a small, stable asset base may engage in activities that lead to additional income, such as vocational training or other livelihood opportunities. LIFT's targeted technical assistance ensures that governments and partners are equipped to deliver appropriate, high-quality interventions that foster economic security and produce lasting results.

Special considerations for women

When a husband dies, widows, especially those living with HIV, often lose their homes, inheritance, possessions and livelihoods. These women may adopt survival strategies that put them at increased risk for HIV. LIFT helps local partners develop economic opportunities for women, address gender-related barriers to accessing services and ensure that programs are sensitive to local gender norms. LIFT also assists in the protection and promotion of women's inheritance rights and supports expanded efforts to keep girls in school.

Youth

Children who are forced to leave school to care for a sick relative or contribute to household income can face a lifelong cycle of poverty and lost opportunities. LIFT's technical assistance enables local partners who work with orphans and other vulnerable children to strengthen the economic capacity of households, helping families meet their nutritional needs and keep their children in school. LIFT also works with local partners to expand economic opportunities for older youth. Initiatives include market-relevant vocational training and business education, as well as private-sector partnerships that develop and expand young people's skills.

Research

To date, there is limited research that examines the integration of sustainable economic strengthening interventions into HIV/AIDS care programs. In addition, the impact of economic strengthening, livelihood and food security programs on patient health and nutrition is not well understood. LIFT is dedicated to building an evidence base for the effect of economic strengthening interventions on health and nutrition. LIFT will pilot models that link clinical nutrition assessment, counseling and support programs with economic strengthening opportunities; test and document best practices; and disseminate findings. LIFT will continue to contribute to the global body of evidence on best practices for developing, implementing and measuring the impact of economic strengthening, livelihoods and food security interventions.

Funding for LIFT is provided by USAID's Global Health Bureau, Office of HIV/AIDS. FHI 360 manages the LIFT project, with technical support from its core partners, Save the Children and CARE International.

LIFT programs can ensure that individuals and families, particularly those affected by HIV and AIDS, are able to pursue healthier, more economically secure lives.

 

PHOTO: (Top, by Jim Daniels) An Ethiopian woman shows a large pan of flat bread to the camera. (Bottom, by Jessica Scranton) For people living with HIV and AIDS, malnutrition can be both a cause and effect of poor health, so an adequate, well-balanced diet is an essential component of care.

LIFT: Promoting healthier, more economically secure lives (downloadable PDF)