Samuels Fiona A, Rutenberg Naomi
Overseas Development Institute, ODI, London, UK.
AIDS Care. 2011 Jun;23(6):748-54. doi: 10.1080/09540121.2010.532535.
Although ART is increasingly accessible and eases some stresses, it creates other challenges including the importance of food security to enhance ART-effectiveness. This paper explores the role livelihood strategies play in achieving food security and maintaining nutritional status among ART patients in Kenya and Zambia. Ongoing quantitative studies exploring adherence to ART in Mombasa, Kenya (n=118) and in Lusaka, Zambia (n=375) were used to identify the relationship between BMI and adherence; an additional set of in-depth interviews with people on ART (n=32) and members of their livelihood networks (n=64) were undertaken. Existing frameworks and scales for measuring food security and a positive deviance approach was used to analyse data. Findings show the majority of people on ART in Zambia are food insecure; similarly most respondents in both countries report missing meals. Snacking is important for dietary intake, especially in Kenya. Most food is purchased in both countries. Having assets is key for achieving livelihood security in both Kenya and Zambia. Food supplementation is critical to survival and for developing social capital since most is shared amongst family members and others. Whilst family and friends are key to an individual's livelihood network, often more significant for daily survival is proximity to people and the ability to act immediately, characteristics most often found amongst neighbours and tenants. In both countries findings show that with ART health has rebounded but livelihoods lag. Similarly, in both countries respondents with high adherence and high BMI are more self-reliant, have multiple income sources and assets; those with low adherence and low BMI have more tenuous livelihoods and were less likely to have farms/gardens. Food supplementation is, therefore, not a long-term solution. Building on existing livelihood strategies represents an alternative for programme managers and policy-makers as do other strategies including supporting skills and asset accumulation.
尽管抗逆转录病毒疗法（ART）越来越容易获得，减轻了一些压力，但它也带来了其他挑战，包括粮食安全对提高抗逆转录病毒疗法效果的重要性。本文探讨了生计策略在肯尼亚和赞比亚的抗逆转录病毒疗法患者实现粮食安全和维持营养状况方面所起的作用。正在进行的关于肯尼亚蒙巴萨（n = 118）和赞比亚卢萨卡（n = 375）抗逆转录病毒疗法依从性的定量研究被用于确定体重指数（BMI）与依从性之间的关系；另外还对接受抗逆转录病毒疗法的人群（n = 32）及其生计网络成员（n = 64）进行了深入访谈。使用现有的衡量粮食安全的框架和量表以及积极偏差方法来分析数据。研究结果表明，赞比亚大多数接受抗逆转录病毒疗法的人粮食无保障；同样，这两个国家的大多数受访者都报告有过不吃饭的情况。吃零食对饮食摄入很重要，尤其是在肯尼亚。在这两个国家，大多数食物都是购买的。拥有资产是肯尼亚和赞比亚实现生计安全的关键。食物补充对于生存和发展社会资本至关重要，因为大多数食物是在家庭成员和其他人之间共享的。虽然家人和朋友是个人生计网络的关键，但对于日常生存而言，与他人的亲近程度以及立即行动的能力通常更为重要，这些特征在邻居和租户中最为常见。在这两个国家，研究结果都表明，随着抗逆转录病毒疗法的应用，健康状况有所恢复，但生计却滞后了。同样，在这两个国家，依从性高且体重指数高的受访者更自给自足，有多种收入来源和资产；而依从性低且体重指数低的受访者生计更为脆弱，拥有农场/菜园的可能性较小。因此，食物补充不是一个长期解决方案。在现有生计策略的基础上进行拓展，对项目管理人员和政策制定者来说是一种选择，其他策略包括支持技能培养和资产积累也是如此。
