Food insecurity is rampant in sub-Saharan Africa. In 2020, more than 65% of people experienced moderate to severe food insecurity. Rates were even higher among people living with HIV. Despite progress in reducing world hunger, the COVID-19 pandemic has worsened food insecurity. It’s expected to rise in the coming decades due to supply disruptions, climate change, and environmental degradation. 

HIV/AIDS and food insecurity are intertwined—for people living with HIV, food insecurity is linked with declines in physical health, decreased viral suppression, and increased rate of serious disease and death. These relationships are often amplified by weak health care systems, unsustainable agricultural practices, and entrenched poverty. 

Global health agencies have recommended integrating sustainable food production strategies into HIV programming to ensure that food insecurity doesn’t compromise universal access to effective HIV care. Researchers in the Shamba Maisha study performed a cluster randomized control trial in 3 counties in Kenya, with the aim of addressing roots causes of food insecurity and poor health in the region. 

The components of the program were a market interest loan of approximately $175 to purchase agricultural implements; implements purchased with the loan, including a human-powered water pump, seeds, fertilizers and pesticides; and education in financial management and sustainable farming.  

Results published in JAMA Network Open showed that the Shamba Maisha program led to improvements in food security, mental health, self-confidence and social support. These findings support the potential for agricultural and livelihood interventions to address important underlying causes of poor physical and mental health outcomes among people living with HIV.  

Change in viral suppression didn’t differ between the study groups, approaching the UNAIDS 2030 goal for viral suppression of at least 95%. There were major changes to HIV treatment programs in Kenya during the time of the study, including implementation of wide-reaching test and treatment programs and a switch in antiretroviral therapy medications. Although those changes may have made it more difficult to detect impacts of the study, those programs weren’t in place during the Shamba Maisha pilot in 2012 and 2013, which showed strong and significant differences in viral load suppression for people who participated in the program. Agricultural livelihood programs may be more effective in improving HIV outcomes among people living with HIV in regions with less effective HIV treatment programs and within groups in sub-Saharan Africa who have lower rates of viral suppression, such as pregnant and postpartum people, adolescents, and young adults. 

The Shamba Maisha study is among the first to demonstrate that a livelihood intervention can reduce depression. Livelihood interventions that address food insecurity have the potential to improve mental health in multiple ways, including improved food security and income, increased physical activity and productive labor, an improvement sense of self, and contribution to one’s community.