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HIV Management Within Changing Social-Ecological Systems

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Abstract

After decades of research on the HIV/AIDS epidemic, there remain critical gaps in understanding how HIV-positive people manage their health through their interactions with dynamic and coupled social-ecological systems. During the course of the 2014–2016 El Niño, multiple climate shocks occurred in Southern Africa, which is home to the largest HIV-positive population in the world. Using mixed method longitudinal techniques, we find statistically significant relationships between HIV-positive households and decreased dietary consumption due to a lack of food during and following climate shocks. During the El Niño years, HIV-positive households were more likely to draw on secondary plant collection to manage disease progression, underscoring an important and understudied ecological impact from the epidemic. This demonstrates clear evidence that climate shocks amplify food insecurity vulnerabilities during the El Niño years, likely mediated by changes within coupled social-ecological systems. Knowledge on the direct relationships between HIV management and climate shocks is needed to better inform global responses to the HIV/AIDS epidemic under regimes of increasing uncertainty.

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Acknowledgements

The household survey would not have been possible without the outstanding support from research assistants Ncobile Thumbathi, Sindisiwe Nhone, and Erens Ngubane. Evan Gover and Marina Burka were supported on National Science Foundation Research Experiences for Undergraduates (REU) awards to support the structured survey in summer 2013 and qualitative interviewing in 2014, respectively. Everleigh Stokes conducted the initial statistical analyses of the survey data, and Don Miller completed all additional analyses. The research presented in this article was supported by a National Science Foundation CAREER grant (GSS#1056683). Finally, we would like to thank our study participants who made this work possible.

Funding

The research presented in this article was supported by a National Science Foundation CAREER grant (GSS#1056683).

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Authors and Affiliations

  1. Department of Geography, The Pennsylvania State University, 302 Walker Building, State College, 16802, PA, United States

    Brian King

  2. University of Toronto, Toronto, Canada

    Andrea Rishworth

  3. Dickinson College, Carlisle, 17013, PA, United States

    Margaret S. Winchester

  4. Independent Scholar, Johannesburg, South Africa

    Wendy Ngubane, Golden Nobela & Tsakani Nsimbini

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Contributions

BK contributed to the study design, data collection, data analysis, and writing. AR contributed to data analysis and writing. MSW contributed to the study design, data collection, data analysis, and writing. WN, GN, and TN contributed to study design, data collection, and data analysis.

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Correspondence to Brian King.

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The research presented in this article was supported by a National Science Foundation CAREER grant (GSS#1056683). A team of highly skilled and trained interviewers in Mpumalanga Province, who completed certification on human subjects’ protection from Penn State University, were responsible for conducting the structured household survey and assisted as translators as needed during the qualitative components of the research. Most interviews were conducted in SiSwati, while others were conducted in English. Before all interviews, consent was verbally obtained. All information was securely stored without personal identifiers to protect the identity of the participants. Ethical approval was granted for the study through the Human Subjects office at the Pennsylvania State University.

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King, B., Rishworth, A., Winchester, M.S. et al. HIV Management Within Changing Social-Ecological Systems. Hum Ecol 51, 137–149 (2023). https://doi.org/10.1007/s10745-022-00379-5

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