Case Study: PEPFAR’s El Nino Response: Lessons Learned from Food Security and HIV/AIDS Crisis Funding

Strong El Niño events can exacerbate vulnerabilities across the globe. In 2015-2016, El Niño had a devastating impact on Southern Africa’s environment and human health. This case study describes the experience of the United States President's Emergency Plan For AIDS Relief (PEPFAR) and its El Niño response beginning in 2016. This response included a significant increase in funding to improve food security in HIV/AIDS programs and a one-time release of earmarked El Niño funding. It also fostered a groundbreaking collaboration with the World Food Programme (WFP). This case examines the relative benefit of the response as well as the potential for similar work to inform future programming.

El Niño is a climatic phenomenon characterized by increased sea surface temperatures in the Pacific Ocean and associated with significant changes in extreme weather and climate patterns globally. The 2015-16 El Niño led to the worst drought in 35 years in Southern Africa, with particularly severe consequences for lives and livelihoods. This resulted in high food insecurity across the region and posed significant challenges for vulnerable populations, including those living with HIV/AIDS. Food insecurity, which contributes to malnutrition, can reduce the effectiveness of antiretroviral therapy – and this was especially the case for treatments available at the time of the 2015-16 El Niño, which were more dependent on nutritional intake than today’s treatment options.

Food insecurity is also associated with higher HIV transmission rates, as individuals may engage in riskier sexual behaviors - including transactional sex- to secure essential food resources.2 Addressing food insecurity was therefore a critical component of managing HIV transmission and symptoms during and following the 2015-16 El Niño. It was also important to prevent malnutrition to ensure good immune function, limit higher infection risk for other diseases, and enhance the overall effectiveness of HIV/AIDS programming.

In response to the severe El Niño-induced drought in 2015-16, PEPFAR provided more than $20 million to WFP to address the impacts of El Niño-related food insecurity for HIV-affected populations in five prioritized countries: Lesotho, Malawi, Mozambique, Eswatini (formerly Swaziland), and Zimbabwe. The grant enabled WFP to treat cases of severe acute malnutrition (SAM) and moderate acute malnutrition (MAM) in people living with HIV. In total, the assistance reached about 349,099 people, including vulnerable children. The support also targeted entire households that had members with HIV/AIDS, so that individuals with the disease did not have to share their food. Funding and additional resources also led to the formation of the Southern African Development Community (SADC) El Niño Response Team and fostered improved collaboration through a dedicated Inter-Agency Task Team (IATT) for HIV in Emergencies (HIV-E). These groups did not leverage forecasted information systematically at the time of the onset of El Niño but emerged with the capacity to better manage the impacts and risks, raise awareness, improve support to vulnerable individuals in emergencies (including individuals with HIV/AIDS), and better prepare for future El Niño events.

The 2015-2016 El Niño and associated food security crisis in Southern Africa highlights several critical lessons on how to leverage climate information services to strengthen health systems and improve health outcomes. For instance, effective inter-agency collaboration was key to this intervention, allowing a multi-sectoral and unique response. This case further exemplifies how climate events can lead to complex humanitarian emergencies, intertwining issues of health, food security, nutrition and pre-existing health conditions like HIV/AIDS. In this context, understanding interconnected complexities and vulnerabilities is crucial to planning and executing effective support programs in the context of climate variability and change.