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Context
In 2024/2025, Southern Africa experienced a severe food security crisis due to the El Niño induced drought, which caused crop failures, livestock deaths, and poor water, sanitation, and hygiene (WASH) conditions. Malawi, Mozambique, Zambia, and Zimbabwe were most affected, with temperatures 5 degrees above average leading to anticipated below average cereal harvests and widespread crop failures. In Mozambique, the severe drought affected an estimated 1.8 million people, mostly in the central and southern regions of the country. In drought-affected areas, where crops failed, one in every three people was classified as vulnerable1 . As of 2024, 4.9 million people face Crisis-level food insecurity (IPC Phase 3+), including 912,000 in Emergency (IPC4)—the highest IPC figures recorded in the country. Rising child wasting (up to 12 per cent in some districts) combined with stunting rates over 37 per cent signals severe nutritional stress. Most households cannot afford a nutritious diet, and malnutrition remains a leading cause of child mortality.
UNAIDS estimates that in 2023, 1 in 9 Mozambican adults were HIV positive, placing Mozambique with the eighth highest HIV prevalence in the world. Amongst adults living with HIV (PLHIV), 89% were aware of their HIVpositive status and 86% were on antiretroviral treatment (ART). It is increasingly recognized that HIV and malnutrition are closely interlinked, forming a vicious cycle. Energy and nutrition requirements are high for people living with HIV who are not on ART and virally suppressed. Opportunistic illnesses frequently faced by PLHIV can reduce appetite and food intake or decrease nutrient absorption, increasing the risk of becoming malnourished. Malnutrition among PLHIV who have special dietary and nutritional needs can weaken the immune system even further, increasing susceptibility to infections and the progression of HIV to AIDS and mortality risk, particularly if viral suppression is not achieved and maintained. Adherence to HIV treatment can also be severely affected by food insecurity: ART patients are often unable to continue their treatment because certain side effects are more likely when they don’t have access to adequate food. A person who does not take their medication consistently will not achieve satisfactory viral suppression, therefore increasing the likelihood of both disease progression and transmission. The conditions brought by an emergency heighten HIV vulnerabilities by reducing access to food, shelter, health services, WASH, and schooling, which can enable the spread of HIV/AIDS as well. People living with HIV and other key populations at higher risk of exposure to HIV may require specific measures to protect themselves against neglect, discrimination and violence. They also need support to prevent them from using negative coping strategies (such as commercial sex or sex for food) that contribute to an increased rate of HIV transmissions.
The government of Mozambique is currently implementing the new National Strategic Plan for the Response to HIV and AIDS (PEN V) 2021- 2025 and has defined “responding to HIV and AIDS in emergency situations” among its seven key priorities. The absence of data on the specific needs of PLHIV remains an ongoing challenge and prevents from properly addressing HIV in a humanitarian context.
As set out in the Global UNAIDS Division of Labour, WFP will seek opportunities to integrate PLHIV/TB into social protection and resilience programmes, and support PLHIV/TB in humanitarian contexts. Supporting food insecure and malnourished PLHIV in emergency settings is key in delivering on WFP’s humanitarian imperative. In its HIV/TB response, WFP should implement interventions to prevent HIV/TB infection, as well as to reach PLHIV/TB with treatment and other support. This involves implementing programming to improve the food security and nutrition of PLHIV/TB and their households; strengthen access to health services; reduce stigma; and increase knowledge and health-seeking behaviour.