Coffee, Popcorn, Soup and HIV: Reducing vulnerability to malnutrition and food insecurity among households affected by HIV in Ethiopia

This blog was submitted by Marcy Levy and is based on an original case study written by Kara Greenblott of Nzinga International. The full case study can be found online at the AIDSTAR-One website.

It is 11:00 a.m. at the antiretroviral therapy (ART) unit of Gandhi Hospital in Addis Ababa, Ethiopia. Women have been arriving slowly over the last two hours for their monthly coffee ceremony discussion. The reception area is transformed—condoms and pamphlets swept off the table to make way for a colorful tablecloth and a bowl of flowers. Popcorn is popping, coffee brewing, and the aromas of coffee, popcorn, and incense mingle in the air. Smiles appear on the women’s faces as they enter the room and rekindle their monthly friendships.

The coffee ceremony, part of everyday life in Ethiopia, is a key component of the Food Secure and HIV-Positive in Ethiopia project managed by Project Concern International (PCI), a San Diego-based nongovernmental organization. The project began in 2006 as a supplementary feeding intervention supported by a small grant to PCI from theU.S. Agency for International Development’s (USAID) International Food Relief Partnership (IFRP) and is a promising example of an integrated HIV and food and nutrition security (FNS) program that intentionally links food assistance with activities to address participants’ long-term FNS needs. It combines distribution of highly nutritious soups, promotion of urban agriculture, and delivery of educational messages (via coffee ceremonies) on issues related to HIV and FNS. The project’s overall aim is to reduce vulnerability to malnutrition and food insecurity among households affected by HIV.

Ethiopia has an HIV prevalence rate of 2.4 percent, with an estimated 1.2 million people currently living with HIV[J1] . Chronic food insecurity compounds the problems posed by HIV, and the country has one of the world’s highest child malnutrition rates[J2] .

All of the women participating in this morning’s coffee ceremony are either living with HIV and pregnant or lactating; or, they are caring for children living with HIV who receive life-saving antiretroviral (ARV) drugs at the hospital. As the coffee ceremony participants begin to seat themselves in a large circle, laughter erupts on the far side of the room. Two women share their story with the others.

The coffee ceremony is a central part of Ethiopian life and a sign, to those invited, of friendship and respect. In traditional village life, the coffee ceremony is the main social event in the village, a time to discuss current events, politics, and gossip about who did what with whom. It is impolite to retire until you have consumed at least three cups, as the third round is said to bestow a blessing.

The project’s coffee ceremonies build on this tradition of friendship and information-sharing to deliver and reassert a variety of messages related to HIV and FNS. The ceremony provides a place for women to discuss their HIV status and the status of their children; session topics are planned in advance.  Facilitators keep the messages clear and succinct, and deliver them slowly and repeatedly, giving women of different education levels time to absorb the concepts. Sometimes, the ceremony will include a guest speaker; alternatively, the facilitator will invite some of the women from within the group to speak about their own experiences.

The familiar setting and ritual of coffee-drinking encourages participants to relax and talk openly about HIV, sex, illness, domestic abuse, rape, birth control, and other taboo topics that are normally difficult to discuss in this extremely traditional society. Given the traditional three-cup minimum, the ceremony provides enough time to delve into a wide array of issues; some ceremonies last up to two or three hours.

Working closely with hospital staff, PCI designed the project to complement the PMTCT, ART, nutrition assessment, education, and counseling services that women and children living with HIV receive during hospital and health facility visits. As the project gathered momentum, PCI deliberately linked the soup distributions to its coffee ceremony and agriculture activities to ensure that nutrition supplementation does not stand alone. Read more here about how these coffee ceremonies, Breedlove’s soup distribution and urban gardening and poultry production combine to offer participants not only an improved quality of life today, but better opportunities for tomorrow.

[J1](Addis Ababa HIV/AIDS Prevention & Control Office 2010).

[J2](Ethiopian Health and Nutrition Research Institute 2010).

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