This dissertation provides evidence that food assistance, livelihood interventions, and antiretroviral therapy (ART) all have a role to play in improving the economic and nutritional well-being of people living with HIV in developing countries, but that they are likely to work best when well-targeted (to those who need them most, at the point in time they need them most), and integrated with both comprehensive care (including mental health support) and social safety nets. In particular, the results indicate that integrating ART, food assistance, nutritional support, and livelihoods programs in an efficient, sustainable manner could effectively create a positive feedback loop between food security and ART. Policy makers could leverage this "upward spiral" in well-being to counteract the "vicious cycle" of HIV and food insecurity that has taken such a toll in resource-limited settings. This can not only improve the lives of people living with HIV around the world, but help realize the gains of donor and recipient countries who invested billions of dollars and significant human capital in fulfilling the promise of ART to save and transform lives.
This document was submitted as a dissertation in May 2012 in partial fulfillment of the requirements of the doctoral degree in public policy analysis at the Pardee RAND Graduate School. The faculty committee that supervised and approved the dissertation consisted of Kathryn Pitkin Derose (Chair), Homero Martinez, and Krishna Kumar. Sheri Weiser was the outside reader for the dissertation.
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