New York City’s FreshDirect Deal – Just Doesn’t Go Far Enough

A Bad Deal from the Start

On February 7^th, Mayor Bloomberg, Governor Cuomo, and Bronx Borough President Diaz announced a deal that provides FreshDirect with $127.8 million in taxpayer money to subsidize a relocation of FreshDirect’s headquarters from Long Island City to the Harlem Rail Yard on the South Bronx waterfront.  Two days later, the NYC Industrial Development Agency (IDA) held a hearing on the FreshDirect deal to give provide community members with an opportunity to voice their opinions before the deal was sealed.   South Bronx residents have real concerns about the impact of the FreshDirect deal on the environment, promised job creation, living wages, acceptance of EBT (food stamps), and the inaccessibility of FreshDirect services to South Bronx residents.  Residents came together under the title of “South Bronx Unite: Stop FreshDirect” to speak out against the deal.  South Bronx Unite members have created quite a buzz within the city, raising awareness about the city’s failure to provide community members with a real opportunity to voice their opinions before the deal was decided upon.  South Bronx Unite members have created social media outlets (blog, facebook and twitter) to get the word out about their disapproval of the FreshDirect deal.  There has even been a Change.org petition created to stop FreshDirect from building its new headquarters in the South Bronx. 

The opposition to the FreshDirect deal has been covered in media outlets all over the city, from El Diario to the New York Times.  New York City Council member Melissa Mark-Viverito and NYC Comptroller John Liu have both publicly expressed their disapproval of the FreshDirect.  Despite the opposition to the deal, the IDA held its board meeting on February 14^th – which was attended by members of South Bronx Unite – and the FreshDirect subsidy deal was voted on in the affirmative by all parties present except Comptroller Liu.  South Bronx Unite members are demanding to see the Environmental Impact Assessment conducted on the Harlem Rail Yards; for the City Council to demand oversight hearings of the NYC Economic Development Corporation; and for NYS Attorney General Eric Schneiderman to audit the Harlem River Rail Yards deal.  South Bronx Unite members would also like to see Bronx Borough President Ruben Diaz hold a public meeting where all South Bronx residents would be invited to express their concerns. 

These concerns are real ones, too. While the Bronx Borough President put together a Memorandum of Understanding to try and address the concerns of South Bronx residents, the MOU is non-binding and does not adequately address the concerns:

·    Lack of democracy: Since the very beginning, there was a lack of a true democratic process that would provide community members with enough time to express their opinions before the decision was made. 

·    Environmental Impact:  There has not been an adequate environmental impact assessment conducted on the site, nor has any environmental impact analysis been provided to members of South Bronx Unite.  The promise of using a small number of alternative fuel vehicles doesn’t adequately address the concerns of having an additional 130 trucks per day on the road in the South Bronx – already home to highest asthma rates in the country – nor the increased truck emissions that would come from the removal of more than 380 tons of solid waste per month.

·    Job creation:  FreshDirect is promising that almost 1000 jobs will be created over the next 10 years, which may sound like good news to Bronx county with some of the highest poverty rates in the nation.  But there are no written guarantees to ensure that a certain number of these jobs will be provided to South Bronx residents.  Further, past recipients of IDA subsidies have not have a good track record of holding true to promised job creation:  ALIGN – the Alliance for a Greater New York – has reviewed the State Comptroller’s data and found that for the NYC IDA: “Only eight of the 23 IDA subsidized projects that ended in 2009 met or exceeded their job creation promises.”  In addition, the amount of money being provided through the subsidy deal is out of proportion compared to the amount of money given for job creation in previous deals. According to Comptroller John C. Liu’s office, “A few months ago, the EDC attracted a world-class university by promising $100 million in capital for a project that by their own estimate will generate 30,000 jobs. Now the EDC is giving close to $100 million to create 962 jobs.  The cost to the City is $93,000 for each new job.” 

·    Living Wages: While nearly 40% of current FreshDirect employees make less than $25,000/year, FreshDirect would be exempted from any local living wage mandates adopted by the city.   According to the New York Times – City Room, “As it stands, the city will pour about $130 million into a modestly profitable company over a decade without requiring that it pay more than $9 an hour to workers who labor in frigid warehouses hauling 50-pound boxes. The workers get less than two weeks off a year, and that includes sick, personal and vacation days.”

·    Labor Practices:  As described in South Bronx Unite’s message to the NYS Attorney General, NYC Comptroller, Bronx Borough President, NYC Economic Development Corporation, Empire State Development, and NYS Energy Research and Development Authority: “Numerous complaints have been filed with city, state and federal agencies regarding FreshDirect’s labor practices, including 27 discrimination and nine unfair labor claims against FreshDirect in the last four years alone.  The description of wages and employment in FreshDirect’s NYCIDA application fails to provide taxpayers with enough information to gauge the quality of jobs, including with respect to salary or how many jobs are part-time or full-time.”  

·    Acceptance of EBT: As pointed out by Joel Berg of the NYC Coalition Against Hunger, the MOU does not identify FreshDirect as officially agreeing to accept food stamps: “Fresh Direct previously sought to accept food stamps, had been prevented by doing do by "the State", and that Fresh Direct and the Bronx BP would work together to ‘continue these efforts’ to try to get accept food stamps through EBT.  Unfortunately, Fresh Direct's story that they were prevented from accepting food stamps by "the State" is likely untrue. Under federal law, only USDA, not any state, has the power to decide which retailers can or cannot accept food stamps.”

·    Servicing the South Bronx:   FreshDirect has never and currently does not serve the South Bronx – only the wealthier areas of the Bronx such as Riverdale.  FreshDirect has only discussed expanding to “new Bronx neighborhoods.”  The Bronx Borough President’s office created a facebook page to “illustrate to the company just how many Bronx residents are willing to not only use their service, but have the technical capabilities to do so.” (FreshDirect is an entirely online grocery ordering and delivery system. As the Bronx includes one of the poorest Congressional districts in the nation, many residents do not have readily available Internet access.)  So far, the Borough President’s facebook page has accumulated more opposition than support for the FreshDirect deal.  So has a Crain’s poll.

·    Misuse of public land: As described by South Bronx Unite, “The proposed site at the Harlem River Yards in The Bronx is owned by New York State Department of Transportation and has been leased for 99 years to Harlem River Yard Ventures II (HRYV), which is 95% owned by the Galesi Group.  The purpose of the Harlem River Yards project (together with its partner project, the Oak Point Link) was to reduce air pollution by decreasing truck traffic and to help avoid $500 million in public road improvements through development of a Full Freight Access Program, which has not been developed in the more than 20 years that HRYV has held the lease.  Instead, the Bronx community has had 1.9 miles of waterfront made inaccessible to the public.”

·    Greenway and Waterfront Access:  As described in South Bronx Unite’s message to the Borough President, “Harlem River Yards is essential to a Harlem River Greenway as a necessary Bronx West - East connection from High Bridge and the Harlem River Greenway to the South Bronx Greenway and Randall’s Island.  The New York City Economic Development Corporation (EDC) has been negotiating for some time with HRYV to create access to a pedestrian bridge, currently under construction, that will link the South Bronx Greenway to Randall’s Island and then to Queens and Manhattan (the “Connector”).  The Connector will provide a safe and legal means to cross an important waterway that unites the Bronx with the open space and green playing fields of Randall’s Island.  EDC is now granting more than $100 million in public subsidies to FreshDirect, some of which will be allocated to Harlem River Yards, when HRVY has so far refused to grant an easement to complete the vital Connector project through the Harlem River Yards.  Equitable land use, in accordance with the public trust doctrine, includes meaningful waterfront access and recreational opportunities in addition to the swift completion of the Connector.” 

With all of these concerns, members of “South Bronx Unite” would prefer “a community-led development plan that makes efficient use of nearly 100 acres of public waterfront land and incorporates sustainable development, living wage jobs, clean air and waterfront access for South Bronx residents.”  

A Better Solution

As for improving access to healthy food, landlord and developer Steve Smith has crafted a vision for a regional food campus at Oak Point in the South Bronx, that would provide access to “locally grown, locally raised, locally made” food for South Bronx residents and the larger NYC area.  While the plans are still under development, Paul Lipson, consultant to the project, presented at Bronx Health REACH’s February 2012 Nutrition and Fitness Workgroup meeting. Here's the story: 
A 2003 study gauged the unmet demand for local and regional agricultural products at upwards of $1 billion in the New York metropolitan areas.  The proposed 130,000 sq ft regional food hub would house GrowNYC’s Wholesale Farmers Market and would serve as a non-profit aggregator of growers so upstate and regional growers can have a space to access markets.  There would be an opportunity for store owners and community members to access produce directly. Co-located next to the largest wholesale grocery and restaurant supplier in the New York metro area, it would be convenient for middlemen and store and restaurant owners to do all their shopping in one location. The operation could include a “market within a market” allowing products to be sold directly to Jetro and Restaurant Depo, as well as bodegas, small to medium-sized grocery stores, and small (10-20 table) restaurants.

Plans include a kitchen on the second floor, which would create many jobs for artisanal food manufacturing.  They would also like to create a wash and chop facility – something sorely needed in the city – which would allow everyone – from bodegas to institutions such as the NYC Department of Education Office of SchoolFood – to make more direct use of local produce.

Smith hopes to add a rooftop hydroponic greenhouse operation serving grocery and grocery delivery chains in the New York metro area; an agricultural cooperative aggregating over 60 regional growers and producers; a borough-based brewer of beers and ales (the Bronx Brewery currently brews in Connecticut); a Bronx-based caterer and institutional food service providing meals for charter schools and senior centers; and a produce distributor serving NY metro area.

Moreover, this project would save a lot on carbon emissions, fuel and transportation costs due to streamlining of operations and logistics. Individual farmers would not have to send their trucks to the city, but rather the Oak Point facility could send its trucks to them to pick up their produce and then deliver “tropicals” and other items available only in the city to them on the return trip. 

Located on 9.6 waterfront acres, a ½ mile east of the Triborough Bridge and ½ west of the Hunts Point Food Distribution Center, there would be rail and deep water access, thus creating a means for a true regional food hub. 

This whole project is dependent on subsidies – albeit, a tenth of the price of the subsidies the City is planning on giving to FreshDirect.  While it may not “promise” as many jobs as the FreshDirect deal, the jobs would provide workers with living wages, and the regional food campus would have many benefits and implication for public health, including air quality benefits, improvements to institutional food, etc.

Steve Smith and Paul Lipson are currently looking to connect with small food businesses and growers cooperatives that would like to share a food kitchen.  They are seeking support from the City Council and other elected officials to provide public subsidies for the project.  Paul can be reached at paul (at) barrettobay (dot) com

If only all bodegas looked like the one on the northwest corner of 96th & Lex...

Promoting healthy items in corner stores is one of those hot topics in public health right now.


(Market Makeovers video)

Yet, this fad is only beginning to take off in places like the Bronx. I've been working at Bronx Health REACH for the past year, where several years ago the staff were involved in a campaign to promote healthy snacks in bodegas. Well, now it's time to actually encourage community members to advocate for changes to the bodegas themselves, such as through the city Department of Health's Adopt a Bodega initiative.

If community members in schools and churches are educated about the importance of consuming healthy foods, provided some instruction as to how to prepare said healthy foods, and empowered to work towards changing the food environment, would this be enough to actually create lasting change?  I can't say for sure, but I'm excited to find out.

The city's Adopt a Bodega program encourages people to talk to their bodega owners about possible changes they could make to the bodega to promote consumption of healthier foods. They could work towards changing the store inventory, marketing / advertising practices, and/or do a store cleanup, improving the overall look and cleanliness of the store.  Partnerships may be with local schools, churches, or other community-based organizations such as community centers.  (More information available in the toolkit here.)
I think a particularly interesting Adopt a Bodega / community food assessment project could be worked through Citizen Schools, an expanded learning day program in some middle schools in low-income neighborhoods across the country.  The students would get to work on the project 90 minutes per week for 10 weeks, and then present their work to peers and parents. Who knows how many ripple effects this could have.

In my quest to figure out how to get fresh, local produce from the Wholesale Market at Hunt's Point (the largest food distribution center in the country, located in the Bronx) into Bronx bodegas, I found out about a bodega on the border of Harlem & the Upper East Side that judging by its inventory, seems more like a health food store you would find in Brooklyn than a bodega. But I think if folks from the Bronx were exposed to the items sold in this healthy bodega, mixed with some nutrition education information about the foods sold at that store, they would be more engaged in looking to make some of those healthy changes to the bodegas in their own neighborhoods than if they hadn't seen the healthier version.  First-hand experience in visually seeing / learning about alternatives to the status quo can speak volumes.

Here are some photos I snapped of the bodega at the northwest corner of 96th & Lexington:

Lots of produce

Unsalted, raw nuts that you package yourself!

Apples from New York State

Good, healthy staples available: almond milk, vegetable broth, organic tomato sauce...heck they even have the BPA-free Eden Foods canned beans

And some good, quality grains.

Aside from Bronx Health REACH, one of the NY Faith and Justice food justice working groups is also working on an outreach plan to encourage more churches to Adopt a Bodega. You can access the page here: http://nyc.changeby.us/project/451 or email the group at business.outreach@nyfaithjustice.org,

GROW!

You’ve seen the numbers: more than 925 million hungry. But hunger is not about too many people and too little food. Our rich and bountiful planet produces enough food to feed every woman, man, and child on earth. Hunger is about power. Its roots lie in inequalities in access to resources. The results are illiteracy, poverty, war, and the inability of families to grow or buy food.

Thus begins the October 2010 Oxfam Fact Sheet entitled Food for All, posted during Oxfam's Sow the Seed campaign.  

Today marks the official launch of Oxfam's new campaign on food justice, GROW, which reminds us that by 2050 there will be 9 billion of us on the planet, and so we must find a way to feed everyone.  The great international non-profit humanitarian organization Oxfam, 400+ scientists and researchers who contributed to the IAASTD report, and Frances Moore Lappe and Anna Lappe from the Small Planet Institute agree:  "more of the same" ways of growing food - vested interests, using up natural resources and increasing inequalities in access to healthy food - is not the answer. To meet the needs of a growing population, we must grow more fairly and sustainably.

But wait...there won't be enough food for all if we grow organically, you say. Industrial agriculture is more efficient than organic production.  Sustainably, organically grown produce is elitist and cannot feed the world. If you are only talking about developed countries such as the US, which grows chemical-laden produce at the expense of environmental sustainability and then wastes vast quantities of it - then yes, a switch from conventional to organic production may either not affect or slightly decrease yields (the average yield ratio ranged from 0.891 to 1.060), according to a research study cited by Anna Lappe (Badgley, 2007).  However, adopting sustainable farming practices in developed countries can increase ratios from 1.736 to 3.995 - nearly two to four times better than the farmers' previous practices. "Because most farming in these regions is currently low input and low yielding, shifting toward more climate-friendly organic agriculture with the help of capacity building and research would result in relatively higher yields and improve local food security," explains Anna. 

All this and more you can learn by reading Oxfam's "Growing a Better Future" report by visiting the WHY Hunger Food Security Learning Center, or yes, by reading Diet for a Hot Planet, where Anna Lappe gives a ton of resources with useful information such as Food Routes, the Eat Local Challenge, and lists of some books such as the recipe books Grub and Vegan Soul Kitchen.  I personally have been consuming less and less meat as my awareness and environmental consciousness raises, and vow to continue to learn more about vegetarian and vegan eating - especially after recently finishing Diet for a Hot Planet and watching the films Food Matters and PLANEAT. 

If you're in NYC tomorrow, please come visit the Oxfam Action Corps NYC table at the southeast corner of Union Square between 12-8pm.  If you're not, I hope you can tune in to the GROW launch where Frances Moore Lappe and some other panelists will speak about the campaign starting at 12:20pm. 

Reference:

Badgley, Catherine et al, "Organic Agriculture and the Global Food Supply," Renewable Agriculture and Food Systems 22 (2007):86-108.

Oxfam's Sow the Seed Campaign

Now more than ever is the time to get keyed in to the good work Oxfam is doing. For the past few years (up until Congress dropped climate change legislation from the radar), Oxfam America's main focus was getting Congress to finance international adaptation to climate change. The next mini-campaign, up until the UN Millennium Development Goals summit, was around calling on President Obama to develop a US Global Development Strategy (victory!). Now Oxfam is expanding the conversation to include food, and as far as I know will continue to do so up until the 2012 Farm Bill is voted on.

Oxfam's current campaign, "Sow the Seed," is asking world leaders to support the world’s poorest food producers as they fight climate change. This campaign officially begins on World Food Day, which leads up to the climate summit in Cancun November 29.

Our two "asks" in the US are for our members of Congress to:

1. Pass the Global Food Security Act. Strengthen it to support communities in their efforts to build resistance to climate change - and combat the adverse effects of climate change on their crops.

2. Urge President Barack Obama to establish a fair, accessible and accountable global climate fund at the climate summit in Cancun later this year that will sow the seed for a binding global climate agreement by 2012.

People can get involved in advocating for these causes with Oxfam by

a) joining an Oxfam Action Corps if you live in one of the following cities:
Albuquerque, NM
Austin, TX
Boston, MA
Chicago, IL
Columbus, OH
Indianapolis, IN
Minneapolis, MN
New York, NY
Philadelphia, PA
San Francisco, CA
Seattle, WA

Several of my fellow Oxfam Action Corps NYC volunteers have been in Iowa this week for the Norman Borlaug Dialogue / World Food Prize event, learning more about ending world hunger. You can find out more about OAC NYC at http://www.oxfamactioncorpsnyc.org/ (the other OAC pages are linked from here as well). Or alternatively, visit http://www.oxfamactioncorps.org

b) Tomorrow (World Food Day), Oxfam Action Corps in these various cities will be holding events to get petition signatures and have people plant seeds through creative activities. If you do not live in one of these cities, you can still support the Sow the Seed campaign by growing a "virtual plant" by taking the actions listed on the website, sowtheseed.net - growing plants, uploading photos of plants grown at home for the "photo petition," and sharing and promoting the actions through your own social networks. The number of actions taken around the world will be shown as a rolling number on this virtual plant.

c) Get advocacy updates from Oxfam America by signing up at http://oxfamamerica.org/

Food Security and HIV/AIDS in Kenya

Ellen Gustafson, the co-founder of FEED Projects, launched the "30 Project" on TEDxEast this past Friday. In light of reading the statistics on the new 30 Project website (namely, "The U.S. now spends 20 times more on food aid to Africa than it does helping Africans develop ways to feed themselves," I've decided to post a paper I wrote last semester for my International Nutrition class (where Ellen actually was a guest lecturer). Ellen is a fantastic speaker, but more on that later. For now here's my paper.

Food Security and HIV/AIDS in Kenya (by Kelly Moltzen)

In Kenya, as well as many other places around the world particularly in sub-Saharan Africa, human immunodeficiency virus (HIV) is still a huge epidemiological issue despite access to antiretroviral medications. One of the reasons for the high rates of HIV in Kenya is because people do not have access to adequate food, thereby compounding the effects of the disease on the immune system. Rates of food insecurity in Kenya are very high, particularly in rural areas.[1] There are many contributing factors to the problem of food insecurity, not excluding political corruption, which led the World Bank and the IMF to delay giving loans to the government in 2006.[2] In addition, Kenya suffers from severe droughts which reduce agricultural output, and low investment in the country’s economic growth.² There is still no funding specifically dedicated to food security for the HIV population.¹

In any country in which it occurs, the coexistence of HIV, poverty, and food insecurity has devastating impacts on people’s health.¹ HIV worsens nutritional status, further leading to the decline in health of people living with HIV/AIDS (PLWHA).[3] When HIV-infected people do not receive sufficient food to nourish them and help them recover, this leads to the perpetuation of the disease and increased numbers of PLWHA.[4] This happens through several mechanisms, occurring through biological as well as social and economic pathways.⁴ HIV can be transmitted horizontally when food insecure women – who are responsible for the health of their families – engage in transactional sex to make money to buy food for their families. It can also be transmitted vertically, as pregnant malnourished women with HIV have a greater chance of transmitting the disease to an unborn infant than well-nourished pregnant women. In particular, factors associated with higher mother-to-child transmission are low iron and Vitamin A stores, low BMI, and maternal weight loss.⁴

Food insecurity also impacts access to treatment and care services.⁴ While the Kenyan Ministry of Health has worked with Doctors Without Borders to provide free access to ARV treatments in the Nairobi slums of Kibera, a considerable number of eligible individuals have not accepted the offer for medications.[5] Oftentimes, even when receiving free ARV medications, parents need to choose between paying for transportation to attend health care appointments, and using the money to adequately feed themselves and their children.⁴ This problem seems like it would be even larger in rural areas than urban areas, where traveling is less convenient. Also, in the study of Kibera, one of the main reasons for not accepting the offer for medications was because of a fear of taking the medication on an empty stomach.⁵

Lack of food has shown to negatively impact the efficacy of antiretroviral (ARV) medications. Food insecurity has been associated with a decrease in the effectiveness of protease-inhibitor based regimens, and specifically a 30% decrease in drug plasma concentrations.⁴ Very high viral loads have been found among those receiving highly active antiretroviral treatment (HAART).⁴ Taking ARV regimens with food has been shown to increase the bioavailability of medications by as much as 700%.⁴ The ability of the human body to suppress the virus has shown to be 70% lower in people reporting food insecurity, even after levels of adherence to the medication regimen were taken into account.⁴ Thus, it is of paramount importance that patients receive adequate nutrition, if there is any chance of halting the spread of HIV in sub-Saharan Africa and elsewhere.

HIV prevalence in Kenya is more concentrated in the west of the country⁶ and where there are higher poverty rates, small plots of land, and poor soil quality.¹ There are over 1.5 million people in Kenya currently living with HIV, and there are approximately 100,000 deaths from AIDS per year in this country.[6] Up to 700 people reportedly die on a daily basis in Kenya from infections related to their HIV status.[7] One study found that PLWHA were more likely to be malnourished than people whose status was not established.⁷

The study found that the majority of foods eaten by PLWHA were low in nutrients that help build up the immune system and maintain adequate weight, and that there was not a lot of variety in the foods consumed.⁷ High protein foods such as meats and legumes were found to be consumed by less than a quarter of the sampled households.⁷ Interestingly, those surveyed showed a lack of nutrition knowledge in terms of which foods were appropriate for PLWHA to eat to support a healthy immune system.⁷ This is likely related to the literacy rates, as many people cannot understand educational brochures which are handed out if they are illiterate. The literacy rates in Kenya are approximately 80% for females and 90% for males, as estimated in 2003.²

Additionally, there are high numbers of widows, orphans, and falling school attendance rates in Kenya.¹ Many children must care for their ailing parents who have HIV/AIDS, and this adversely affects their ability to participate fully in obtaining their education. Mishra et al found that “orphans, fostered children, and children of HIV–infected parents are significantly less likely to attend school than non–orphaned/non-fostered children of HIV–negative parents.”[8]

The Academic Model Providing Access to Healthcare (AMPATH) identified over 67,000 individuals from 17 clinics in Kenya as food insecure in 2007, which amounts to 33.5% of the total number of people assessed.¹ AMPATH began as a collaboration between a consortium of universities in Indiana and the Moi Teaching and Referral Hospital and Moi University School of Medicine. When the extent of the problem of HIV and food insecurity was realized, AMPATH established partnerships with the World Health Organization’s World Food Program (WFP) and the United States Agency for International Development (USAID), and began producing food on farms in Kenya to complement food donations.¹

Essentially, these international aid organizations are working with clinical staff and community groups to provide resources and support to HIV patients and their families. Nutritionists assess all patients in the AMPATH clinics with the Household Food Insecurity Access Scale used by USAID.¹ The nutritionists were given criteria to use to decide who would qualify for the program, which included meeting one or more of the following: “a) having insufficient access to food to support patient recovery; b) Body Mass Index (BMI) below 19; c) Household income less than 3,000 Ksh per month; d) CD4 count less than 200.”³ In general, however, the nutritionists subjectively decide eligibility status, giving food insecurity the most weight.³ Those who qualify for the program are provided 6 months of nutrition support, as this is the amount of time thought necessary to recover and be able to carry out activities of daily living; however, there is some flexibility in the length of time a patient could receive the food support.^1,3

The amount of food allotted to patients is determined based on the number of people in the household.^1,3 Monthly follow-ups are used so that patients renew their “food prescription” on a regular basis¹; patients are also weighed and receive nutrition counseling during these monthly follow-ups.³ Patients are enrolled either through the WFP or through the “HAART and Harvest Initiative” (HHI), and fill their food prescriptions at distribution sites on a regular basis, depending on how far the site is from their residence.³ When patients are weaned off food support, they are enrolled in the “Family Preservation Initiative” which provides education on income generating activities or food production.^1,3 They could also choose to attend patient-led support group meetings.³

To provide necessary food to the patients, a combination of production, purchase, and donation of food is used; as stated, food production is “a key component of the AMPATH nutrition program.” ¹ Six farms were started, 4 of which are used for high production of food (3 rural, 1 urban), and two of which are used for educating patients on how to increase the yield of small plots they may own.^1,3 A continuous source of water is provided, which allows the farms to produce a year-round supply of fresh vegetables.¹ Over 20 tons of vegetables are produced per month, and an expected 4 tons of fruits are also expected to be produced as the farms become more productive.¹

In addition to food production, the WFP provides food donations of legumes, corn, corn-soy blends, and cooking oil, for up to 30,000 recipients and 1500 orphans and vulnerable children; an additional 2,000 people receive corn-soy blends from USAID. AMPATH also coordinates the distribution of eggs and milk which are produced by patients within the program,¹ as well as local and exotic herbs.³

Industrial engineers from Purdue University worked with AMPATH to design a computerized nutritional information system that could be used to coordinate the distribution of food to patients throughout western Kenya. The foods available, as well as patients needing that food, are entered into the system, which then helps coordinate who will pick up, transport, and deliver the food to the proper places. Altogether, food and fixed costs of the program cost $0.27 per patient per day. ¹

The AMPATH model and collaboration with the WFP and USAID provides a remarkable opportunity to improve the nutritional status of Kenyans, especially those living with HIV/AIDS. It uses an academic partnership, teaches native Kenyans how to farm the land and uses the crops they produce as part of the food support package given to the HIV/AIDS patients and their families. It also provides the patients with nutrition education, and an opportunity to learn skills on income-generating activities through the Family Preservation Initiative.

However, as noted by Mamlin et al, the current system still relies heavily on food donations and is unsustainable in the long run.¹ It is necessary to teach more Kenyans how to till the land and increase the number of farms and gardens producing crops. There should be more diversity of crops grown on these farms, as this would help not only decrease dependence on foreign food aid, but also to improve the nutritional status of Kenyans – both PLWHA and those currently without the disease. By improving the nutrition of all Kenyans, this will strengthen people’s immune systems and make them less susceptible to acquiring and transmitting HIV to others.

Currently the country is still receiving a significant amount of corn-soy blend through the WFP and USAID. ¹ Alternatively, people could learn to grow a variety of crops that are diverse, have a high nutrient density, and are native to the land in Africa, such as amaranth, millet and sorghum[9]. Research is beginning to show a tendency towards increased food security in Kenya when traditional crops are grown.[10] In rural areas, people should be provided with support needed to start new farms with a variety of crops. This can provide a source of nutrition as well as become an income-generating activity if a sufficient number of crops are grown. If these farms aim to produce large numbers of crops on a scale which could feed the nation of Kenya (either directly or through increased trade), it may be necessary to invest in resources to help farmers cope with the effects of climate change. Climate change has a greater negative impact on developing countries such as those in Africa, and has led to droughts and desertification across the continent. Work should be done to expand Navdana, the program Dr. Vandana Shiva has started in India which is a women-centered movement focused on biodiversity and food sovereignty in the face of climate change.[11]

On a smaller scale, in both rural and urban areas, gardens can be built alongside hospitals to provide patients with both nutritious food and the educational and physical exercise of harvesting the crops. In urban areas, support should be provided to allow people to start their own gardens at home.

There are already non-profit organizations helping to start these types of gardens to support PLWHA in Kenya, such as Development in Gardening (DIG)[12]. DIG has a partnership with USAID, so this relationship should be fostered further in order to provide more individuals with the opportunity to garden.

For the multitude of reasons outlined above, ensuring the food security of HIV/AIDS patients and their families is critical in improving the health of the patients and helping to limit the spread of HIV. This should be done by training Kenyans to increase the food productivity of their land in a sustainable manner.

References

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[1] Mamlin J, Kimaiyo S, Lewis S, et al. Integrating Nutrition Support for Food-Insecure Patients and Their Dependents Into an HIV Care and Treatment Program in Western Kenya. American Journal of Public Health. 2009;99(2):215-221.

[2] The World Factbook. Kenya. Central Intelligence Agency. https://www.cia.gov/library/publications/the-world-factbook/geos/ke.html. Accessed December 14, 2009.

[3] Byron E, Gillespie S, Nangami M. Integrating nutrition security with treatment of people living with HIV: lessons from Kenya. Food Nutr Bull. 2008; 29:87–97. http://programs.ifpri.org/renewal/pdf/KenyaAMPATH.pdf. Accessed December 14, 2009.

[4] Anema A, Vogenthaler N, Frongillo EA, Kadiyala S, Weiser SD. Food Insecurity and HIV/AIDS: Current Knowledge, Gaps, and Research Priorities. Current HIV/AIDS Reports 2009;6:224–231.

[5] Unge C, Johansson A, Zachariah R, et al. Reasons for unsatisfactory acceptance of antiretroviral treatment in the urban Kibera slum, Kenya. AIDS Care 2008, 20:146–149.

[6] Kenya. Epidemiological Country Profile on HIV/AIDS. WHO. 2008. http://apps.who.int/globalatlas/predefinedReports/EFS2008/short/EFSCountryProfiles2008_KE.pdf. Accessed December 14, 2009.

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