ABSTRACT
Introduction: Human immunodeficiency virus' (HIV's) threat to food security is highest in areas with high poverty levels. The OR Tambo district in the Eastern Cape province has the highest poverty rate in South Africa (80.4%); HIV prevalence is 11.4%. Objective: The purpose of the study was to describe the threat that HIV poses to farm employment and food security in the Eastern Cape province of South Africa. Methods: A multi-method approach was used. The quantitative component was a cross-sectional design and the qualitative component was a narrative design. The study population comprised approximately 7 000 smallholder farmers from the five local municipalities in the OR Tambo district. Participants for both the qualitative and quantitative aspects of the study were selected using convenience sampling. Quantitative data were collected using questionnaires and qualitative data were collected from face-to-face interviews. Quantitative data were analysed using descriptive statistics and the chi-square test. Qualitative data were analysed using Tesch's eight-step procedure for thematic content analysis. Results: Five hundred and ninety-three farmers completed the questionnaire. Most agreed that HIV affects food security (n = 486, 72.0%), that HIV negatively affects food security (n = 454, 76.6%), that people living with HIV are excluded from farming activities (n = 426, 71.8%), and that HIV affects farming skills (n = 495, 83.5%). A significantly larger proportion of farmworkers older than 60 years than those who were younger perceived the threat to food security. Twenty participants described the effect of HIV on farm workers in interviews, and highlighted that HIV impacts farm skills and labour due to ill health and lost income from farming, which threatens food security. Conclusion: HIV threatens food security among smallholder farmers in the OR Tambo district due to farmworkers' diminished capacity to work and consequent reduced income, which affects their ability to secure food.