Malnutrition rates continue to climb throughout the world, and food/nutritional security interventions, particularly those targeting children, are increasingly turning to foreign food aid donations, economic development interventions, and agricultural subsidy programs to address the problem of malnutrition. Donors and implementers alike are asking whether the solutions to these problems lie in interventions involving fortification (adding nutrients to food), nutritional supplementation (provision of vitamins), commercialization (growing food on large scale to be sold in the market), and provision of food aid and therapeutic food (free or subsidized provision of food); or in promoting the use of local resources and traditional knowledge in local gardening or subsistence farming.

Operating in an HIV/AIDS-affected context magnifies the urgency of resolving these questions. People living with HIV (PLWHIV) are often at risk for food and nutritional insecurity due to the disease's negative effect on individual and family resources. In response to this risk, Project Concern International organized the Africa Forum 2009 to strengthen the collective efforts of organizations working on the African continent in the areas of HIV/AIDS and Food and Nutritional Security. At the Forum, practitioners engaged in a debate about whether local gardens or fortification/supplementation/commercialization provide the most effective ways to address food and nutritional security in the context of HIV/AIDS. As with similar dialogues within and among organizations around the world, the debate at the Africa Forum generated much discussion, but little consensus.

The debate addressed questions such as:

• Can small-scale household gardens really meet the nutritional demands of the world's increasing population, or are outside interventions necessary?
• Are nutritional intervention programs necessary for children in urban communities that lack access to land for farming and gardening?
• How do these two different approaches to food and nutritional security fit into the larger picture of sustainable development?
• Don't children with specific diseases, such as HIV, require addition nutritional supplementation that cannot be obtained from simple household gardening systems?
• Are there particular situations where food aid and supplementation are appropriate?
• With the current downturn in the global economy, don’t people need safety nets to ensure health and nutrition?

A particular sticking point for participants was whether dire short-term needs or the demand for long-term sustainability should underpin the decision on which food and nutritional security approach to employ.

Arguments for greater use of food aid, nutritional supplementation, fortification, direct food transfers and commercial agricultural systems concluded that in the short term and the long term they are simply a cheaper - and easier – way to get food and nutrition to thousands of people, especially children. Gardens are risky: they take a long time to grow, they cannot be easily implemented at scale, they require energy to maintain that PLWHIV do not have or need to direct to other income-generating activities, and they need resources such as water, fertile soil and good quality seeds and seedlings, which may be hard to access. Furthermore, specific diseases such as HIV/AIDS, or specific circumstances such as pregnancy, require additional nutritional supplementation and therapeutic food, which cannot be obtained from simple household gardening systems. These are also often essential as immediate forms of treatment when situations reach their most dire: when children could die if they do not receive the nutrition from therapeutic food that they need; when people have illnesses that require special nutritional needs; and in post-conflict or post-natural disaster situations where there has been large population displacement.

The argument for local gardens countered that thousands of local resources can be used for foods and natural medicines. Furthermore, when food needs become dependent on outside funding and food provision, communities are vulnerable to external economic fluctuations, which local gardens can help guard against. Participants brought up cases of poor practices in the provision of food aid, such as long-term provision of minimally nutritious food. In terms of concerns about inputs and resources associated with gardens, it was argued that gardens require less space than people assume: “functional landscaping,” which utilizes all available space to grow food and takes advantage of the fact that many kinds of produce can be grown with little soil, opens gardening up to those who have little access to land, including households in urban areas. In addition, gardening has the potential to be accessible through organizations such as hospitals, churches, and schools. Gardening that utilizes local resources that have adapted to growing conditions over thousands of years helps eliminate the need for purchased seed and agricultural inputs such as synthetic fertilizer, hybrid seeds, and other chemicals. Gardening also carries benefits such as diversifying food crops, which is beneficial to households nutritionally. With a 12-month growing season, gardeners in Africa have the potential to access fresh food year-round with minimal need for cash, and the potential to expand production to the point of being able to sell produce as well as consume it.

Participants did come to one point of agreement: the issue is not one of selecting one approach over another, but marrying household food production with supplementation, fortification, direct food transfers, therapeutic foods, and commercialization in a way that is sustainable and meets communities' and children’s needs. Identifying the best paths to achieving this goal, however, continues to challenge practitioners.