A Case Study of the HIV, Tuberculosis, and Food Insecurity Syndemic Among Pregnant Women Amidst Climate-Induced Drought in Djibouti

This case study investigates the syndemic of HIV, tuberculosis (TB), and acute food insecurity among pregnant women in Djibouti, a nation in the Horn of Africa facing recurrent climate-induced droughts. The research examines how these concurrent crises interact within a fragile health system to exacerbate adverse maternal and child health outcomes. Employing an explanatory sequential mixed-methods design from 2023 to 2024, the study analysed retrospective clinical data from two urban antenatal centres (n=412) and conducted focus group discussions with 30 pregnant women and 15 healthcare providers in drought-affected communities. Quantitative results indicated a significant clinical co-occurrence of HIV and TB, alongside a 40% increase in antenatal admissions for severe acute malnutrition between 2022 and 2024. Qualitative findings revealed that food insecurity directly undermined antiretroviral therapy and TB treatment adherence, primarily due to severe medication side effects exacerbated by hunger and the prioritisation of scarce household resources for food. This analysis demonstrates that prolonged drought acts as a critical syndemic driver, intensifying disease synergies and overwhelming clinical responses. The study concludes that effective intervention in such contexts requires integrated, climate-resilient health programmes that combine biomedical management with robust nutritional support. It underscores the necessity for public health planning in drought-prone regions to adopt syndemic frameworks, addressing the foundational social and environmental determinants of health.