TAC/AIDS Law Project (ALP) Statement on World Health Organization (WHO) Consultation on Nutrition and HIV/AIDS in Africa
"Improved social grants and scientifically accurate public information on nutrition, particularly HIV and nutrition, are essential to reduce food insecurity."
************
On 10-13 April 2005 in Durban, a number of international, regional and local organisations and scientific bodies from Eastern and Southern Africa met under the auspices of the WHO to discuss the nutritional aspects of treating persons living with HIV/AIDS in Africa.
The meeting was co-hosted by the South African National Department of Health. On Friday 15 April the Durban meeting issued a Participants' Statement. It is available at http://www.sahims.net/ and on the Treatment Action Campaign (TAC) website (http://www.tac.org.za/).
The Participants' Statement puts to rest unfounded allegations that adequate nutrition alone can cure HIV infection. It cannot. It is uncontroversial that nutrition is an essential part of managing HIV. The statement makes clear that:
**Both antiretrovirals (ARVs) and proper nutrition are essential in providing comprehensive care, treatment and support of persons living with HIV/AIDS.
**Nutrition alone cannot cure HIV infection.
**The life-saving benefits of ARVs are clearly recognised.
**Adequate nutrition is required to optimise the benefits of ARVs, which are essential to prolong the lives of people living with HIV and prevent HIV transmission from mother-to-child.
President Mbeki and Minister of Health Tshabalala-Msimang frequently cite the importance of nutrition in alleviating AIDS. However, the Minister's comments are often scientifically inaccurate, with her overemphasizing the importance of particular foods such as garlic, olive oil and the African Potato.
Both leaders also create the impression that nutrition is an alternative to antiretroviral treatment; it is not. Furthermore, there is little evidence of Department of Health action to improve nutrition in people with HIV based on science, despite the Minister's rhetoric.
TAC and ALP are conducting an investigation to see what nutritionbal interventions are being made available as part of the Operational Plan and whether they are sufficient and sustainable.The Durban meeting reached the following evidence based conclusions:
Nutrition and ARV interaction
The life-saving benefits of ARVs are clearly recognised.
** To achieve the full benefits of ARVs, adequate dietary intake is essential.
** Dietary and nutritional assessment is an essential part of comprehensive HIV care both before and during ARV treatment.
The Participants' Statement also notes that the long-term use of ARVs can be associated with metabolic complications (cardiovascular disease, diabetes and bone related problems). However, it unambiguously states that the benefits of ARVs far outweighs the risks and that metabolic complications need to be adequately managed. It made the following important recommendations:
** Interactions between nutrition and ARVs in chronically malnourished populations, severely malnourished children, and pregnant and lactating women need to be investigated.
** The effects of traditional remedies and dietary supplements on the safety and efficacy of ARV drugs need to be evaluated.
TAC and ALP also agree with the Participants' Statement that “there is a proliferation in the marketplace of untested diets and dietary therapies, which exploit fears, raise false hopes and further impoverish those infected and affected by HIV and AIDS”. In this respect, we agree that we must “strengthen the capacity of government and civil society to develop and monitor regulatory systems to prevent commercial marketing of untested diets, remedies, and therapies for HIV-infected adults and children”.
Micronutrients
** Micronutrient supplements are not an alternative to comprehensive HIV treatment including ARV therapy.
** Micronutrient intakes at daily-recommended levels need to be through consumption of diversified diets, fortified foods, and micronutrient supplementation as needed.
Macronutrients
** Adults and children living with HIV have increased energy needs compared with uninfected adults and children.
** However, there is no evidence for an increased need for protein intake of people living with HIV/AIDS over and above that required in a balanced diet to satisfy energy needs (12 to 15% of total energy intake).
Growth
** The growth and survival of children living with HIV is improved by prophylactic cotrimoxazole, ARVs and the early prevention and treatment of opportunistic infections.
** Improved dietary intake is essential to enable children to regain lost weight after opportunistic infection.
Pregnancy and Lactation
** Optimal nutrition of HIV-infected mothers during pregnancy and lactation increases weight gain, improves pregnancy and birth outcomes.
Infant and Young Child Feeding
** WHO/UNICEF recommend that HIV-infected mothers avoid breastfeeding when replacement feeding is acceptable, feasible, affordable, sustainable and safe. However these conditions are not easily met for the majority of mothers in the region. Early breastfeeding cessation is recommended for HIV-infected mothers and their infants. There is an immediate need to evaluate suitable ways of meeting nutritional needs of infants and young children who are no longer breastfed.
TAC and ALP Recommendations
We recognise that the nutritional needs of countries cannot be dealt with in isolation of prevailing food insecurity. We support the call of the conference to all governments, including our own, to implement urgent measures to “reverse the current trends in malnutrition, HIV infection and food insecurity in most countries in the region, in order to achieve the Millennium Development Goals”.
At least the following three critical interventions are needed to eliminate food insecurity in people with HIV in South Africa. The third of these is already implemented.
1. The social grant system is the most effective mechanism for ensuring people can afford to eat enough. The disability grant is insufficient, because it lapses if people commence antiretrovirals and recover, leaving them the insiduous choice between the grant or medicine. A nutrition grant for people with HIV would be problematic because it would create inequalities between people with and without HIV. A Basic Income Grant, or similar measure is therefore the only viable solution that has been offered.
2. Government must run a public information campaign providing accurate information on nutrition. The only accurate nutrition and HIV facts sheets for wide distribution that we are aware of are the two produced by Soul City and TAC. Government should use these fact sheets to produce radio, television and print media to convey useful nutritional information. Government should also resist the prevalent pseudo-scientific claims that exaggerate the usefulness of particular foods, such as garlic, or food-groups, such as vitamins, in alleviating HIV.
3. Government should continue to distribute multivitamins through public clinics to people with HIV. The balance of evidence suggests that multivitamins, in moderate doses, do have some benefit.
There are proposals and efforts to distribute food parcels and nutritional supplements, other than multivitamins, to people with HIV through clinics. This gives a greater degree of food security to people with HIV, TB and other serious illnesses. However, it should be seen as a medium-term measure because it leads to inequalities and tensions between recipients of these parcels and other poor people. The main challenge is to meet the food and income security needs of every poor household.
Source: TAC Electronic Newsletter - 26 April 2005
************
On 10-13 April 2005 in Durban, a number of international, regional and local organisations and scientific bodies from Eastern and Southern Africa met under the auspices of the WHO to discuss the nutritional aspects of treating persons living with HIV/AIDS in Africa.
The meeting was co-hosted by the South African National Department of Health. On Friday 15 April the Durban meeting issued a Participants' Statement. It is available at http://www.sahims.net/ and on the Treatment Action Campaign (TAC) website (http://www.tac.org.za/).
The Participants' Statement puts to rest unfounded allegations that adequate nutrition alone can cure HIV infection. It cannot. It is uncontroversial that nutrition is an essential part of managing HIV. The statement makes clear that:
**Both antiretrovirals (ARVs) and proper nutrition are essential in providing comprehensive care, treatment and support of persons living with HIV/AIDS.
**Nutrition alone cannot cure HIV infection.
**The life-saving benefits of ARVs are clearly recognised.
**Adequate nutrition is required to optimise the benefits of ARVs, which are essential to prolong the lives of people living with HIV and prevent HIV transmission from mother-to-child.
President Mbeki and Minister of Health Tshabalala-Msimang frequently cite the importance of nutrition in alleviating AIDS. However, the Minister's comments are often scientifically inaccurate, with her overemphasizing the importance of particular foods such as garlic, olive oil and the African Potato.
Both leaders also create the impression that nutrition is an alternative to antiretroviral treatment; it is not. Furthermore, there is little evidence of Department of Health action to improve nutrition in people with HIV based on science, despite the Minister's rhetoric.
TAC and ALP are conducting an investigation to see what nutritionbal interventions are being made available as part of the Operational Plan and whether they are sufficient and sustainable.The Durban meeting reached the following evidence based conclusions:
Nutrition and ARV interaction
The life-saving benefits of ARVs are clearly recognised.
** To achieve the full benefits of ARVs, adequate dietary intake is essential.
** Dietary and nutritional assessment is an essential part of comprehensive HIV care both before and during ARV treatment.
The Participants' Statement also notes that the long-term use of ARVs can be associated with metabolic complications (cardiovascular disease, diabetes and bone related problems). However, it unambiguously states that the benefits of ARVs far outweighs the risks and that metabolic complications need to be adequately managed. It made the following important recommendations:
** Interactions between nutrition and ARVs in chronically malnourished populations, severely malnourished children, and pregnant and lactating women need to be investigated.
** The effects of traditional remedies and dietary supplements on the safety and efficacy of ARV drugs need to be evaluated.
TAC and ALP also agree with the Participants' Statement that “there is a proliferation in the marketplace of untested diets and dietary therapies, which exploit fears, raise false hopes and further impoverish those infected and affected by HIV and AIDS”. In this respect, we agree that we must “strengthen the capacity of government and civil society to develop and monitor regulatory systems to prevent commercial marketing of untested diets, remedies, and therapies for HIV-infected adults and children”.
Micronutrients
** Micronutrient supplements are not an alternative to comprehensive HIV treatment including ARV therapy.
** Micronutrient intakes at daily-recommended levels need to be through consumption of diversified diets, fortified foods, and micronutrient supplementation as needed.
Macronutrients
** Adults and children living with HIV have increased energy needs compared with uninfected adults and children.
** However, there is no evidence for an increased need for protein intake of people living with HIV/AIDS over and above that required in a balanced diet to satisfy energy needs (12 to 15% of total energy intake).
Growth
** The growth and survival of children living with HIV is improved by prophylactic cotrimoxazole, ARVs and the early prevention and treatment of opportunistic infections.
** Improved dietary intake is essential to enable children to regain lost weight after opportunistic infection.
Pregnancy and Lactation
** Optimal nutrition of HIV-infected mothers during pregnancy and lactation increases weight gain, improves pregnancy and birth outcomes.
Infant and Young Child Feeding
** WHO/UNICEF recommend that HIV-infected mothers avoid breastfeeding when replacement feeding is acceptable, feasible, affordable, sustainable and safe. However these conditions are not easily met for the majority of mothers in the region. Early breastfeeding cessation is recommended for HIV-infected mothers and their infants. There is an immediate need to evaluate suitable ways of meeting nutritional needs of infants and young children who are no longer breastfed.
TAC and ALP Recommendations
We recognise that the nutritional needs of countries cannot be dealt with in isolation of prevailing food insecurity. We support the call of the conference to all governments, including our own, to implement urgent measures to “reverse the current trends in malnutrition, HIV infection and food insecurity in most countries in the region, in order to achieve the Millennium Development Goals”.
At least the following three critical interventions are needed to eliminate food insecurity in people with HIV in South Africa. The third of these is already implemented.
1. The social grant system is the most effective mechanism for ensuring people can afford to eat enough. The disability grant is insufficient, because it lapses if people commence antiretrovirals and recover, leaving them the insiduous choice between the grant or medicine. A nutrition grant for people with HIV would be problematic because it would create inequalities between people with and without HIV. A Basic Income Grant, or similar measure is therefore the only viable solution that has been offered.
2. Government must run a public information campaign providing accurate information on nutrition. The only accurate nutrition and HIV facts sheets for wide distribution that we are aware of are the two produced by Soul City and TAC. Government should use these fact sheets to produce radio, television and print media to convey useful nutritional information. Government should also resist the prevalent pseudo-scientific claims that exaggerate the usefulness of particular foods, such as garlic, or food-groups, such as vitamins, in alleviating HIV.
3. Government should continue to distribute multivitamins through public clinics to people with HIV. The balance of evidence suggests that multivitamins, in moderate doses, do have some benefit.
There are proposals and efforts to distribute food parcels and nutritional supplements, other than multivitamins, to people with HIV through clinics. This gives a greater degree of food security to people with HIV, TB and other serious illnesses. However, it should be seen as a medium-term measure because it leads to inequalities and tensions between recipients of these parcels and other poor people. The main challenge is to meet the food and income security needs of every poor household.
Source: TAC Electronic Newsletter - 26 April 2005
posted by AIDS-Care-Watch at 12:05 pm
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